Having Problems Getting a Checklist for CHC completed?
The public are still not being told about NHS Continuing Healthcare funding (CHC) – free funded care provided by the NHS for adults with significant healthcare needs arising out of a disability, accident or illness.
Unless you are eligible for Fast Track funding (i.e. where there is a rapidly deteriorating condition which may be entering a terminal phase), nearly all assessments for CHC funding start with the Checklist assessment.
The Checklist is a simple screening tool looking specifically at 11 care domains, namely:
- Breathing*
- Nutrition -food and drink
- Continence
- Skin and tissue viability
- Mobility
- Communication
- Psychological & Emotional needs
- Cognition
- Behaviour*
- Drug therapies and medication*
- Altered states of consciousness*
The care domains are broken down into three levels: A, B or C (where A represents a high level of care need, and C is a low level of care need).
The outcome of the Checklist depends on the number of As, Bs, and Cs identified. To achieve a positive outcome you need to score:
- 2 or more As; or
- 5 or more Bs, or 1A and 4Bs; or
- At least 1A in any domain marked with an asterisk (*)
Here’s a link to the Checklist and NHS guidance: https://www.gov.uk/government/publications/nhs-continuing-healthcare-checklist
However, the Checklist is NOT the CHC assessment, it is just a screening tool – nothing more. If you meet the criteria and get a positive outcome, then you screen into the CHC process and move forward to a full assessment for CHC funding. The full assessment is carried out by a Multidisciplinary Team (MDT). The MDT presents your first real opportunity to try and secure CHC funding to pay for all your assessed healthcare needs, including the expensive cost of accommodation in a care home or other care facility.
The threshold for passing the Checklist is set deliberately low so that most people pass this preliminary stage and have the opportunity to move forward to a full MDT assessment.
According to paragraph 115 of the National Framework for NHS Continuing Healthcare funding (July 2024), “Completion of the Checklist is intended to be relatively quick and straightforward.” However, we’ve being hearing concerning accounts from families who are having problems even getting to first base and having a Checklist for CHC completed.
Part of the problem is that, if they happen to chance upon the possibility of CHC funding, they are not being given the right advice about the CHC process or end up struggling to speak to anyone who is prepared to actually trigger the Checklist process. Often, they are fobbed off and just told that their family member ‘won’t qualify’ – when, in our mind, there are strong grounds to suggest the contrary i.e .that their relative is indeed likely to be eligible for CHC.
Of course, the longer the delay, the more fees you or your relative might be paying from private funds for care fees – draining resources!
Para 122 of the National Framework says: “The Checklist can be completed by a variety of health and social care practitioners, who have been trained in its use. This could include, for example: registered nurses employed by the NHS, GPs, other clinicians or local authority staff such as social workers, care managers or social care assistants”.
So, in theory, there are several avenues you can approach to get the ball rolling and start the Checklist assessment.
In most locations across England, starting the Checklist is the responsibility of Social Services. It should be as simple as calling your local Social Services team, asking to be put through to an appropriate social worker, and then requesting a meeting to fill in the Checklist. Sounds simple? Seemingly not.
In fact, our recent enquirers are telling us that it is far from proving simple – with Social Services saying they are not responsible and pointing them in the direction of the District Nurse (DN), GP, or the CHC team at the Integrated Care Board (ICB). These people then send you on a loop back to Social Services, or elsewhere. Applicants seeking a Checklist are becoming exasperated and hugely frustrated as they are led a merry dance, being passed back and forth, from pillar to post, in the hope of speaking to someone who can arrange the Checklist.
Part of the problem is that there are no hard and fast rules about how to access the Checklist. The National Framework for NHS Continuing Healthcare Funding indicates that a Checklist can be completed by anyone with the correct training on how to fill it in. Different regions across England have different local arrangements. So, it is not always clear who to contact, and more problematically, there does not appear to be anyone willing to signpost you in the right direction.
It is correct that the GP or DN can fill in the Checklist, but they must be trained on how to do it, and mostly they haven’t been trained, and so will not wish to get involved.
If you are lucky enough to have a GP that can assist, you can still experience problems trying to get the Checklist uploaded to the ICB’s portal, causing further frustration and delay.
If there is already a social worker involved in the your relative’s care, it is likely that you will already have a contact name and number and this should, theoretically, make things a lot easier. But again, we have heard from families that have come up against a total brick wall, with the social worker denying responsibility and passing the buck elsewhere.
We took the time to look at a some ICB websites and note in the main there is little or no information about Checklists, no point of contact, no telephone numbers, and no guidance on how to start the Checklist process. So much for transparency and upholding the core principles of the National Framework i.e. putting the individual at the centre of the CHC process (see paragraphs 68 & 69).
For more information and guidance about checklists see https://www.gov.uk/government/publications/nhs-continuing-healthcare-checklist/nhs-continuing-healthcare-checklist-guidance
For more reading around on Checklists, see some of our other blogs:
Understanding The Checklist Assessment
Getting started with CHC? How does the CHECKLIST work?
Getting through the Checklist assessment – avoid these common mistakes!
We would like to hear from you if you have had problems getting a Checklist completed.
Let us know which ICB and Social Services team you have experienced problems with, and an outline of the problems you have encountered in no more than a few paragraphs. We will collect the information you send, and when we have a sufficient number of cases to show there is a widescale problem, we will contact the relevant teams. Your personal information will remain confidential.
Our intention is to try to improve services within Social Services and ICBs, so that you, and other families, don’t continue to experience problems having the basic Checklist completed. The longer the delay, the more fees you might be paying from private funds!
My mother is 101 years old and has been in care as a self-funder for 3.5 years. I applied for NHS Continuing Care 1.5 years ago but was unsuccessful. Her condition has deteriorated substantially since then. I would like to make another application but cannot even get the checklist completed. The nursing home manager emailed social care direct (Barnet) 2 months ago and I have chased them by ‘phone several times since then but have had no joy.
Any suggestions would be welcome. Thank you.
After GP passing request to district nurse & this being ignored & after much chasing I contacted CHC dept directly who were very helpful & got the District nurse to do the check list – then I just kept chasing but it was a stupidly long process, I’m sure easier if professionals act for you and also if you have Nursing care plans for every condition from NHS community or hospital teams – or find a private CHC nurse to provide them. Currently following retrospective claim & next step is to seek professional support depending on what they come back with. I do know it is almost impossible to get!
I have been directed by the hospital Discharge Team to my GP or ICB for a Checklist for Mum. I had already tried with the ICB in any case. The response was frosty, as if to suggest that by having to ask them directly, Mum was clearly off the radar for a Checklist. I’ve also emailed her previously friendly SWorker. No reply. I really suspect it’s an even tougher line they are taking now. They are aware of lawyers who might help, so even the Checklist becomes the Holy Grail. We’re in Lincs
Sorry – forgot to stress that …. THIS IS NOT SOCIAL SERVICES – It is NHS NURSING CARE and comes under the Council PUBLIC HEALTH nursing responsibilies if the ICB has made the council responsible for delivering (funding and arranging) community nursing care rather than the former Primary Care NHS Community health trust district nurses. If I understand correctly hopefully Care to be Different can confirm this
This is probably a very familiar story. My father in law was transferred by the social services or ICB – I don’t know which – direct from hospital to a care home in October 2022. At that time his mental problems were such that he was unable to do anything for himself and required, according to the social services care plan completed on 24th October 2022, full care for all his needs. He did not even know where he was at that time. The Report said that he was not eligible at that time for CHC but may be in the future, presumably because they thought he might recover somewhat. This of course is not allowed and Prof Luke Clements states that there is no permission anywhere for the ICB to delay a Checklist taking place where a person MAY be eligible for CHC and my relative clearly was at the time of the Report. There is also, Clements says, no warrant to wait for the patient to optimise and I cannot see the word optimisation anywhere in the Framework or other guidance, even though this is often quoted and was indeed quoted by the ICB to me at a much later stage. As his Attorney, I waited for the ICB to arrange a Checklist of their own volition as they are bound to do in appropriate circumstances but nothing happened. I therefore wrote on 1st Feb 2023, recorded delivery, to the Director of the ICB locally but had no response and so I wrote again in April 2023. when I received a holding letter. It was not until June, however, when I managed to speak with the Chief Nurse and her deputy and also with the Director of Adult Care for social services to ask why the delay and for a CHC assessment to be done. This was finally arranged by them for the end of October 2023 – one year on from when one should have been done.
Needless to say, when this was done, the response was that he was much better and had been for the 3 months prior to the assessment which was the limit of time they had set themselves for considering evidence. However, he was nowhere near better in comparison to how he had been before his latest hospitalisation. So no CHC.
The point I make here is that if the Checklist and DST had been done within 3 months of the Social care report in October 2022, all the evidence from hospitalisation and horrific behaviour at one care home would have been within their time limits and he would undoubtedly have been awarded CHC. He had, and has, incurable paranoid schizophrenia and has good and bad times and so the ICB waited for the good ones.
We have a situation here in which my father in law’s needs had fluctuated for 10 years and alternated between being able to live at home on his own to putting himself and others in great danger, attacking staff and patients at one care home and almost starving himself to death to name a few and then remaining on the surface relatively normal, albeit needing full time care in a home.. None of the bad times I have mentioned was evaluated in the assessment because all of it, due to the ICB machinations, was outside their timeframe. His psychiatrist told me that you do not usually get CHC for mental health issues. This issue was raised in parliament in 2006 by mental health charities, my professional body the Law Society and the select committee themselves. It seems nothing has changed.