July 2019: This chapter has been revised as a result of local review.
The NHS Continuing Healthcare Checklist is a screening tool to help practitioners identify if a person requires a full consideration of their eligibility for NHS Continuing Healthcare. Completing a Checklist provides evidence that eligibility for NHS Continuing Healthcare has been considered.
The Checklist can be completed by one discipline, which can be an Adult Care practitioner; it does not have to be a qualified social worker. Although it may be appropriate in some cases, it is not essential for a health professional to be involved in completing the Checklist.
2. Guidance on when NHS Continuing Healthcare Checklists should be completed
When completing an adult care assessment or review, practitioners must give consideration to completing a Checklist. After completing an adult care assessment or review they will use their professional judgement and experience to make a decision as to whether or not it is appropriate to complete a Checklist.
Where a decision is made not to complete a Checklist, the practitioner must record their rationale in the person’s case notes. They should also discuss their decision with the person and / or their representative. A Checklist should be completed if a request to do so is made by the person or, where lacking capacity, their formally appointed representative.
2.1 When to complete the Checklist
A practitioner would be expected to complete a Checklist in the below examples:
- where, on a first assessment, a person has significant support needs;
- wherever a person requires a long-term care home placement with nursing. NHS-funded Nursing Care cannot be awarded (except in urgent placements) without consideration of eligibility for CHC;
- where a review indicates a significant change in needs that does not meet the criteria for health funding through the Fast Track process and may impact on the person’s eligibility for CHC;
- where a person’s health needs are complex or unstable and require the involvement of community health services to manage aspects of their support;
- where equipment is being provided in response to a significant change in the person’s needs or presentation, consideration should be given to completing a Checklist.
2.2 When a Checklist will not be required
Situations when a Checklist will not be required include when:
- it is clear to practitioners working in the health and care system that there is no need for NHS Continuing Healthcare at this point in time. If there is doubt between practitioners, a Checklist should be undertaken;
- the person has short-term health care needs or is recovering from a temporary condition and has not yet reached their optimum potential (if there is doubt between practitioners about the short-term nature of the needs it may be necessary to complete a Checklist);
- it has been agreed by the CCG that the person should be referred directly for full assessment of eligibility for NHS Continuing Healthcare;
- the person has a rapidly deteriorating condition and may be entering a terminal phase – in these situations the Fast Track Pathway Tool should be used instead of the Checklist;
- a person is receiving services under Section 117 of the Mental Health Act that are meeting all of their assessed needs. A Checklist should only be completed when needs arise that are not related to Section 117 for example from a physical injury;
- where, in the practitioner’s judgement, having completed an assessment or review, the outcome for CHC eligibility would be negative;
- irrespective of any previous Checklist or DST outcomes, a Checklist is not required where, at review, there is no significant change in needs or requirement to vary the support plan;
- where assessments lead to provision of minor equipment and where there are no identified complex or unstable health issues (see above);
- where an occupational therapist is contributing an additional specialist assessment and CHC has already been considered as part of the current Adult Care episode. Practitioners should record the detail of previous considerations.
3. Checklist Process
Before completing the Checklist, the practitioner should:
- inform the person that the Checklist needs to be completed and gain their consent;
- explain the process to the person and provide a brief explanation of what NHS Continuing Healthcare is. Practitioners are advised to make use of the CHC Prompt Card;
- give the person a copy of the Department of Health Public Information Booklet for NHS Continuing Healthcare and NHS-Funded Nursing Care and a leaflet about Beacon, an organisation that provides free expert advice on NHS Continuing Healthcare;
- inform the person that they have a right to a personal health budget if they are found eligible for NHS continuing healthcare, or a joint funded care package, and provide them with information on the Personal Health Budget NHS England website;
- inform the person that the Checklist does not determine if they are eligible for NHS Continuing Healthcare, only whether they are entitled to full consideration of their eligibility, that is, a positive Checklist does not mean the person has a primary health need and is eligible for CHC funding;
- ask the person if they wish a family member or another representative to be present while the Checklist is completed. If they do and the identified person isn’t present, the practitioner will have to make a return visit;
- inform the person that the CCG will notify them in writing of the outcome of their Checklist;
- inform the person of their right to ask the CCG for a reconsideration of any decision not to proceed to a full assessment for NHS Continuing Healthcare. How to do this will be in the letter from the CCG;
- record that they have completed all of the above within the person’s case notes.
It is good practice to provide a blank copy of the Checklist to the person and their representative, so they can look at it while the practitioner goes through the domains with them.
4. Checklist Domains
Using the Adult Care assessment and any other available care records (for example, care and support plans and daily records), compare the descriptions of need to the needs of the person and select level A, B or C, as appropriate, for each domain. If the needs of the person are the same or greater than anything in the A column, then ‘A’ should be selected.
For each domain, give a brief description of the need and state where the evidence that supports the indicated level can be accessed. This helps with accessing the appropriate information to complete the Decision Support Tool if the person proceeds to a full NHS Continuing Healthcare assessment.
Where it can reasonably be anticipated that the person’s needs are likely to increase in the next three months, for example, because of an expected deterioration in their condition, this should be reflected in the levels selected. Where the extent of a need may appear to be less because good care and treatment is reducing the effect of a condition, the need should be recorded in the Checklist as if that care and treatment was not being provided.
A full assessment for NHS Continuing Healthcare is required if there are:
- two or more domains selected in column A;
- five or more domains selected in column B, or one selected in A and four in B; or
- one domain selected in column A which is marked with an asterisk in one of the four domains that carry a priority level in the Decision Support Tool which are:
- medications and symptom control;
- altered states of consciousness.
There may also be circumstances where, using their knowledge of the person and their experience in NHS Continuing Healthcare, the practitioner decides that a full assessment for NHS Continuing Healthcare is necessary, even though the person does not apparently meet the indicated threshold, for example, one domain selected in column A and three domains selected in column B.
The practitioner must inform the person, and their representative, of the outcome as to whether or not the Checklist has screened the person in for a full consideration of their eligibility for NHS Continuing Healthcare.
The practitioner must clearly indicate the outcome of the Checklist and provide a rationale for the decision in the ‘Rationale for Decision’ box, which should give enough detail for the person and their representative to be able to understand why the decision was made.
Where the decision to proceed or not to proceed to a full consideration of eligibility is based on the number of As, Bs, and Cs scored, a statement to this effect will often be sufficient.
In cases where the person does not meet the threshold, but the practitioner makes a decision that they should be referred for a full consideration of their eligibility, the practitioner will need to provide a more detailed rationale to support their decision.
The practitioner should record in the ‘Rationale for Decision’ box that they have discussed the outcome of the Checklist with the person and their representative.
The practitioner must sign and date the Checklist and provide their contact details including their email address.
They must also ensure that they have recorded the name, address and phone number of the individual’s next of kin / representative on the Checklist. Failure to provide these can result in the representative not being invited to attend the multidisciplinary team (MDT) meeting to complete the DST.
The person or their representative should be given a copy of the completed Checklist, including the Checklist user notes. This may be achieved by completing two Checklists, ensuring that the recording on each of them is identical, and allowing the person or their representative to choose which one they wish to keep. Alternatively, the practitioner may agree with the person and their representative that the practitioner will post them a copy of the completed Checklist. Where the person is a resident in a care home, the home manager may allow a photocopy to be made.
Before photocopying the Checklist, the practitioner should record on it that a copy has been provided to the person or their representative.
The practitioner must send the completed Checklist and evidence of consent to the CCG via secure email. This applies whether or not the Checklist has screened the person in for a full assessment. If the Checklist is positive, practitioners should provide three availability slots over the next two to three weeks (AM or PM) to indicate when they will be available to attend a DST.
Where the practitioner has determined that the person lacks capacity, they must also send evidence to support this and the best interests decision to complete the Checklist to the CCG.
Where a third party holds Lasting Power of Attorney or is a Court Appointed Deputy for Health and Welfare for the person, a copy of their authorisation should be securely emailed with the Checklist. Alternatively the practitioner can record on the Checklist that evidence of a valid LPA or Court Appointed Deputy has been viewed.
There is a local agreement in place between Lincolnshire CCGs and LCC that in cases where the practitioner completes a positive Checklist, they should submit a copy of the person’s adult care assessment.
The practitioner must ensure that there is a copy of the completed Checklist on Mosaic. The Department of Health and Social Care has set a 28 day target for the NHS Continuing Healthcare process. This means from the date the CCG receive a Checklist screening the person in for a full consideration of their eligibility for NHS Continuing Healthcare, it should take no longer than 28 days for the assessment process to be completed and a decision on the person’s eligibility to be made.
In order to assist in the prevention of delays and promote a quality experience for the person in their journey through the CHC process, it is essential the Checklist is fully and accurately completed.
If any of the following are not completed or provided, the Checklist will be returned to the practitioner:
- person’s name;
- date of birth;
- person’s GP and practice address;
- practitioner’s signature, job title, contact telephone number and secure email address;
- date the Checklist was completed;
- person’s current location (for example, hospital and ward, own home);
- person’s usual / home address;
- evidence of the person’s consent;
- evidence, where appropriate, of capacity and best interests decision;
- ABC levels for all domains;
- references to where supporting evidence can be found for each domain (this should include a brief description of the need);
- clear rationale as to outcome of the Checklist.
In cases where the Checklist is returned, the practitioner will be required to complete the missing information and re-submit it within two working days. You can read the latest Standard Operating Procedure for completing Checklists in Lincolnshire.