Full Assessment

Stage two of the NHS Continuing Healthcare assessment process

A Full Assessment is a detailed appraisal of your care needs, to decide if you are eligible to receive NHS Continuing Healthcare.

An assessment is usually triggered when initial screening using the Continuing Healthcare Checklist indicates that you may have sufficient needs to qualify for funding.

The assessment will be coordinated by the Continuing Healthcare team at your local NHS Clinical Commissioning Group (CCG), or a third party who have been commissioned to do this on their behalf. They should contact you to arrange an assessment within days of receiving a positive Checklist result.

Everyone deserves an accurate, detailed and fair assessment. If you would like help to prepare thoroughly for your assessment, or to understand what you should expect during the process, please refer to our free toolkit, or get in touch.

Who carries out the Continuing Healthcare assessment?

The assessment should be completed by a multidisciplinary team (MDT); a mix of at least two care professionals from different disciplines.

These should be practitioners who are regularly providing care or treatment for the individual, and are therefore knowledgeable about their specific care needs. Where necessary they may be asked to provide detailed specialist assessments to enable the whole MDT to fully understand the individual’s care needs. Ideally, one member of the team should be a social worker.

The team will be led by a coordinator who represents the CCG and may or may not also be a member of the MDT.

A common failing is that the assessment team (the MDT) comprises a nurse assessor from the CCG and a social worker, neither of whom have directly been involved in the individual’s care, while excluding professionals who understand the individual’s care needs.

More information about the appropriate make up of an MDT is available in our free toolkit.

What happens during a Continuing Healthcare assessment?

The assessment consists of an appraisal of recent care records, together with a face-to-face meeting which should fully involve the individual and/or their representative (usually a family member).

The MDT use this evidence to complete a document called the Decision Support Tool (often referred to as the DST), which organises information about the individual’s care needs.

The Decision Support Tool is divided into 12 areas, known as domains, which are:

·         Behaviour

·         Cognition

·         Psychological and emotional needs

·         Communication

·         Mobility

·         Nutrition – food and drink

·         Continence

·         Skin and tissue viability

·         Breathing

·         Drug therapies and medication

·         Altered states of consciousness

·         Other significant care needs

 

The team will assign a level of need ranging from ‘No Needs’ to ‘High’, ‘Severe’ or ‘Priority’ to each domain.

You can download a blank Decision Support Tool here.

Who makes the decision?

When the Decision Support Tool has been completed and considered by the Multidisciplinary Team, they should have a genuine and meaningful discussion about whether they feel the individual has a primary health need. This is a role for the entire MDT, not just the CCG’s coordinating assessor and the social worker.

The MDT will then make a recommendation to the CCG as to whether the individual is eligible for NHS continuing healthcare. This recommendation is recorded in the Decision Support Tool.

The CCG will then make the final decision, which should – in all but clearly defined exceptional circumstances – uphold the recommendation of the MDT.

A common misconception is that the CCG can choose to reject the MDT recommendation if they disagree with it. However, if the CCG feels there is a mismatch between the evidence and the recommendation it should refer the Decision Support Tool back to the MDT for further work or clarification. It cannot simply overturn the recommendation in favour of its own view. The CCG must not choose to disregard the MDT’s recommendation simply because it disagrees with the recommendation when presented with the same information.

If eligible, NHS Continuing Healthcare funding should be awarded and paid from the point 29 days after the positive Checklist assessment was received by the CCG.

If you disagree with the decision of the CCG, you can appeal.

Funding reviews

The person’s eligibility for NHS Continuing Healthcare will be reviewed after three months and then each year afterwards.

Reviews should be primarily to check that all the person’s care needs are being met appropriately. Full re-assessments of eligibility for Continuing Healthcare should only be requested if there have been significant changes to the person’s care needs.

However, we know that this is often not the case; funding is often removed at review stage when an automatic reassessment has taken place.

More help and information

For comprehensive information about all aspects of NHS Continuing Healthcare please download or request a copy of our Free Navigational Toolkit.

We’ve also written a two-part guide to getting assessed for NHS Continuing Healthcare.

You can call our Free Information and Advice Service with any questions or concerns about the assessment process.

If you’d like more support to give yourself the very best chance of a fair and thorough assessment, talk to us about our Assessment Support Service.