Part 1: The Screening Checklist

Getting assessed for NHS Continuing Healthcare (CHC) funding can seem complicated and confusing, so we have written an essential guide to help you through.

For most people, the first step in getting assessed for NHS Continuing Healthcare funding is a screening stage where a health or social care professional evaluates your needs against a Checklist.

Here we explain when and how you can request a Checklist assessment, what it entails, and what happens next.

If you have questions or concerns about the outcome of a Checklist assessment – or any other part of the Continuing Healthcare assessment process – you can contact our Free Information & Advice service to talk to a Beacon advisor.

Request a Checklist assessment

A Checklist assessment can be triggered by health or social care professionals such as your care home nurse, GP or social worker. But the starting point for many people will be to request an assessment for themselves or a loved one.

For example, a common time to request a Checklist is if you are due to be discharged from hospital to a care home, or back to your own home, with a care package.

You can ask your GP, social worker, hospital nurse, district nurse, care home nurse or any other health professional to carry out a Checklist assessment at any time. In theory, any health or social care professional who is able to complete the paperwork can carry out the Checklist, but not all will be familiar with the procedures.

Even GPs don’t always understand the criteria and might tell you you’re wasting your time. Don’t be put off by this, they can get it wrong. Read more about this in our blog: Five things you need to know about eligibility for NHS Continuing Healthcare.

Another way to request a Checklist is to contact your local Integrated Care Board (ICB). You can find contact details for your ICB on the NHS website. Ask to speak to the Continuing Healthcare department.

In some cases, where it is clear a person is likely to need a full or fast tracked assessment, the Checklist stage may be skipped altogether.

The Checklist process

You should be given reasonable notice that the Checklist is to be completed, and supported to be consulted during the process. You (or the person who acts on your behalf) should be asked for consent and your consent should be recorded.

Despite this, we frequently hear that hospital patients and their families were not informed that a Checklist was to be completed. This is usually due to a lack of understanding of the correct procedures.

The Checklist briefly assesses 12 areas of care needs (called ‘domains’), such as behaviour, cognition, continence and mobility. Under each domain, the assessor records if the person’s needs are high, moderate or low/no need. These descriptors are assigned a letter A, B or C, with A being the highest.

The Checklist should be completed as accurately as possible, and backed up with supporting evidence from your recent care records – such as care plans.

Read more about the 12 care domains and the assessment of need in The Essential Guide to getting assessed for NHS Continuing Healthcare funding: Part 2.

The Checklist outcome and next steps

The outcome of the Checklist assessment will be used to decide whether a person should be offered a full assessment of eligibility for NHS Continuing Healthcare funding.

A full assessment will be triggered if the Checklist shows:

• two or more domains rated ‘A’
• five or more domains rated ‘B’ or one ‘A’ and four ‘B’s
• an ‘A’ rating in any of the following domains: behaviour, breathing, drug therapies and medication, altered states of consciousness.

If you meet these criteria you must be referred for a full assessment. However, the ICB can use their discretion to proceed even if you don’t meet the criteria.

The health professional who carried out the Checklist must submit the result – and any supporting evidence – to the relevant ICB. Depending on the quality of the Checklist, it is not uncommon for ICBs to ask for more information.

Regardless of your eligibility for the full assessment, you should receive a decision letter explaining the outcome of your Checklist assessment and your rights to challenge the decision. If you have not been informed of the Checklist outcome, you’re entitled to request an outcome letter from the person that carried out the Checklist, or from your ICB.

The time between Checklist referral and a final decision regarding eligibility (including the full assessment procedure) should not exceed 28 days. However, it is very common for the assessment process to take longer than this, and we’ve dealt with extreme cases in which the time between Checklist referral and eligibility decision exceeded 12 months.

If the eventual decision is that you are eligible for NHS Continuing Healthcare, funding should be backdated to the 29th day after a positive Checklist referral was received by the ICB.

The pressures on the system are great, but long delays are unacceptable.

What if I disagree with the Checklist decision?

Checklists aren’t always completed accurately and procedures can be misapplied, resulting in people being refused full assessments unreasonably.

There is a complaint process, and at Beacon we have successfully challenged inaccurate Checklist assessments, and supported clients to navigate a complaint themselves.

If you are feeling overwhelmed by the CHC assessment process, you can contact our Free Information & Advice service for up to 90 minutes of free advice with a specialist adviser.

Or, why not register for a Free Navigational Toolkit to help you make sense of the assessment and appeals process.