Guidance

NHS continuing healthcare checklist guidance

Updated 27 October 2022

What the checklist is and why it is used

1. The NHS continuing healthcare checklist is a screening tool that can be used in a variety of settings to help practitioners identify individuals who may need a referral for a full assessment of eligibility for NHS continuing healthcare.

2. All staff who complete the checklist should be familiar with the principles of the national framework for continuing healthcare and NHS-funded nursing care and also be familiar with the decision support tool for NHS continuing healthcare.

3. The checklist threshold at this stage of the process has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility for NHS continuing healthcare have this opportunity.

Practitioners should advise those for whom the checklist is completed that a positive checklist does not automatically lead to eligibility for NHS continuing healthcare and only indicates that the individual requires a full assessment for NHS continuing healthcare.

4. One of 2 potential outcomes is possible following completion of the checklist:

• a negative checklist – meaning the individual does not require a full assessment of eligibility and they are not eligible for NHS continuing healthcare
• a positive checklist – meaning an individual now requires a full assessment of eligibility for NHS continuing healthcare. It does not necessarily mean the individual is eligible for NHS continuing healthcare

Note

All these tools are available electronically (as editable Word or ODT documents) and pages or boxes can be expanded as necessary.

It is important to note that these are national tools and the content should not be changed, added to or abbreviated in any way. However, integrated care boards (ICBs) may attach their logo and additional patient identification details if necessary (such as adding NHS number and so on).

When the checklist should be completed

5. Where there may be need for NHS continuing healthcare, the checklist should normally be completed.

6. There will be many situations where it is not necessary to complete the checklist – see paragraph 121 of the national framework for continuing healthcare and NHS-funded nursing care and ‘When not to use the checklist’ below.

7. Screening and assessment of eligibility for NHS continuing healthcare should be at the right time and location for the individual, and when the individual’s ongoing needs are clearer.

This may be in a variety of settings, although the full assessment of eligibility should normally take place when the individual is in a community setting, preferably their own home.

The core underlying principle is that individuals should be supported to access and follow the process that is most suitable for their current and ongoing needs. This will help practitioners to correctly identify individuals who require a full assessment of eligibility for NHS continuing healthcare.

8. To understand how NHS continuing healthcare interacts with hospital discharge, refer to paragraphs 101 to 108 of the national framework.

Who can complete the checklist

9. The checklist can be completed by a variety of health and social care practitioners as long as they have been trained in its use.

The role of the individual in the screening process

10. The individual should be given reasonable notice of the intention to undertake the checklist and have the process explained to them.

They should normally be given the opportunity to participate actively in the completion of the checklist, together with any representative they may have, so that they can contribute their views about their needs.

11. There are a number of principles that underpin the NHS continuing healthcare process: most importantly that assessments and reviews should always focus on the individual’s needs and follow a person-centred approach. The individual should be fully informed and empowered to participate actively in the assessment process and any subsequent reviews, and their views should be considered.

In addition, there are a number of legal requirements when it comes to an individual’s consent for parts of the NHS continuing healthcare process.

12. In the spirit of the person-centred approach, practitioners should make all reasonable efforts to seek the participation of the individual (or their representative) for the assessment and review process for NHS continuing healthcare during each stage of the process.

For a comprehensive assessment, the best evidence available at the relevant time should be considered. This should involve consideration of the individual’s (or their representative’s) view, and they should be empowered and assisted to participate. Throughout the process, this person-centred approach should be embedded in all decisions that relate to the individual’s needs assessment and their care planning.

13. Consent is a legal requirement for any physical intervention on, or examination of, a person with capacity to give consent. To the extent that screening for NHS continuing healthcare involves such an intervention or examination, informed consent must be sought from an individual with capacity to give consent.

Refer to paragraph 85 of the national framework, which gives detailed guidance on what is required for consent to be valid.

14. It is necessary to obtain an individual’s explicit consent before sharing any personal data with a third party such as a family member, friend, advocate and/or other representative.

15. However, it is not necessary to seek consent from an individual in order to share their personal data as part of their NHS continuing healthcare assessment (and subsequent reviews) between health and social care professionals.

16. If there is a concern that the individual may not have capacity to give consent to a physical intervention or examination that is part of the assessment process, or to the sharing of personal data with third parties such as a family member, friend, advocate and/or other representative, this should be determined in accordance with the Mental Capacity Act 2005 and the associated code of practice.

It may be necessary for a ‘best interests’ decision to be made, bearing in mind the expectation that everyone who is potentially eligible for NHS continuing healthcare should have the opportunity to be considered for eligibility. Guidance on the application of the Mental Capacity Act 2005 in such situations is provided in paragraphs 86 to 96 of the national framework.

How to complete the checklist

17. Completion of the checklist is intended to be relatively quick and straightforward. It is not necessary to provide additional detailed evidence along with the completed checklist.

18. Practitioners should 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.

If the needs of the individual are the same or greater than anything in the A column, then ‘A’ should be selected.

Practitioners should briefly summarise the individual’s needs that support the level chosen, recording references to evidence as appropriate.

19. A full assessment for NHS continuing healthcare is required if one of the following criteria is met:

• 2 or more domains are selected in column A
• 5 or more domains are selected in column B, or one is selected in A and 4 in B
• one domain is selected in column A in one of the boxes marked with an asterisk (meaning those domains that carry a priority level in the decision support tool) with any number of selections in the other 2 columns

20. There may very occasionally be circumstances where a full assessment of eligibility for NHS continuing healthcare is appropriate even though the individual does not apparently meet the indicated threshold as set out above. A clear rationale must be given in such circumstances and local protocols followed.

21. The principles in relation to ‘well-managed need’ (outlined in the ‘Assessment of eligibility’ section in paragraphs 162 to 166 of the national framework) apply equally to the completion of the checklist as they do to the decision support tool.

What happens next

22. Whatever the outcome of the checklist – whether or not a referral for a full assessment of eligibility for NHS continuing healthcare is considered necessary – the outcome must be communicated clearly and in writing to the individual or their representative, as soon as is reasonably practicable.

This should include the reasons why the checklist outcome was reached. Normally this will be achieved by providing a copy of the checklist.

What happens following a negative checklist

23. A negative checklist means the individual does not require a full assessment of eligibility and they are not eligible for NHS continuing healthcare.

24. Where it can reasonably be anticipated that the individual’s needs are likely to increase in the next 3 months (for instance, because of an expected deterioration in their condition), this should be recorded and a decision made as to whether the checklist should be reviewed within a specified period of time.

25. If an individual has been screened out following completion of the checklist, they may ask the ICB to reconsider the checklist outcome.

The ICB should give this request due consideration, taking account all of the information available and/or including additional information from the individual or carer, though there is no obligation for the ICB to undertake a further checklist.

What happens following a positive checklist

26. A positive checklist means that the individual requires a full assessment of eligibility for NHS continuing healthcare. It does not necessarily mean that the individual will be found eligible for NHS continuing healthcare (refer to paragraphs 134 to 137 of the national framework).

27. An individual should not be left without appropriate support while they await the outcome of the assessment and decision-making process.

When not to use the checklist

There will be many situations where it is not necessary to complete the checklist.

Practitioners should review the statements below on when it may not be appropriate to screen for NHS continuing healthcare before they start the process of completing the checklist.

The situations where it is not necessary to complete the checklist include:

• it is clear to practitioners working in the health and care system that there is no need for NHS continuing healthcare at this point in time. Where appropriate or relevant, this decision and its reasons should be recorded. If there is doubt between practitioners, the checklist should be undertaken
• the individual has short-term healthcare needs or is recovering from a temporary condition and has not yet reached their optimum potential (although, if there is doubt between practitioners about the short-term nature of the needs, it may be necessary to complete the checklist). See paragraphs 101 to 108 of the national framework for how NHS continuing healthcare may interact with hospital discharge
• it has been agreed by the ICB that the individual should be referred directly for full assessment of eligibility for NHS continuing healthcare
• the individual has a rapidly deteriorating condition and may be entering a terminal phase – in these situations the fast-track pathway tool should be used instead of the checklist
• an individual is receiving services under section 117 of the Mental Health Act 1983 that are meeting all of their assessed needs
• it has previously been decided that the individual is not eligible for NHS continuing healthcare and it is clear that there has been no change in needs

If, upon review of these statements, it is deemed that it is not necessary to screen for NHS continuing healthcare at this time, the decision not to complete the checklist and its reasons should be clearly recorded in the patient’s notes.

Appropriate clinicians should complete the accompanying NHS continuing healthcare checklist referral form – original and accessible versions of which are available in PDF, Word and ODT format – alongside this guidance.