FAQs > Screening & Checklist

If you feel that you or your relative/loved one needs an assessment for NHS Continuing Healthcare you should ask your GP, social worker, district nurse, care home nurse or other health professional for a Checklist assessment. This is the first stage of the assessment process and all the professionals listed above 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 local Integrated Care Board (ICB)’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 threshold is set intentionally low in order to screen people in rather than out. It uses the same 12 care domains as the Decision Support Tool (DST) to organise an individual’s needs but instead of containing between 4 and 6 descriptions of need in each domain, it contains 3. These relate to the High, Moderate, and Low/No needs descriptors in the Decision Support Tool. These 3 descriptors are assigned a letter ‘A’, ‘B’ or ‘C’ with ‘C’ being the least intense description and ‘A’ being most intense.

A Full Assessment will be required if you are assessed with any of the following:

• Two or more domains with an ‘A’ descriptor selected
• Five or more domains with a ‘B’ descriptor selected or one ‘A’ and four ‘Bs’
• An ‘A’ descriptor selected in any of these domains: Behaviour, Breathing, Drug therapies and Medication, and Altered States of Consciousness

It is not always necessary to complete a Checklist, the ICB may decide to carry out a Full Assessment without the need for a Checklist if they believe there is a reasonable chance that you may be eligible. Eligibility for a full assessment does not necessarily mean that you will be end up being eligible for continuing healthcare.

Yes you should be supported to play a full role in the process, although we are aware that often hospital patients and their families are not told that a Checklist is to be completed or even informed of the outcome. Experience has taught us that this is usually because the health or social care professional completing the Checklist does not understand continuing healthcare procedures and is unaware of the need to involve the patient or their next of kin.

After a Checklist has been completed the outcome should be communicated to you (or your representative where appropriate) in writing with a rationale for how the decision was reached. If the decision is not to proceed with a full assessment the letter should contain details about how to ask the ICB to reconsider its decision.

If you have been unsuccessful in finding a health or social care practitioner who is aware of your needs to complete a Checklist (due to them being unable or unwilling to do so), you should contact the CHC team of your local ICB. In accordance with Practice Guidance Note 14 of the National Framework for NHS Continuing Healthcare you may request that the ICB sends someone to visit you and complete the Checklist. In accordance with the National Framework, this should be done within 14 days of your request. You should also quote the relevant paragraph of the Framework, as follows:

‘PG 14 Can someone self-refer by completing a Checklist themselves?

If the individual is known to a health or social care practitioner, they could ask that practitioner to complete a Checklist. Alternatively, they should contact their ICB NHS continuing healthcare team to ask for someone to visit to complete the Checklist, or if they already have a care home or support provider, they could ask them to contact the ICB on their behalf. Where the need for a Checklist is brought to the attention of the ICB through these routes it should respond in a timely manner, having regard to the nature of the needs identified. In most circumstances it would be appropriate to complete a Checklist within 14 calendar days of such a request.’

There are no limits on when you can ask for a new Checklist, but we would recommend requesting one three months after a negative checklist, or six months after a negative full assessment/MDT assessment. If the person’s needs change suddenly, you should ask for a new Checklist immediately.

If your relative has been found ineligible, but receives funded nursing care (FNC), their Integrated Care Board (ICB) should review their care after three months and then annually. This is to check if they should be reassessed. Even so, you should still be able to request a new checklist if things change before then.

The ICB may reject a new checklist if it is clear there has been no change in needs since the person was last assessed. Nonetheless, you can challenge this. You should read through the original checklist, then write to the ICB noting any changes. Our Navigational Toolkit has a breakdown of the care domains that should be helpful for this. You can read it on pages 23 to 33 of part 2 (Assessments).

Health and social care professionals – including care home nurses – do not have the right to refuse to carry out a Checklist or refuse to make a referral to the ICB for a Checklist to be completed, regardless of their opinions on your eligibility. If you are receiving care in a nursing home then you must be screened for continuing healthcare before a NHS-Funded Nursing Care assessment takes place. If you are receiving ongoing care in your own home, in a care home without nursing or in any other setting, you can still request a Checklist assessment from a health or social care professional and this request should be actioned.

Eligibility is based upon the presence of a primary health need which is established through an in-depth assessment process in which a multidisciplinary team fully assesses the totality of your needs. Until this detailed process has taken place nobody can unilaterally decide that you will or will not be eligible. Furthermore, unless the professional concerned has a wide range of experience within the field of continuing healthcare to draw from it is likely that their understanding of what constitutes eligibility will not be entirely accurate.

If you have been unsuccessful in finding a health or social care practitioner who is aware of your needs to complete a Checklist (due to them being unable or unwilling to do so), you should contact the CHC team of your local ICB. In accordance with Practice Guidance Note 14 of the National Framework for NHS Continuing Healthcare and NHS funded Nursing Care July 2022 (Revised), you may request that the ICB sends someone to visit you and complete the Checklist. In accordance with the National Framework, this should be done within 14 days of your request. You should also quote the relevant paragraph of the Framework, as follows:

PG 14 Can someone self-refer by completing a Checklist themselves?

14.1       No. If the individual is known to a health or social care practitioner, they could ask that practitioner to complete a Checklist. Alternatively, they should contact their ICB NHS continuing healthcare team to ask for someone to visit to complete the Checklist, or if they already have a care home or support provider, they could ask them to contact the ICB on their behalf. Where the need for a Checklist is brought to the attention of the ICB through these routes it should respond in a timely manner, having regard to the nature of the needs identified. In most circumstances it would be appropriate to complete a Checklist within 14 calendar days of such a request.

No, it is not. The Checklist is designed to screen people in rather than out. The National Framework is clear that if you meet the criteria for a full assessment in any of the scenarios described above – including where five or more domains with a ‘B’ descriptor have been selected – the ICB must carry out a Full Assessment.

Checklists are often completed by hospital, care home or community health professionals rather than coordinating assessors. Depending on the quality and substance of the Checklist it is not uncommon for ICBs to ‘re-screen’ a Checklist assessment if they feel it is inaccurate. To avoid this it is best to try and ensure that the Checklist is completed as accurately as possible and backed up with supporting evidence from your recent care records, such as care plans.

If the ICB have altered the Checklist so that you no longer qualify for a full assessment they must provide you with a written explanation about how the decision was reached so that you are able to understand exactly where the difference of opinion lies. If you disagree with the ICB, you have the right to formally request a reconsideration of the decision and then to access the NHS complaints procedure. At Beacon we have successfully challenged a number of inaccurate Checklist assessments. We are able to review your Checklist and advise you as to how it can be challenged.

Yes, the Fast Track Pathway Tool should be used by an appropriate clinician such as a GP, hospital consultant or district nurse who need to outline the reasons for the Fast Track decision.

Where a recommendation has been made appropriately, the ICB will work with the individual’s Multidisciplinary Team (MDT) to arrange an urgent package of care or an appropriate placement into a care home to support the preferred choice for end of life care delivery when possible.

If your family member has a “rapidly deteriorating condition and may be entering a terminal phase”, you can ask a registered medical professional involved in their diagnosis, treatment or care, to make a Fast Track application for them. When making the application, it is important for the professional to remember that “rapidly deteriorating” should not be interpreted narrowly as only meaning an anticipated specific or short time of life remaining, and “may be entering a terminal phase” is not intended to mean only situations in which death is imminent. If your family member is currently demonstrating few symptoms but it is clear that rapid deterioration is expected in the near future, it may be appropriate for the application to be made now. Once a properly completed Fast Track application has been made, the Integrated Care Board must accept and immediately action it.  Although the Fast Track application replaces the need for a Checklist and Decision Support Tool to be completed, individuals who have been “Fast-Tracked” will be reviewed within three months and in certain circumstances a full assessment will be arranged. If at that review it is clear that the individual is likely to die in the very near future or if they still have a rapidly deteriorating condition and may be entering a terminal phase, a full assessment should not be arranged.