Can the NHS refuse to carry out an initial Checklist?

If your relative is or is about to go into a care home setting, they are entitled to request that the NHS undertake an initial Checklist assessment to see whether they are eligible for NHS Continuing Healthcare Funding or NHS-Funded Nursing Care.

The initial Checklist assessment can take place in whatever setting your relative is currently living – whether in a care or nursing home or even in their own home.

The Checklist assessment is a useful preliminary ‘screening’ tool to see whether an individual would in fact trigger for a full NHS Continuing Healthcare (CHC) assessment at a Multi-Disciplinary Team meeting.

Anyone can ask for a Checklist assessment to be carried out.

However, if you are told in advance of the Checklist assessment that ‘there’s no point because your relative won’t qualify for funding’ – then you must object. Comments like this are misleading, and suggest that the outcome has already been predetermined before the assessment process has even begun! The whole essence of the Checklist assessment is to see if there is a possibility that your relative may qualify for CHC Funding.

It is a good idea to familiarise yourself with the Checklist, which can be accessed by clicking here.

The initial Checklist has 11 Care Domains, which are set out below.

1. Breathing*
2. Nutrition – food and drink
3. Continence
4. Skin integrity (including tissue viability)
5. Mobility
6. Communication
7. Psychological/emotional needs
8. Cognition
9. Behaviour*
10. Drugs/medication/symptom control*
11. Altered states of consciousness *

The Care Domains are broken down into 3 levels, A, B or C – where A represents the highest level of care needed, and C is the lowest.

The outcome of the Checklist depends on the aggregate number of A’s, B’s, and C’s scored.  In order for the CCG to consider doing a comprehensive (full) assessment, you have to have a minimum ‘score’ in the Checklist:

• 2 or more ‘A’s
• 5 or more ‘B’s (or 1 A and 4 Bs)
• or at least 1 A in a domain with an asterisk*

The Checklist threshold to proceed to a full assessment has been set at a deliberately low level in order to enable all those who require a full assessment for eligibility to have that opportunity.

Therefore, whilst your relative might proceed to a full assessment, that does not automatically mean that they will actually qualify for fully funded CHC at the next stage. There are still many hurdles to overcome, and getting past the initial Checklist stage is only the first rung on the ladder.

Following the initial Checklist Assessment, your relative will either score positively – thereby progressing to a full assessment for NHS Continuing Healthcare at a Multi-Disciplinary Team assessment; or negatively – meaning that your relative’s healthcare needs are not (yet) at a sufficiently high level of need to justify a full assessment.

If your relative gets a negative decision, they are entitled to receive written reasons for that rejection, and should also be given a copy of the NHS Complaints Procedure.

Although the threshold to trigger a full assessment is set low, scoring is subjective, and each CCG may deal with matters differently, depending on their assessors’ training and how they  interpret the individual’s health needs against the various Care Domains.  That means there can be inconsistency across the country, and room for error. Some refer to it as the ‘postcode lottery’ and your chances of success can vary depending on where you live.

It is a good idea to take someone with you to the initial Checklist assessment and to keep a note of what was said and discussed. This may be useful evidence if you feel that the assessment was not carried out properly.

If you feel that your relative has been wrongly screened out of the assessment process, or the assessment process was flawed in any way, then you must complain and act swiftly  – otherwise it could count against your relative later down the line. You only have 12 months to raise a complaint. So, if you suspect abuse of process, you should request that the Checklist be repeated. Write to the Continuing Care Team at the CCG, and state your reasons. You can also state what scores you believe should have been awarded – but make sure those scores are high enough and that they match the combinations needed for a full assessment.

If your relative does not succeed at the initial Checklist stage, assuming that the assessment has been carried out fairly and robustly, then it is a good indication that your relative does not meet the necessary level of healthcare needs to obtain eligibility for fully funded CHC.

Don’t despair! A negative outcome, whilst disappointing, can still provide a very useful baseline to refer back to at any subsequent assessments should your relative’s healthcare needs deteriorate in the future. You can use it to compare any changes in needs against the previous Care Domains, as a basis for justifying that an updated Checklist be carried out.

Are there circumstances when the NHS can refuse to carry out an initial Checklist?

 Yes, there are.

Paragraph 91 of the NHS National Framework 2018 gives several examples where it is not necessary to complete an initial Checklist, including:

• Where it is obvious that there are simply no health needs. It would clearly be a waste of valuable NHS time and resources to do an assessment in these circumstances;
• If the CCG agree that the individual’s needs are such that they should bypass the initial Checklist and move straight to a full assessment;
• If the individual has a rapidly deteriorating condition and may be entering a terminal phase, in which case the Fast Track Pathway Tool should be used instead. Read, “How To Fast Track The Continuing Healthcare Funding Process.”
• The individual is already receiving services under Section 117 of the Mental Health Act to meet their assessed needs.

Conclusion

If your relative has a genuine healthcare need, they should ordinarily get past the initial Checklist assessment stage and then proceed to a full assessment for CHC Funded care.

If you are dissatisfied with the outcome of the Checklist assessment, or feel that it was not done fairly or robustly, then you must consider challenging that outcome immediately.

Care To Be Different has lots more useful free information and resources on our website to browse at your leisure. If you want professional help visit our one-to-one help page.

Share your experiences of Checklist assessments –  good or bad, we would like to hear from you…

For further related information or appealing the Checklist assessment read:

What to do when an NHS Continuing Healthcare Checklist is rejected

Frustrated with CCG delays? Here’s how to complain

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