The NHS Checklist is a document developed by the Department of Health & Social Care tool which may be used to determine which individuals need to be referred for a full assessment of their eligibility for NHS Continuing Healthcare.
The NHS Checklist can be found here.
The NHS Checklist is the usual starting point for assessing eligibility for NHS Continuing Healthcare. It may be completed in relation to an individual to decide whether they may need an assessment now, or it may be retrospectively applied in relation to evidence of past needs, to determine if a full retrospective eligibility assessment is necessary.
How should the NHS Checklist be completed?
The NHS Checklist should be completed by health or social care practitioners who are trained in its use and be familiar with the NHS Continuing Healthcare assessment process. This is usually a nurse or a social worker.
Completion of the NHS Checklist is intended to be quick and straightforward. It is not necessary to provide additional detailed evidence alongside it.
When should the NHS Checklist be completed?
The NHS Checklist should be completed once the individual’s longer-term care needs are better understood. This is usually shortly after the commencement of their care package, whether at home or in a care home.
The National Framework for Continuing Healthcare discourages the completion of NHS Checklists in acute settings, such as in hospital, unless there is good reason to do so. Priority should be given to discharge of the individual with a package of care that is appropriate to meet their needs, and thereafter the NHS Checklist should be completed.
In limited cases, the NHS may choose to undertake a full eligibility assessment without undertaking screening via the NHS Checklist, but it should not refuse to assess eligibility for NHS Continuing Healthcare without completing an NHS Checklist screening tool to inform that decision.
What is the criteria for a full eligibility assessment?
The individual’s needs are considered across various areas of need, known as the “care domains”:
- Breathing
- Nutrition – Food and Drink
- Continence
- Skin and tissue viability
- Mobility
- Communication
- Psychological and Emotional needs
- Cognition
- Behaviour
- Drug Therapies
- Altered States of Consciousness
The practitioner must compare the domain descriptors to the needs of the individual and select level A, B or C, as appropriate, choosing whichever most closely matches the individual. A level of 'A' indicates greater need, whilst 'C' indicates a lower level of need.
The NHS Checklist positive – i.e. - a full assessment of eligibility for NHS Continuing Healthcare is required if there are:
- One A selected in Breathing, Behaviour, Drug Therapies, or Altered States of Consciousness, irrespective of the other domain levels; or
- Any two or more domains selected in column A; or
- Any five or more domains selected in column B, or one selected in A and four in B.
The NHS Checklist negative if any other levels are identified – i.e. – a full assessment of eligibility for NHS Continuing Healthcare is not required.
What if the NHS Checklist is positive?
If a suitable multi-disciplinary team comprising of health and social care professionals is available on the day the NHS Checklist is completed, then the full eligibility assessment may take place immediately after the Checklist. This is often not practical, and best practice guidance indicates that the NHS should arrange for a full eligibility assessment should take place within the next 28 days.
What if the NHS Checklist is negative?
This is an indication that it is very unlikely that the patient would qualify for a full eligibility assessment because the threshold for screening with the NHS Checklist is set very low.
However, there may be good reason to challenge the NHS Checklist, such as where needs have been downplayed, important aspects of the patient’s needs have been overlooked, or procedural requirements have not been adhered to.
The usual means of challenge is by making a Formal Complaint to the ICB, which should be undertaken as soon as possible, and within 12 months at the latest.
It is usual for the individual’s eligibility to be reconsidered in 12 months’ time and consideration should be requested if it is not instigated by the NHS. An NHS Checklist may be completed sooner than that if the individual’s needs increase or their condition deteriorates.
