Do I need a CHC assessment?

Understanding whether you need to be assessed for NHS Continuing Healthcare

If you have been through the first stage of NHS Continuing Healthcare assessment – the Checklist – and it was positive, you should automatically be referred for a full CHC assessment.

The decision as to whether or not you need a Checklist in the first place is more nuanced. It must be taken by health and social care professionals, using their professional judgement.

The National Framework states that a Checklist should normally be completed where there may be a need for NHS Continuing Healthcare. More specifically, if you require a long-term care home placement with nursing or have significant support needs, a Checklist is expected to be completed.

It is not appropriate for a professional to refuse to complete a Checklist just because they don’t think you will ultimately be eligible for CHC. To do so would constitute a unilateral decision that you are not eligible without having completed an assessment.

To help professionals make sound decisions about who should be Checklisted, the National Framework sets out a number of situations in which it is not necessary to complete a Checklist (para. 91). These include where:

• It is clear to practitioners working in the health and care system that there is no need for NHS Continuing Healthcare at this point in time. Where appropriate/relevant this decision and its reasons should be recorded. If there is doubt between practitioners a Checklist should be undertaken.

• The individual has short-term health care needs or is recovering from a temporary condition and has not yet reached their optimum potential (if there is doubt between practitioners about the short-term nature of the needs it may be necessary to complete a Checklist). See paragraphs 109-117 for how NHS Continuing Healthcare may interact with hospital discharge.

• It has been agreed by the CCG that the individual should be referred directly for full assessment of eligibility for NHS Continuing Healthcare.

• The individual has a rapidly deteriorating condition and may be entering a terminal phase – in these situations the Fast Track Pathway Tool should be used instead of the Checklist.

• An individual is receiving services under Section 117 of the Mental Health Act that are meeting all of their assessed needs.

• It has previously been decided that the individual is not eligible for NHS Continuing Healthcare and it is clear that there has been no change in needs.

While it is important at this time to ensure NHS resources are used efficiently, if you have been refused a Checklist, you have the right to request one again or otherwise make a formal complaint using the NHS complaints procedure.