The Continuing Healthcare (CHC) Assessment Process.

Go straight to: How to apply for Continuing Healthcare (CHC) funding

Assessment for NHS Continuing Healthcare (CHC) is a two-step process. This process is for adults. There is a separate process for children and young people.

Step 1: An initial assessment and screening tool called a Checklist

Step 2: If the Checklist is ‘positive’, the second step is a Full Assessment for NHS CHC

Step 1: CHC Checklist – An initial assessment and screening tool that is completed by a health or social care practitioner who knows you

Please ensure you read the Public Information Leaflet: NHS CHC and NHS-Funded Nursing Care produced by the Department of Health and Social Care. This provides a full overview of the CHC assessment process in England.

The Checklist is a screening tool to help identify individuals who need referral for a Full Assessment of eligibility for NHS Continuing Healthcare. It is the first step in the process.

It is completed by health or social care worker who knows you, such as a District Nurse, Community Nurse, Community Mental Health Nurse, Social Worker, or other health/social care practitioner. They must have been trained how to complete a Checklist.

How is it completed?

You will be asked to consider whether you consent to sharing information about your health and care needs in relation to the CHC process with third parties, such as friends, family members, and other representatives. This also includes seeking consent to share information with any non-health and social care organisations, such as private care providers (care agencies and care homes). This is documented on a Consent Form and submitted to NHS Devon along with your Checklist.

To complete the Checklist, the practitioner may gather and review GP records, care plans, risk assessments, nursing notes and any other relevant documentation.

The practitioner will share the information gathered with you and/or your representative and give you an opportunity to discuss and comment on what has been found and provide any additional relevant information.

Once completed, Checklists are submitted for quality assurance and validation by senior registered health professionals within NHS Devon Integrated Care Board (ICB). The outcome of the Checklist will be communicated to you, in writing, by the Continuing Healthcare Team.

You can find the NHS Continuing Healthcare Checklist documentation here.

What could the outcome be?

The outcome of the Checklist will either be:

Negative checklist – Full Assessment is not required, you are not currently eligible for NHS Continuing Healthcare.

Positive checklist – Full Assessment (Step 2) is required to determine whether you are eligible for NHS Continuing Healthcare. You will be referred to NHS Devon to complete the Full Assessment.

Please be aware the checklist positive threshold is low intentionally to ensure that all those who require a Full Assessment of eligibility have this opportunity. A positive checklist does not automatically lead to eligibility for NHS CHC. Less than 1 in 4 people with positive Checklists are then Eligible for CHC funding after Full Assessment (Based on NHS figures for CHC 2022-23 Q3, England).

Step 2: Full Assessment – Led by a healthcare professional working on behalf of NHS Devon

Key Information:

The assessment does not take place in hospital as this is not the best place to make long-term decisions about your ongoing care. A full assessment is only undertaken when your condition is stable and your ongoing health care needs are clear.

A registered healthcare professional working on the behalf of NHS Devon will lead the assessment and collate evidence from people involved in your care such as your GP, social worker, carer, specialist nurse, or other health and social care practitioner to build an overall picture of your needs. The healthcare professional will then work with at least one other health or social care professional, ideally a Social Worker from the Local Authority, forming a multidisciplinary team. They will use the information gathered prior to and during the assessment appointment to complete a document called a Decision Support Tool (DST). A copy of a blank DST is available here.

The purpose of the Decision Support Tool (DST) is to help the multidisciplinary team to explore the nature, complexity, intensity and unpredictability of your needs – and so recommend whether or not you have a ‘primary health need’.

You, and any third party supporting you (friend, family, other representative), should be fully involved in the assessment process, kept informed and have your views about your needs and support taken into account as part of the DST.

Following the completion of the Decision Support Tool, the multidisciplinary team will then make a recommendation to NHS Devon as to whether or not you have a ‘primary health need’, which will determine your eligibility for NHS Continuing Healthcare. NHS Devon will determine whether you are eligible for NHS Continuing Healthcare following a review of the document and the multidisciplinary team’s recommendation.

A decision about eligibility for NHS Continuing Healthcare should usually be made within 28 days of an initial assessment or request for a full assessment (usually a ‘positive’ checklist) being received by NHS Devon. The team will inform you in writing, with a copy of the Decision Support Tool as soon as they can, providing clear reasons for NHS Devon’s decision on whether you are eligible. The letter will also provide details about your right to request a review of the decision.

Our standard practice is to complete CHC appointments virtually. By this we mean over video conferencing (Microsoft Teams), where there is the option to be visible over the video and to see others, or for individuals to just ‘dial in’ to the meeting using a phone number. We do this to maximise our efficiency and as we have found that individuals and their representatives frequently report finding this preferable and easier to fit into their schedules, when compared to face-to-face meetings. We expect a full assessment meeting to last a maximum of two hours.

We understand that some individuals, named friends, family, advocates and/or other representatives have limited availability and we will be as flexible as we are able to be to enable attendance. However, as NHS Devon are required to complete CHC processes within a limited time frame, we cannot guarantee that we will be able to rearrange all appointments provided. For those who are unable to attend, the assessor will offer a post-meeting telephone call to relevant parties to discuss gathered information and hear comments and views.

Can I choose not to have assessment for NHS Continuing Healthcare?

NHS Devon has a statutory (legal) duty to complete NHS Continuing Healthcare assessments. This means we have to complete the Continuing Healthcare process for individuals who may be eligible for this funding, including for those with a positive Checklist outcome. As it is a legal requirement for us to do this, consent is not required to carry out the assessment or to gather evidence/information from health and social care records or professionals.

We will seek consent for sharing information with other third parties, such as friends, family members, and other representatives. This also includes seeking consent to share information with any non-health and social care organisations, such as private care providers (care agencies and care homes).

You can decide the extent to which you participate in the assessment process. NHS Devon encourages individuals to engage as much as they can, and to think about who they have in their support network who would be able to provide information to support the assessment. We find this makes the process more thorough and eligibility decisions more accurate. If an individual and their family representatives decline to engage in the process, the assessment must still go ahead, but will be based only on health/social care written records and verbal reports.

Useful Resources:
NHS Continuing Healthcare and NHS Funded Nursing Care documents and tools – Department of Health and Social Care

Public Information Leaflet: NHS CHC and NHS-Funded Nursing Care

Beacon: an independent organisation offering online resources and a free consultation of up to 90 minutes of advice on NHS Continuing Healthcare.

https://www.beaconchc.co.uk

Tel: 0345 548 0300

Other NHS Devon links:
NHS Devon All Age Continuing Care home page
NHS Continuing Healthcare
How to apply for Continuing Healthcare (CHC) funding
NHS Devon Contact Us – CHC Teams
Our Policies and Procedures