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Here at Beacon we hear from people across the country on a daily basis. They contact us for information, support and representation, and by talking to these individuals we also become aware of Continuing Healthcare (CHC) patterns and trends nationwide.

Recently we are picking up on a number of instances of CHC referrals not being made, for reasons including:

• A lack of awareness of the set criteria amongst health and social care professionals and referrers, and when a referral should be made
• CHC teams within ICBs struggling to keep up with the volume of work including a high number of checklists to process. As a result often checklists are not completed in order for the ICB not to breach their timeframes and be penalised
• It is not the ‘optimum’ time for the individual to be assessed as a result of them having been rehabilitated to a point but not fully
• Sometimes a checklist is completed but rejected because the individual has not reached their ‘optimum’ assessment point
• Individuals waiting for specialist appointments (e.g. mental health, speech and language) which are often scheduled far in advance, resulting in CHC timeframes being exceeded

The above points are not reasonable grounds to refuse a checklist, and the below guide aims to furnish you with your rights, and give you the confidence to challenge incorrect information if you encounter it.

When can I request a Checklist assessment?

The Continuing Healthcare Checklist assessment is the first step to finding out if you are eligible for NHS Continuing Healthcare. This initial assessment is conducted by a nurse, doctor, social worker or other qualified health or social care professional, who carries out a brief evaluation of your care needs against a checklist. If you ‘pass’ the checklist stage, this is when you should be referred for a Full CHC Assessment.

A Checklist assessment can be triggered by a health or social care professional, but the starting point for many people will be to request it for themselves or a loved one. You can do this at any time by speaking to the health or social care professional, or by contacting your local Integrated Care Board (ICB) and asking to speak to the Continuing Healthcare department. You can find contact details for your local ICB by clicking here. CHC National Framework guidance outlines specific examples of when a request would be appropriate, including where the individual is going into a nursing home (not just a care home) and / or where they have significant ongoing care needs.

Individuals should be assessed at the right time, in the right location, and when their ongoing needs are clear. It is not reasonable for somebody’s eligibility for CHC to be postponed indefinitely just because there may be further rehabilitation potential.

Individuals should not be assessed in hospital, but should be identified as needing an assessment at the point of discharge and referred to CHC assessment team according to local processes.

The decision as to whether an individual may need a Checklist or not is ultimately subjective, and this is part of the problem. Health and social care professionals do not always understand the criteria and might tell you that you are wasting your time. Don’t be put off by this, they can get it wrong. The Checklist stage is the first step in the screening process and before it is completed no one can theorise as to likelihood of eligibility.

Remember, every individual is different – no one set of care needs automatically makes you eligible or ineligible for CHC funding.

What does the Checklist involve?

The Checklist briefly assesses 11 areas of care needs (called ‘domains’), including behaviour, cognition, continence and mobility. These descriptors are assigned a letter A, B or C which refer to the descriptions of need within each domain, with A being the highest. The Checklist should be completed as accurately as possible. Some supporting evidence may be helpful to provide further insight into the levels chosen in domains, but extensive evidencing should be avoided.

You and your representative should be given reasonable notice that the Checklist is to be completed, and consulted during the process, though formal consent is not required.

The Checklist is the only tool that can be used to screen for CHC. If any other localised tool is used in its place or as a gatekeeping tool, this should be challenged as it may deny people who meet the Checklist criteria from being assessed in the first place.

Read more about the checklist process here.

What happens after the Checklist is completed?

The outcome of the checklist assessment will be used to decide whether an individual 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 National Framework for CHC outlines one caveat whereby the ICB can refuse to carry out a Full Assessment. This is where a previous assessment has been undertaken and the individual deemed not eligible for CHC. In this rare instance, if the new checklist shows there has been no significant change in needs and the previous assessment is annotated as evidence, the ICB can refuse to proceed with a Full Assessment on these grounds.

The health or social care professional who carried out the Checklist must submit the result and any supporting evidence to the relevant ICB without delay. 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.

Timescales

The time between a positive checklist and the final decision regarding eligibility (including the full assessment procedure) should not exceed 28 days.

Checklists should not be ‘cancelled’ because timeframes have elapsed or for any other reason, unless there has been a significant change in need within a short period of time since leaving hospital. Positive checklists should result in a full assessment.

The pressures on the system are great, but long delays are unacceptable. If you believe your assessment to have taken place outside the accepted timescale, or if you feel you were not communicated with at timely intervals, you have the right to make a formal complaint.

How we can help

Click here to download our Free Navigational Toolkit which includes expert guidance and advice on all aspects of CHC, including referrals, checklists and assessments. We believe that with support, many people can become confident and capable of navigating the CHC process themselves.

If you find you need more help, our caseworkers can provide services to support you at any stage of the process. To enquire about our Checklist Advocacy Service call us on 0345 548 0300 and select option 2, or email enquiries@beaconchc.co.uk.

We will respond to your enquiry for representation within 48 hours. Please try to contact us as soon as possible and let us know if there are any important dates we should be aware of.