Part 2: The Full Assessment of Need

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

Read Part 1 of The Essential Guide to find out when and how you can request a Checklist assessment, what it entails, and what happens next. If a Checklist has been completed and indicates that you’re eligible for a full assessment, your Integrated Care Board (ICB) should get the ball rolling to get the full assessment of need completed.

In Part 2 of The Essential Guide we outline what to expect from a full assessment, who should be involved, and what it comprises.

Who carries out the full assessment?

Full assessments are completed by a group of people who are involved in your care. The team is brought together and led by a coordinating assessor, who is appointed by your ICB.

The assessment group is known as ‘the multidisciplinary team’, and you may see this shortened to MDT. Ideally this team would comprise all the health and social care professionals who are knowledgeable about your needs. The absolute minimum that a team can comprise is a healthcare professional and a social care professional, or two professionals from different healthcare professions.

Your involvement

The person being assessed, or their representative, should be involved at every stage. It is part of the coordinating assessor’s role to invite you to contribute to the assessment, often at the meeting of the multidisciplinary team.

The coordinating assessor should help you to understand the criteria and processes during the meeting, and this will help you to contribute the most relevant evidence and information. We have lots of information to help you make a valuable contribution at an assessment meeting in our free Navigational Toolkit which you can download for free.

The assessment

The assessment will be completed at a meeting of the multidisciplinary team, where the severity, complexity and predictability of your needs across 12 areas will be discussed.

These areas, known as ‘care domains’, are:

• Breathing
• Nutrition
• Continence
• Skin
• Mobility
• Communication
• Psychological and emotional needs
• Cognition
• Behaviour
• Drug therapies and medication
• Altered states of consciousness
• Other significant care needs

The multidisciplinary team uses the evidence that has been provided to assign a level of need against each care domain. The level of need ranges from ‘no need’ to ‘moderate, ‘high’, ‘severe’ or ‘priority’.

Assessments of need are inputted into a detailed form called the Decision Support Tool, often referred to as the DST. Once the DST has been completed, the coordinating assessor should give you an opportunity to review it and add your views in the designated part of the form.

Once completed, the MDT will make a recommendation to the ICB as to whether or not they think you meet the eligibility criteria. The MDT do not have to involve you in this discussion.

Information used to make the decision

All written or verbal information about your needs within the assessment period should be taken into account. This information might include care plans, hospital records, social care records, GP records, medication charts and daily care records.

We cannot stress enough the importance of doing what you can to ensure the multidisciplinary team have full and accurate records on which to base their decision. Read more about how you can prepare and get the required paperwork ready before an assessment.

ICBs usually make the final decision about your eligibility for Continuing Healthcare funding. However, they should accept the recommendation of the assessment team in all but exceptional circumstances.

Disagreeing with the decision

After the assessment you should receive a decision letter from your ICB promptly, with a rationale for how the decision was made.

You have six months from the date of that letter to request a review of the decision, and the appeal process has various stages if you’re not satisfied with the outcome.

Grounds for appeal could be the eligibility decision, the procedures used to make it, or how the criteria have been applied.

The first step in appealing a decision is to write to the ICB outlining your reasons for requesting a review. It’s worth preparing this letter carefully, and we have detailed guidance to help you in our free Navigational Toolkit.

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.