NHS Continuing Healthcare (NHS CHC) is a system of care in the UK where the National Health Service funds the entire cost of health and social care for individuals with complex, long-term health needs. Eligibility for NHS CHC is determined through a rigorous assessment process, and a key component of this process is the Continuing Care Assessment Tool. This article provides a comprehensive guide to understanding the continuing care assessment tool and how it plays a crucial role in determining eligibility for NHS Continuing Healthcare.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is not about the condition you have, but about the level and type of care you require. It is free care, arranged and funded solely by the NHS, for adults who have been assessed as having a ‘primary health need’. This means that the main reason for the care required must be related to health needs, rather than social care needs. This care can be provided in various settings, including your own home, a care home, or another community setting outside of a hospital.
Eligibility for NHS Continuing Healthcare
Eligibility for NHS Continuing Healthcare is based on your assessed needs, not on any specific diagnosis or condition. A team of healthcare professionals, known as a multidisciplinary team (MDT), conducts this assessment. They evaluate your care needs in several areas to determine if they meet the criteria for NHS CHC.
The assessment looks at:
- What help you need: The specific types of assistance required to manage your health needs.
- How complex your needs are: The intricacy and multifaceted nature of your health conditions and care requirements.
- How intense your needs can be: The degree and severity of your care needs, including the level of intervention required.
- How unpredictable your needs are: The variability and unforeseen nature of your needs, including potential risks if care is not timely and appropriate.
Your involvement is crucial throughout the assessment process. Your views and those of your family and carers should be taken into account. A decision regarding a full assessment for NHS CHC should typically be made within 28 days of an initial assessment or request.
If you are not eligible for NHS Continuing Healthcare, you may still be able to receive support from your local council or a joint package of care where the NHS contributes to some of the costs.
The Continuing Care Assessment Tool: A Detailed Look
The continuing care assessment tool, officially known as the Decision Support Tool (DST), is a standardized framework used by the multidisciplinary team to assess eligibility for NHS Continuing Healthcare. It provides a structured approach to evaluating an individual’s care needs across twelve key domains. This tool ensures consistency and fairness in the assessment process across the country.
You can download the Decision Support Tool for NHS Continuing Healthcare from GOV.UK (PDF, 194KB) to review the document.
The twelve care domains assessed by the continuing care assessment tool are:
- Breathing: Assessment of respiratory needs and support required.
- Nutrition (Food and Drink): Evaluation of nutritional needs, including feeding methods and dietary requirements.
- Continence: Assessment of bladder and bowel function and management needs.
- Skin (Including Wounds and Ulcers): Evaluation of skin integrity and needs related to wound care or pressure ulcer prevention.
- Mobility: Assessment of physical movement capabilities and assistance required.
- Communication: Evaluation of communication abilities and support needed for effective interaction.
- Psychological and Emotional Needs: Assessment of mental health and emotional well-being and required support.
- Cognition (Understanding): Evaluation of cognitive function, awareness, and understanding.
- Behaviour: Assessment of behavior patterns and any challenging behaviors that require management.
- Drug Therapies and Medication: Evaluation of medication needs, complexity of regimens, and support required for administration.
- Altered States of Consciousness: Assessment of consciousness levels and needs related to conditions causing altered awareness.
- Other Significant Care Needs: Identification and evaluation of any other substantial care needs not covered in the previous domains.
For each domain within the continuing care assessment tool, the MDT assigns a level of need, ranging from “no needs” to “priority.” The levels are:
- Priority
- Severe
- High
- Moderate
- Low
- No Needs
The assigned levels in each domain are then used to determine overall eligibility for NHS Continuing Healthcare.
Determining Eligibility Based on the Assessment Tool
The continuing care assessment tool is not simply a checklist; it requires professional judgment from the MDT. However, certain thresholds within the tool provide guidelines for eligibility.
Generally, you can expect to be eligible for NHS Continuing Healthcare if you have:
- At least one priority need in any domain, OR
- Severe needs in at least two domains.
Eligibility can also be considered if you have:
- A severe need in one domain plus a combination of other needs.
- A number of high or moderate needs, depending on their specific nature, intensity, complexity, and unpredictability.
The MDT will consider the totality of your needs, the interaction between different needs, and evidence from risk assessments when making their recommendation for NHS Continuing Healthcare eligibility. The continuing care assessment tool provides the structured framework for this comprehensive evaluation.
The NHS Continuing Healthcare Assessment Process
The assessment process typically involves two stages:
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Initial Checklist Assessment: This is a preliminary screening to determine if a full assessment is necessary. It is less detailed than the full assessment. A nurse, doctor, social worker, or other healthcare professional can complete the checklist. If the checklist indicates potential eligibility, you will be referred for a full assessment.
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Full Assessment: A multidisciplinary team conducts the full assessment using the continuing care assessment tool (Decision Support Tool). This involves a comprehensive evaluation of your needs across the twelve care domains. You should be informed who is coordinating the assessment and be actively involved in the process.
For individuals with rapidly deteriorating health and nearing the end of life, a fast-track pathway is available to expedite the process and ensure care is put in place quickly, usually within 48 hours.
Reviews and Ongoing Eligibility
If you are found eligible for NHS Continuing Healthcare, your care and support package will be regularly reviewed, typically within three months of the initial assessment and at least annually thereafter. These reviews ensure that your care package continues to meet your needs and that you remain eligible for NHS CHC, as changes in your health needs can affect eligibility.
Seeking Advice and Support
Navigating the NHS Continuing Healthcare assessment process can be complex. Organizations like Beacon offer free, independent advice and support on NHS continuing healthcare. You can visit the Beacon website or call their helpline for guidance.
Conclusion
The continuing care assessment tool is a vital instrument in determining eligibility for NHS Continuing Healthcare. It provides a structured and comprehensive approach to evaluating an individual’s care needs, ensuring fairness and consistency in the process. Understanding the tool and the assessment process is crucial for individuals and their families seeking NHS CHC funding. By focusing on the specific care needs across the twelve domains of the Decision Support Tool, healthcare professionals can make informed decisions about eligibility, ensuring that those with complex, long-term health needs receive the appropriate level of funded care and support.
