The Continuing Healthcare Checklist (CHC) for funding and free care.
The process surrounding continuing healthcare funding is set out by the government in a document called The National Framework for NHS continuing healthcare assessments and NHS-funded nursing care. It is a Department of Health policy document first introduced in October 2007.
A continuing healthcare checklist is the first stage in determining whether an individual is entitled to free care. A PDF of an example checklist is available here.
An assessment for Continuing Healthcare Funding should not be undertaken whilst a patient is in an acute hospital setting, but should take place once the patient has been discharged to a nursing home or into health and social care. If the patient is already in a nursing home or remains in their own home, then the responsibility for conducting an assessment lies with the Integrated Care Board for the area.
A nurse assessor or social worker will consider the individual’s needs across a range of 12 domains or areas of need and score them on the basis of A (high moderate), B (moderate) or C (low/none).
The next stage and a full assessment are required if an individual is scored as having two or more A scorings, 5 or more B scorings or 1 A and 4 B scorings.
If the result of the CHC checklist clarifies the patient’s condition is serious or long term enough to warrant progressing to the next stage in the continuing healthcare funding assessment process, then a full “Decision Support Tool” should be carried out. This should be conducted by a multi-disciplinary team of clinicians (referred to as an MDT), often a social worker, social healthcare professional, a GP and a nurse assessor.
The Multi-disciplinary team will again assess the patient against a series of domains and score them on a spectrum consisting of no needs up to low, moderate, high and severe, priority.
Having then scored the various domains the multi-disciplinary team will consider all of those needs as a whole result in sufficient nature, intensity, complexity and unpredictability. Resulting in the individuals needs being primarily a health need that should result in continuing healthcare funding being awarded.
A link to the blank decision support tool document can be found here.
Stage 3
A separate panel will convene to consider the recommendation of the multi-disciplinary team resulting from the decision support tool.
Timeframes
The time between receipt of the completed checklist assessment and a funding decision being made following a full assessment and meeting of the Multi-Disciplinary Team should not exceed 28 days.
If the timeframe is longer than this is when funding should be met by the NHS whilst a decision on eligibility is met. We have experienced examples of significant delays where individuals have been expected to pay for their care in full -this is not correct or acceptable. If you are in a similar situation do not hesitate to contact us today.
Fast Track Assessment
If an individual is approaching the end of their life, then a “fast track” continuing healthcare funding assessment may be appropriate. This enables the individual to receive prompt NHS funding to meet the cost of their care at the end of life stage. The only requirement for by-passing the normal NHS continuing healthcare assessment, meeting the criteria and receiving the fast track pathway is that the individual must have:
- A rapidly deteriorating condition that may be entering a terminal phase.
A GP can complete the fast track pathway tool.
It should be noted that strict time limits that base eligibility will be specified, expected length of life remaining should not be imposed.
Appeals
If you do not agree with the decision that has been reached by the panel then the decision can be appealed. This has to be backed by evidence, e.g. the decision reached was flawed. We can assist in this process. With our expert knowledge and experience of this complex area, we are able to determine whether you have a basis for an appeal by reviewing the evidence and assisting you with the full appeals process. We have a strong success rate of securing funding after attending the panel hearings and arguing our client’s case. Contact us today for further details.
Summary
This guide is only a brief outline to provide a useful summary as an overview of the process. The key to success is to ensure that you have sufficient expertise in your corner to support you through the process, ensuring that the correct scorings are awarded according to the needs of the patient and the correct outcome is reached. We will work tirelessly to secure the best result for you, in the swiftest timeframe, at minimal cost.
Do not delay, contact us today. We specialise in securing funding from day one and assisting families with the process from the outset. Don’t wait until a negative decision has been made and it is then necessary to appeal the outcome, this can take many months and all the while the patient will have to pay the cost of their care.
Contact us today and we can start the journey of navigating you to free care.
