CHC assessment process

Continuing Healthcare (CHC) funding is an expensive cost that the NHS has to fund out of their already stretched budgets. For that reason they ensure that they do a full and thorough assessment of each individual prior to awarding such funding.

As you would probably expect the assessment process is a standardised and detailed process consisting of two main elements:

  • The Initial Assessment for Continuing Health Care
    – A simple and less detailed screening tool to establish whether an individual should progress to the more comprehensive final stage of assessment.
    – The Full Assessment Continuing Health Care
  • A full and comprehensive assessment that will establish if you are entitled to CHC Funding or not.

In order to qualify you will need to pass both elements of the process, this article will discuss the Initial Assessment Stage. The next stage of the process, Full Assessment Continuing Health Care assessment will be covered in the next article.

What is your involvement in the Initial Assessment?

The professional completing your checklist must inform you that they are completing the assessment and also fully involve you in its completion. You are entitled to have a family member or friend to support you during the process. You and they are entitled to contribute information, views and insight into your needs. You can even challenge them if you do not agree with their assessment on each specific element.

You should be given reasonable notice of the assessment and have it fully explained to you. If you have capacity you must give your consent for the checklist to be completed. If you do not have capacity either your Power of Attorney must give permission or a best interest meeting must be completed to ascertain if this is the right thing for you or not.

Even where an individual has not chosen someone else to support or represent them, where consent has been given the views and knowledge of family members should be taken into account.

What is the NHS Continuing Healthcare checklist?

The NHS Continuing Healthcare checklist is a form that is completed by a Healthcare Professional that knows your care needs well. It could be done by a range of different people including nurses, doctors, and social workers etc. The main requirement to complete the checklist is not an individual’s role or position; much more important is having been trained in its use.

The checklist covers 11 elements, or domains as they are called. These are listed below, the checklist invites the person completing it (practitioner) to attribute a level of need for each element of care graded from A to C. In this case A is the most significant and C the least.

form gives very precise guidance on what within each element of care constitutes an A, what constitutes a B and what is a C. It would be useful if you had a copy of the checklist in front of you whilst reading the rest of this article as it will help you understand the process better.

Domains of care considered under CHC Checklist:

  • Breathing
  • Nutrition
  • Continence
  • Skin Integrity
  • Mobility
  • Communication
  • Psychological/Emotional
  • Cognition
  • Behaviour
  • Medication
  • Altered state of consciousness

How should the checklist be completed?

The form is designed to be simple to use and quick and easy to complete and it does not require any additional supporting evidence to be submitted at this stage. The professional completing the checklist will do so in page order addressing each part in turn before moving on to the next.

The practitioner should look at the domain descriptors and ascertain which one most closely matches the person being assessed. If the person’s needs are greater than anything indicated in descriptor A then A should be selected as it is the most severe in this part of the process. Once the appropriate level has been assessed it should be entered in the box.

The practitioner should then add a brief description of the individuals needs into the appropriate box.

When the full checklist has been completed the number of As, Bs and Cs should be counted up and then compared to this very specific eligibility criteria:

A full assessment for NHS Continuing Healthcare is required if there are:

  • Two or more domains selected in column A, or
  • Five or more domains selected in column B, or
  • One selected in A and four in B, or
  • One domain selected in column A in one of the boxes marked with an asterisk with any number of selections in the other two columns
    – Breathing, Behaviour and Altered state of consciousness are the elements that are considered priority level and have an asterisk
  • Occasionally a full assessment is recommended without meeting the above criteria although this is done by exception and is very unusual. If this is the case the practitioner will let you know and explain their reasoning.

The principle of a well met or well managed need

One of the key principles of CHC funding is that a well met need is still a need. This means the practitioner should not ignore or marginalise a need just because it is successfully managed: well-managed needs are still needs.
Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS Continuing Healthcare eligibility.

An example the NHS uses to demonstrate this point is:

An individual’s support plan includes support/interventions to manage challenging behaviour because they are a risk to themselves, others or property. The intervention is so successful that there are no further recorded incidents. But, the reduction of incidents is a result of the on-going intervention and the risk remains and incidents would probably occur if that element of care was stopped.

In this situation, the individual may have needs that are well-managed and if so, these should be recorded and taken into account in the eligibility decision.

What happens next if the outcome is positive?

You will be informed of the outcome of the assessment and the paperwork will be sent to the appropriate NHS department which will organise your full assessment if that is appropriate.

You should then be contacted shortly to arrange your full assessment, this is a much more complicated stage that you need to prepare fully for if you wish to be successful.

What happens next if the outcome is negative?

You are entitled to challenge a negative outcome and provide your reasoning as to why they should reconsider their decision. The CCG has a duty to fully consider your appeal and are required to look at any further evidence or insight that you supply.

However, they are not required to re-assess or accept your challenge.

Read the article that explains the second stage of assessment for CHC Funding.

**This author of this article is Geraint Williams, he is one of the Directors of Greensleeves Care and a highly experienced healthcare professional.  He has worked across a range of different healthcare companies that includes charities and commercial companies and he has filled a number of different roles including Registered Manager of several Residential and Nursing Homes. Geraint has supported a number of different people though the CHC assessment process but he also helped his own family achieve CHC funding so he is well versed in its complexities and challenges.