NHS CHC Assessment Process
To speak to a CHC expert today call 0345 548 0066Â
The NHS Continuing Healthcare assessment process is used to determine whether a person’s care needs should be funded by the NHS.
Many families go through the CHC process without fully understanding how decisions are made or whether the outcome is correct.
Eligibility for NHS Continuing Healthcare is not based on financial circumstances. Instead, the assessment focuses on whether the individual’s primary need for care is related to health needs.
CHC should be assessed prior to any financial assessments if the primary reason for care is due to health.
The process involves a number of stages designed to assess the persons health, along with key principles which include the nature, intensity, complexity and unpredictability of a person’s care requirements.
The NHS Continuing Healthcare Checklist
The first stage of the process is usually the CHC Checklist.
This is a screening tool used by health or social care professionals to determine whether a person should receive a full assessment for NHS Continuing Healthcare.
If the checklist indicates that a further assessment is required, the individual will normally proceed to a full Multi-Disciplinary Team assessment.
 Call 0345 548 0066 or click here to request a call backÂ
Full NHS Continuing Healthcare Assessment
This assessment is carried out by a Multi-Disciplinary Team (MDT) made up of health, social and care professionals who might be familiar with the person’s needs. The meeting is chaired by a nurse assessor from the NHS Integrated Care Board (ICB).
The MDT will gather information from the available medical records, care home notes and care plans and sometimes healthcare professionals that are involved in the person’s care.
The Decision Support Tool – DST
During the full assessment, the Multi-Disciplinary team will complete a document known as the Decision Support Tool (DST).
The Decision Support Tool considers a person’s needs across a number of care domains including:
• breathing
• nutrition
• mobility
• cognition
• behaviour
• medication and other care needs
The DST helps the MDT consider the levels of care required and whether the person’s needs amount to a primary health need.
Primary Health Need
Eligibility for NHS Continuing Healthcare is ultimately based on whether a person has a primary health need.
This decision takes into account the care domains and then four key characteristics:
• nature
• intensity
• complexity
• unpredictability
These factors help determine whether the individual’s care needs are primarily related to health rather than social care.
To speak to a CHC expert Call 0345 548 0066 or click here to request a call backÂ
Eligibility Decision
Following the assessment, the Multi-Disciplinary Team will make a recommendation to the relevant NHS body regarding eligibility for NHS Continuing Healthcare funding. A decision should be provided in writing within 28 days.
Where eligibility is confirmed, the NHS becomes responsible for funding the full cost of care.
Reviews
Following an eligible outcome, funding will be reviewed after 3 months. If funding is approved at the 3 month review, it will be reviewed every 12 months thereafter.
What If NHS Continuing Healthcare Funding Is Refused
When NHS Continuing Healthcare funding is not awarded following an assessment, or if it has been removed at a review, families can request a further review of the decision with the local NHS Integrated Care Board.
Where a review cannot satisfy the decision or provide an expected outcome, there is the option of further reviews through the appeals process.
Appeal
The first stage of the appeals process is known as a Local Resolution Panel (LRP), where you have the opportunity to provide additional reasoning or evidence and to question the decision as to why funding was denied.
If following the LRP the funding outcome is still negative, you have the option to progress to NHS England to another appeal known as an Independent Resolution Panel (IRP).
The NHS England IRP, is the final stage of the appeals process, although if you are still unsatisfied with the outcome you can raise a complaint to the Parliamentary and Health Service Ombudsman.
Summary
While we have provided an overview on the process of NHS Continuing Healthcare funding, we would not recommend progressing with any aspect of the process without seeking independent expert advice.
Any part of this process being missed or not carried out correctly can result in a lifetimes savings and property being used to pay for care incorrectly.
To speak to an expert contact us today.
📞 Call 0345 548 0066 or click here to request a call backÂ