FAQs > Full Assessment & Decision

For most people the starting point will be to request a screening Checklist which is the first stage of the assessment process. If you feel that you or your relative/friend needs an assessment for continuing healthcare you should ask your GP, social worker, district nurse, care home nurse or other health professional for a Checklist assessment. All these professionals are qualified to complete the paperwork, however your Integrated Care Board (ICB) may refuse to accept a Checklist from certain professionals if they have not been trained in how to complete it. Alternatively you can contact your Integrated Care Board’s continuing healthcare department directly to request an assessment. You can find contact details for your ICB by searching for ‘services near you’ here. The Checklist outcome should be forwarded to the appropriate ICB and if it indicates that you meet the criteria for a full assessment, you will be automatically referred. Please see the ‘Screening and Checklist’ section for more information.

If you are the appropriate representative for your relative/loved one, it is highly advisable that you contribute as fully as possible to the assessment process and attending the assessment in person is a good way to ensure that you are involved from the outset. The National Framework places great importance on the involvement of the person who is being assessed and/or their representative. This is because it is recognised that the individual’s representatives (e.g. family/friends) are often experts on the care needs of the person in question.

At Beacon we understand that families and friends can often bring highly valuable insight to an assessment – if they have been involved in the care of the individual being assessed they are often able to provide the coordinating assessor with information about the ‘person’ which cannot be gleaned from the care records alone. This is particularly useful when it comes to helping the Multidisciplinary Team (MDT) to understand whether a particular behaviour is out of character and a result of disability or illness.

The National Framework places great importance on the involvement of the person who is being assessed and/or their representative at each stage of the assessment process. The coordinating assessor should invite you to contribute to the completion of the Decision Support Tool (DST). Often this is done in person at a Multidisciplinary Team (MDT) meeting.

The coordinating assessor should explain the assessment process and criteria to you and you should be invited to share your views and opinions about your care needs during the completion of the DST. This includes having an opportunity to provide information about every care domain, to select the level of need you feel is correct in each domain, and to provide an overall view as to the totality of your needs.

If the MDT disagree with a level of need you have specified in a particular domain they should discuss it with you and record your viewpoint in writing.

Sometimes ICBs will invite you or your representative to attend the decision-making panel if they have one, but they are not required to do this. Once a final decision has been made by the ICB they should write to you to explain the outcome and provide a full detailed rationale. This letter should refer to the key indicators, demonstrating that the ICB have carefully considered the nature, intensity, complexity and unpredictability of your needs in reaching their decision. The letter should explain how you can access the dispute resolution process if you disagree with the decision.

To prepare for a Checklist assessment, you can have a go at completing a Checklist yourself before the assessment. The Checklist document is fairly self-explanatory. It sets out what would be considered an A, B or C in each of the 12 care domains. You will see that the focus is on the person’s care needs, not the condition of their health. You can take your draft Checklist with you to the assessment and use it to help you to contribute to any discussion about the levels of the person’s care needs. 

Before the full assessment, you should have a go at completing a Decision Support Tool (DST) for the person being assessed, using Beacon’s Guide to Assessments from our Navigational Toolkit, pages 23 to 33, to help you. You can allocate your own scores and make notes in each domain. Try to back these up with evidence/examples.

The Full Assessment will be attended by a Multi-Disciplinary Team (MDT). Try to ensure that the MDT members are comprised of health and social care professionals who are involved in the person’s care (and therefore knowledgeable about their care needs), such as care home staff, specialists (e.g., Parkinson’s nurses or Spinal Injury specialists) and professionals who have recently completed assessments. You can contact the assessor who will be co-ordinating the full assessment (usually a nurse assessor from the NHS Integrated Care Board (ICB) to discuss composition of the MDT in advance of the meeting.

If there is a care plan in place for the person being assessed, try to ensure it is up to date and accurate before the Full Assessment.  It would be helpful if detailed daily care records can be kept for the 2 or 3 days prior to the MDT meeting. Although verbal evidence should be taken into consideration and have weight, care plans and daily records will be very useful in helping the MDT to understand what a “typical day in the life” of caring for the person being assessed looks like. If you have a diary which refers to any significant instances requiring care, it would also be useful to have that to refer to at the Full Assessment. 

A fundamental principle of the National Framework is that the assessment process is a multidisciplinary process. This means that the assessment, the completion of the Decision Support Tool and the overall recommendation must be multidisciplinary. The minimum requirement for a Multidisciplinary Team (MDT) in continuing healthcare is two professionals from different healthcare professions (for example a care home nurse and a GP), although ideally the MDT should contain a social care professional with a healthcare professional where possible. Those MDT members should be knowledgeable about your needs which usually means that your current care team should be involved.

Once the Multidisciplinary Team have made a recommendation regarding eligibility the Integrated should accept that recommendation in all but exceptional circumstances. Exceptional circumstances are not clearly defined but the implication is that this is where a quick decision is required. Some ICBs choose to use a panel to help them make the final decision. However any decision-making panel is acting for the ICB and must also accept the recommendation of the Multidisciplinary Team in all but exceptional circumstances.

We are aware of situations in which NHS trusts have overturned multidisciplinary recommendations or instructed MDTs to change their recommendations. We have successfully appealed a high number of cases where such procedural failings have been identified and also worked with the NHS to help them bring their procedures in line with national guidance.

The National Framework places great importance on the involvement of the person who is being assessed and/or their representative at each stage of the assessment process. In order for people to contribute to the assessment process in a meaningful way it is important that they understand the criteria, the toolkits and the assessment processes as fully as possible. If the coordinating assessor just asks a number of questions about your care, that information may help them to complete the evidence sections for each care domain but it does not enable you to express an informed opinion as to the level of need you think should be assigned to each particular care domain, nor help you to provide a viewpoint regarding whether your needs meet the criteria. We find that when assessors help people to understand the criteria and processes involved, they are in a much better place to contribute evidence and information which may prove important to the assessment and overall view of the individual’s needs.

The National Framework requires the person who is being assessed or their representative to be given every opportunity to participate in the assessment. Once the assessment has been carried out, the Decision Support Tool completed and your views recorded, this information is submitted to the Integrated Care Board for a decision. There is no requirement for ICBs to include you in their decision-making. Often ICBs will convene panels as part of the decision-making process and some ICBs will choose to invite individuals or their representatives to these panels, but this is the exception rather than the rule.

This depends on how long the assessment takes and on your specific health care needs but as a general rule, we would advise you not to stay in hospital once you have been deemed fit for discharge.

Patients with ongoing care needs who may qualify for continuing healthcare have a right to be assessed before they are discharged from NHS or Local Authority services and start their long-term care placement. If it is thought that you may be entitled to continuing healthcare, a hospital trust cannot begin ‘delayed discharge’ procedures until you have been assessed and the trust has established that you are not eligible for continuing healthcare.

Assessments for continuing healthcare which take place whilst you are in an ‘acute’ hospital setting can be inaccurate because you may not have reached your rehabilitation potential. This means that you may have the potential to continue your recovery in the near future with further treatment or rehabilitation, and this could impact upon your ongoing care needs.

Long stays in acute hospital settings can be detrimental to your recovery because they are not designed for long-term care. Even where basic care is good, we find that patients are often unable to receive the dedicated daily rehabilitation that would be available in a more appropriate long-term care placement whilst they are in an acute setting.

For this reason some NHS trusts operate a policy whereby continuing healthcare assessments only take place once the individual has been moved out of the acute setting and into intermediate care in a community hospital, their own home or a care home.

Continuing healthcare assessments should normally be completed within 28 days although this timescale is often not met. If you have been deemed fit for discharge from hospital but you are awaiting a continuing healthcare decision and no interim care services have been arranged, it is usually advisable to move into your long-term care setting rather than insist upon waiting in hospital until the assessment process has been completed. This avoids the further potential for the type of health issues that can occur during long periods in acute settings and if you are found to be eligible for continuing healthcare, the start date for funding can be backdated.

Continuing healthcare assessments are only as accurate as the information that is provided to inform them. They go into great detail about your day-to-day care needs and so it is very important that medical and care records are complete, accurate and detailed. Verbal evidence from you or your family/friends should be taken into account during the assessment process but greater weight is given to the written evidence that is recorded at the time.

The Care Quality Commission’s National Minimum Standards for Care Homes in England (2003) requires the records kept by care homes to be accurate. If a care home implements a policy preventing the recording of certain types of care needs, it is not meeting the national standards and such policies should be challenged. Registered Nurses also subscribe to a set of professional standards that require them to keep clear and accurate records, which places a greater responsibility on care homes with nursing to keep good records.

Continuing healthcare assessments go into great detail about your day-to-day care needs and so it very important that medical and care records not only capture the individual’s care needs as those needs change and develop, but also that they describe each need in detail including how the need is met and how effective the treatment or management of the need is.

A set of care records should contain care plans that describe how each particular area of need affects your wellbeing and details the necessary steps required to meet that particular need. There are many ways in which one particular care need could interact with another and it is important that records reflect how each need impacts upon the person and carefully describes how their needs should be met. If records do not capture the complexity, intensity and frequency of meeting a need then that complexity or intensity will not be reflected in the continuing healthcare assessment, and since intensity and complexity are key indicators of a primary health need, poor record-keeping could be the difference between you being assessed as eligible or not.

The period of time between the Checklist referral for full assessment and a final decision regarding eligibility should not normally exceed 28 days. However, in over 13 years of dealing with continuing healthcare appeals less than 5% of the assessments we have seen have been completed within this timescale. The majority have taken on average 3 months to complete and some much longer.

If the 28 day timescale has been exceeded we would recommend that you contact your coordinating assessor or local ICB and ask them to specify clear timescales for a decision regarding eligibility, reminding them of their obligation to complete assessments within 28 days of the Checklist referral. If you are unhappy with the final decision regarding eligibility for continuing healthcare and decide to appeal, you can raise the issue of lengthy timescales with the Independent Review Panel as a procedural complaint.

For most people it is the responsibility of the Integrated Care Board to make a final decision as to whether you have a primary health need and meet the eligibility criteria for continuing healthcare. However ICBs should accept the recommendation of the multidisciplinary team in all but exceptional circumstances. Exceptional circumstances are not clearly defined but the implication is that this is where a quick decision is required. Some ICBs choose to use a panel to help them make the final decision but panels should also accept the recommendation of the Multidisciplinary Team in all but exceptional circumstances.

Be aware that some ICBs outsource continuing healthcare assessments to other organisations to complete, often referred to as ‘Commissioning Support Units’. However, it is important to note that regardless of which organisation completes the assessment and writes the decision letter, the ICB still remains legally responsible for eligibility decisions. (NHS England is responsible for making eligibility decisions and commissioning services for prisoners and military personnel).

The role of the coordinating assessor is to bring together the appropriate Multidisciplinary Team (MDT) to assess your needs and then use the information supplied by the MDT to complete the Decision Support Tool. It is also up to the coordinating assessor to ensure that you and/or your representative are involved in each stage of the process, helping you contribute as fully as possible. The coordinating assessor needs to be knowledgeable about the continuing healthcare system so that they can advise the MDT about the criteria and procedures impartially, however the final recommendation regarding eligibility rests solely with the MDT who should be familiar with your needs.

The National Framework clearly specifies that it is the Multidisciplinary Team (MDT) who make a recommendation as to whether or not you meet the eligibility criteria for continuing healthcare and that the multidisciplinary team should comprise of health and social care professionals who are knowledgeable about your needs. This implies that all such professionals who are currently or have recently been involved in your care should be involved in the assessment and also involved in making a recommendation.

Whilst the ICB does have certain responsibilities regarding the MDT, such as appointing a coordinating assessor to oversee the MDT and provide guidance as to how to apply criteria, they do not have the remit to pick and choose who is selected from the MDT to take part in the recommendation. The ICB also do not have the power to instruct the MDT to change their recommendation, even if they disagree.