NHS Continuing Healthcare Assessment Process
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 NHS Continuing Healthcare assessment 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.
The process involves a number of stages designed to assess the nature and complexity of a person’s care requirements.
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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 further assessment is required, the individual will normally proceed to a full multidisciplinary assessment.
Full NHS Continuing Healthcare Assessment
If the checklist is positive, a full assessment will be arranged.
This assessment is typically carried out by a multidisciplinary team (MDT) made up of health and care professionals who are familiar with the person’s needs.
The MDT will gather information from medical records, care home records and professionals involved in the person’s care.
The Decision Support Tool
During the full assessment, the multidisciplinary 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 tool helps the MDT consider the level 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 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.
Eligibility Decision
Following the assessment, the multidisciplinary team will make a recommendation to the relevant NHS body regarding eligibility for NHS Continuing Healthcare funding.
Where eligibility is confirmed, the NHS becomes responsible for funding the full cost of care.
What If NHS Continuing Healthcare Funding Is Refused
If NHS Continuing Healthcare funding is not awarded following an assessment, families can request a review of the decision.
In some cases it may be possible to challenge the outcome through the NHS Continuing Healthcare appeals process.
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