If you feel that you or your relative/friend needs an assessment for continuing healthcare you should ask your GP, social worker, district nurse, care home nurse or other health professional for a Checklist assessment. This is the first stage of the assessment process and all the professionals listed above are qualified to complete the paperwork, however your Clinical Commissioning Group (CCG) may refuse to accept a Checklist from certain professionals if they have not been trained in how to complete it. Alternatively you can contact your Clinical Commissioning Group’s continuing healthcare department directly to request an assessment. You can find contact details for your CCG by searching for ‘services near you’ here.

The Checklist threshold is set intentionally low in order to screen people in rather than out. It uses the same 12 care domains as the Decision Support Tool to organise an individual’s needs but instead of containing between 4 and 6 descriptions of need in each domain, it contains 3. These relate to the High, Moderate, and Low/No needs descriptors in the Decision Support Tool. These 3 descriptors are assigned a letter ‘A’, ‘B’ or ‘C’ with ‘C’ being the least intense description and ‘A’ being most intense.

A full assessment will be required if you are assessed with any of the following:

• Two or more domains with an ‘A’ descriptor selected
• Five or more domains with a ‘B’ descriptor selected or one ‘A’ and four ‘Bs’
• An ‘A’ descriptor selected in any of these domains: Behaviour, Breathing, Drug therapies and Medication, and Altered States of Consciousness

You do not necessarily have to meet this criteria in order to be offered a full assessment, some people may be offered an assessment with (for example) only four ‘Bs’ at the discretion of the CCG. Likewise it is not always necessary to complete a Checklist, the CCG may decide to carry out a full assessment without the need for a Checklist if they believe there is a reasonable chance that you may be eligible. Eligibility for a full assessment does not necessarily mean that you will be end up being eligible for continuing healthcare.

Yes you should be supported to play a full role in the process, although we are aware that often hospital patients and their families are not told that a Checklist is to be completed or even informed of the outcome. Experience has taught us that this is usually because the health or social care professional completing the Checklist does not understand continuing healthcare procedures and is unaware of the need to involve the patient or their next of kin.

After a Checklist has been completed the outcome should be communicated to you (or your representative where appropriate) in writing with a rationale for how the decision was reached. If the decision is not to proceed with a full assessment the letter should contain details about how to ask the CCG to reconsider its decision.

Health and social care professionals – including care home nurses – do not have the right to refuse to carry out a Checklist or refuse to make a referral to the CCG for a Checklist to be completed, regardless of their opinions on your eligibility. If you are receiving care in a nursing home then you must be screened for continuing healthcare before a NHS-Funded Nursing Care assessment takes place. If you are receiving ongoing care in your own home, in a care home without nursing or in any other setting, you can still request a Checklist assessment from a health or social care professional and this request should be actioned.

Eligibility is based upon the presence of a primary health need which is established through an in-depth assessment process in which a multidisciplinary team fully assesses the totality of your needs. Until this detailed process has taken place nobody can unilaterally decide that you will or will not be eligible. Furthermore, unless the professional concerned has a wide range of experience within the field of continuing healthcare to draw from it is likely that their understanding of what constitutes eligibility will not be entirely accurate.

No, it is not. The Checklist is designed to screen people in rather than out. The National Framework is clear that if you meet the criteria for a full assessment in any of the scenarios described above – including where five or more domains with a ‘B’ descriptor have been selected – the CCG must carry out a full assessment.

Checklists are often completed by hospital, care home or community health professionals rather than coordinating assessors. Depending on the quality and substance of the Checklist it is not uncommon for CCGs to ‘re-screen’ a Checklist assessment if they feel it is inaccurate. To avoid this it is best to try and ensure that the Checklist is completed as accurately as possible and backed up with supporting evidence from your recent care records, such as care plans.

If the CCG have altered the Checklist so that you no longer qualify for a full assessment they must provide you with a written explanation about how the decision was reached so that you are able to understand exactly where the difference of opinion lies. If you disagree with the CCG, you have the right to formally request a reconsideration of the decision and then to access the NHS complaints procedure. At Beacon we have successfully challenged a number of inaccurate Checklist assessments. We are able to review your Checklist and advise you as to how it can be challenged.

Yes, the Fast Track Pathway Tool should be used by an appropriate clinician such as a GP, hospital consultant or district nurse who need to outline the reasons for the Fast Track decision.

Where a recommendation has been made appropriately, the CCG will work with the individual’s multidisciplinary team to arrange an urgent package of care or an appropriate placement into a care home to support the preferred choice for end of life care delivery when possible.