How is NHS Continuing Healthcare assessed?
In order to find out it you are eligible for NHS Continuing Healthcare a two stage assessment process is followed:
- Stage 1: Screening via the Checklist tool
- Stage 2: Full assessment of eligibility via a Multi-Disciplinary Team Meeting
In order for the NHS Continuing Healthcare process to begin you, or your chosen representative will need to provide written consent, both for the process to take place, and for the sharing of data with the relevant health and social care professionals.
The above video put together by NHS England acts as a useful guide to the Continuing Healthcare process and procedures.
This NHS CHC Flow Chart provides you with the overall step by step process.
Although the usual NHS Continuing Healthcare assessment would involve a face-to-face Multi-Disciplinary Team meeting, due to COVID-19 some of these meetings are being completed virtually in order to reduce the risk of spreading the virus.
To help correctly identify if you require a full assessment of eligibility for NHS Continuing Healthcare, a health or social care professional involved in your care will complete a screening tool called a Checklist.
They may also speak to your family or others who support you to build up a picture of your needs. This checklist is sent to us, the NHS Continuing Healthcare team at West Hampshire CCG. You should also receive a copy of the Checklist tool.
Once completed, if the checklist indicates that you require a full assessment of eligibility, we will arrange for a ‘multi-disciplinary team’ meeting to take place.
A ‘multi-disciplinary team’ (MDT) means a team drawn from a number of professional ‘disciplines’ such as doctors, nurses, therapists and social workers. The multi-disciplinary team will be made up of two or more professionals who understand your care needs. They may be from health or social care services.
At the full assessment, CHC staff from West Hampshire CCG will make sure that you, your chosen representative, as appropriate, and whoever cares for you are invited to be involved. If you need an advocate to support you through the assessment process, WHCCG can help arrange this for you.
Members of the multi-disciplinary team will meet with you to undertake the assessment and complete a ‘decision support tool’. You may hear this term shortened to a DST.
The decision support tool allows the multi-disciplinary team to gather a full picture of your health and care needs by looking at 12 different areas:
- Psychological and Emotional Needs
- Drug Therapies and Medication: Symptom Control
- Altered States of Consciousness
- Other significant care needs to be taken in consideration
These care needs are then considered against the NHS Continuing Healthcare 4 key indicators to assess whether the individual has a Primary Health Need and should therefore be recommended eligible for NHS Continuing Healthcare.
What is a Primary Health Need?
Anyone over 18 years of age, assessed as having a ‘primary health need’, should be eligible for NHS Continuing Healthcare. It is not dependent on a particular disease, diagnosis or condition.
A ‘primary health need’ is a concept, rather than a legally set definition. It was introduced by the Secretary of State for Health, to assist in identifying whether a person’s primary need is for healthcare (therefore being the duty of the NHS to provide under the 2006 Act) rather than for social care (under the Care Act 2014).
A primary health need would be indicated by the nature, complexity, intensity or unpredictability of health needs, or a combination of these.
Nature, Complexity, Intensity and Unpredictability are also known as the NHS Continuing Healthcare 4 key indicators.
The 4 Key Indicators
Nature: this describes your needs and the type of needs e.g physical, psychological, etc. Nature also describes the effects of your needs on you and the type of help you may require to help manage and meet your needs.
Intensity: this considers the extent and severity of your needs and the type and level of support you need to meet them, which includes the need for ongoing or continuous care.
Complexity: this describes how your needs may interact or affect each other, which may make them difficult to manage or control. It also looks at the level of skill required to monitor your symptoms, treat your condition and/or manage your care.
Unpredictability: this looks at how your needs may vary and fluctuate and how a difficulty in predicting changes in your needs might create challenges in being able to manage or meet them. This includes the risks to your health if adequate and timely care is not provided.
How is the final eligibility decision made?
The multi-disciplinary team will put forward their recommendation with regards to eligibility for NHS Continuing Healthcare to West Hampshire CCG.
A registered professional within West Hampshire CCG will look at the recommendation made by the multi-disciplinary team, alongside the supportive evidence collected, and finalise or “ratify” the decision. This will usually be in line with the recommendation made, unless there are exceptional circumstances.
Once we have made a decision, we will send you a letter confirming the outcome. This letter will also include a copy of the decision support tool. If you are found to be not-eligible for NHS Continuing Healthcare you have the right to appeal the decision.