Understanding The Checklist Assessment
This article is based on an older blog which has been updated to help you. We’ve had a lot of new enquirers recently asking how to get the CHC process started…
If your relative has a ’primary health need’ i.e. the main purpose of their care is for health needs (as opposed to social care needs), then they may be eligible for NHS Continuing Healthcare Funding.
NHS Continuing Healthcare Funding (‘CHC’) is a package of fully-funded care, paid for by the NHS, and which is ’free at the point of need’. CHC is paid, regardless of the setting where the care takes place and irrespective of the recipient’s wealth (as it is not means–tested).
Without CHC Funding, your relative may end up self-funding their care and paying for it out of private savings or even be forced to sell their home.
In order to be considered for CHC your relative will need to engage with the CHC assessment process to determine their eligibility for NHS Funding.
Here are some quick Questions and Answers to help you:
What is the purpose of the Assessment?
The assessment process has 2 key objectives, namely to establish:
1) what your relative’s care needs are (crucially, so that the right care is in place); and
2) whether that care is the legal responsibility of the NHS or the Local Authority to fund.
It should never be an assessment of your relative’s money, nor is it an assessment of the Integrated Care Board’s (‘ICB’) budgets, or their willingness to pay.
When does the assessment process start?
The assessment process should ideally begin as soon as your relative needs full time care, or in any circumstance that would suggest they may be potentially eligibility for NHS Continuing Healthcare. If it is delayed, they risk being means-tested and told to pay for their care before anyone has explored whether the NHS may have a duty to pay.
What is the Checklist?
The process to determine eligibility for CHC starts with an initial Checklist – a preliminary screening tool used by the NHS to help practitioners assess a basic level of need and determine whether an individual is eligible to move forward to a full assessment for NHS Continuing Healthcare Funding.
Families often get confused and wrongly believe that the Checklist is the actual final decision. It isn’t! It’s simply a process designed to screen out individuals who aren’t eligible for CHC funding and to enable those who may be, to move on to a full assessment.
Where do I begin?
Firstly, you need to establish whether an assessment (for NHS Continuing Healthcare) has already been carried out.
If it has, ask for a copy of the completed Checklist as you need to find out exactly what type of assessment took place. It may have in fact been a financial assessment to assess affordability to pay for care home fees, and not a Checklist assessment to determine eligibility for NHS Continuing Healthcare (remember, which is free).
WARNING! If your relative is already in a care facility and no assessment for CHC has been done, they could be paying thousands of pounds a month for their care unnecessarily!
Where does the Assessment take place?
The Checklist assessment used to take place in hospital, but that changed under new guidance in the revised edition of the National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (October 2018) and still remains the position in the updated National Framework (July 2022).
Preferably, the Checklist assessment should now take place once the individual is back in their own environment or appropriate community care setting where they are going to be living i.e. back in their own home or care home facility. That way, a more accurate picture of their long-term healthcare needs and requirements can be obtained away from an acute hospital setting.
How do I start the assessment process?
If your relative is about to be discharged from hospital, ask your local ICB’s NHS Continuing Healthcare Department/Team to start set up a Checklist assessment for them.
If they are going into a care home for the first time, ask the Care Home Manager to arrange the Checklist assessment.
If they are living in their own home, ask their GP, therapist, social worker, community or District Nurse to set up the Checklist assessment with the NHS.
If your relative is already paying care fees and you believe they may be eligible for NHS Continuing Healthcare, as above, ask a health or social care professional or care home manager to arrange an assessment.
How does the NHS arrange the Checklist assessment?
The ICB has a duty to carry out an assessment even if your relative is currently paying for their care out of private funds (self–funding).
As your relative’s representative, whether acting under a Lasting Power of Attorney or in their ‘best interests’, the ICB should contact you directly to advise you of the proposed appointment date for the Checklist assessment.
If your relative is living in a care home, then they may notify you of the appointment.
Can the NHS refuse to do the Checklist assessment?
Yes. There are circumstances set out in the National Framework where the NHS can refuse to carry out a Checklist assessment. These include the following:
- Where it is plainly obvious that there are simply no health needs;
- If the NHS considers the individual’s needs are so obvious 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.
Tip: If you feel that the NHS have wrongly declined to undertake a Checklist assessment, then you must complain immediately to the NHS Continuing Healthcare Department/Team.
Who attends the Checklist assessment from the NHS?
The ICB will appoint an assessor to carry out the initial Checklist assessment.
The assessor will be a health or social care practitioner for example: a registered Nurse employed by the NHS, GP, other clinician or local authority staff such as a social worker, care manager or social care assistant.
They should be trained in the National Framework and using the Checklist Tool, and also been involved in assessing or reviewing individuals’ needs as part of their day-to-day work. They must understand how to apply the CHC eligibility criteria against the scoring system when carrying out the Checklist assessment.
Some ICBs will delegate completion of the Checklist to the care home or other organisation under an agreed protocol.
How much notice will I get of the Checklist taking place?
You have every right to be present at the Checklist assessment, so you should be given reasonable notice as you need time to prepare for the appointment.
However, sometimes, if an urgent decision is needed, the Checklist assessment can be arranged at short notice, which, understandably, may be inconvenient for you.
If so, ask for it to be postponed to a more convenient date, as ideally, you should be there and be involved in the process.
Quite often, we hear from families that the Checklist assessment took place (behind their backs) without them or their relative being notified; or else, even if notified, were then excluded from being involved in the process. That is contrary to the National Framework which puts the person at the centre of the process.
If the Checklist assessment took place without your knowledge or involvement and your relative was not successful, then ask for it to be redone.
Do I have to be present At the Checklist Assessment?
In short, yes! It’s vital that you attend.
Don’t let your relative be wrongly filtered out of the assessment process before it has even begun!
Whilst it is not a mandatory requirement, we strongly recommend that family representatives get involved and contribute to the assessment process.
You are best placed to know your relative’s healthcare and daily needs better than anyone. Use that advantage to explain their needs to the ICB assessors (who may be meeting your relative for the first time) and to ensure that the assessment process is conducted in a fair, open and transparent manner.
You must try and make every effort to be at this initial assessment to support your relative’s case for CHC funding and at least get on to the next rung of the ladder – which is a full assessment.
How do I prepare for the Checklist Assessment?
Good preparation and planning are essential at this stage of the assessment process.
We recommend that you go through the Checklist yourself and score your relative’s needs against the prescribed criteria/descriptions for each Care Domain. That way, you will know in your own mind whether the assessor’s scores are fair and can argue the case if you disagree with them and correct any misinformation they have.
A lack of preparation can prove costly and end up with your relative paying for their care!
Can I have someone to attend with me?
The National Framework provides that you are entitled to have any person you choose to be with you at the Checklist assessment, and they can also act as an advocate, take notes for you, be another pair of ‘eyes and ears’, or simply just be with you to give you encouragement and support.
You don’t have to fight this battle alone. For further reading buy our book “How To Get The NHS To Pay For Care”. If you need specialist advocacy support visit our one-to-one page.
What happens at the Checklist assessment?
The ICB’s appointed assessor will review your relative’s healthcare needs and score them against the Checklist.
The assessor will look at 11 main Care Domains, namely:
- Breathing*
- Nutrition – food and drink
- Continence
- Skin integrity (including tissue viability)
- Mobility
- Communication
- Psychological/emotional needs
- Cognition
- Behaviour*
- Drugs/medication/symptom control*
- Altered states of consciousness *
Each Care Domain is divided into 3 levels and scored A, B or C – with ‘A’ being the highest level of needs and ‘C’ being the lowest.
In order to pass on to the next stage i.e. to a full assessment, your relative will need to achieve a minimum aggregate score of:
- 2 or more As
- 5 or more Bs (or 1A and 4Bs), or
- at least one A in a domain with an asterisk*
How long do I have to wait for the Checklist outcome?
The Checklist will usually be completed within 14 days from the date of request.
The National Framework states that whatever the outcome of the Checklist, it should be communicated clearly and in writing to the individual or their representative as soon as “reasonably practical”.
So, if you do not receive any communication from the ICB within 14 days of the assessment, then we recommend you contact them to chase their outcome decision.
What are the possible outcomes of the Checklist assessment?
There are 2 possible outcomes:
- A negative Checklist; or
- A positive Checklist
Let’s explore both scenarios below.
What happens if the Checklist is positive?
As above, you should be notified of the successful outcome in writing and be given a copy of the Checklist and reasons for the outcome decision (usually contained within the Checklist).
Your relative will now be passed on to a full assessment which is carried out by a Multi-Disciplinary Team (MDT).
Important! A positive Checklist does not necessarily mean that your relative will be found eligible for CHC funding at the MDT stage. Indeed, many applications are turned down (whether correctly or incorrectly) by the MDT assessors.
Keep the Checklist outcome handy as it may become a useful comparator in due course if your relative is reassessed and CHC funding is subsequently withdrawn.
What happens if the Checklist is negative?
As above, you should be given a copy of the Checklist with written reasons for that negative outcome decision, together with information about how to ask the ICB to reconsider their decision (ie complain!).
Beware! You have 12 months to challenge the outcome and to lodge your complaint.
When reviewing the matter, the ICB should take into account all the information available at the assessment and any additional information that is supplied. However, according to the National Framework, the ICB are not obliged to undertake a further Checklist.
You must adhere to the timescales to challenge the outcome, otherwise you may be stuck with it (even if it’s blatantly wrong).
According to the National Framework, the threshold for passing on to a full assessment “has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity.”
Therefore, a negative outcome suggests that your relative’s healthcare needs are not considered sufficiently high enough to pass forward to a full assessment at an MDT meeting.
If you don’t agree with the outcome, or there has been an abuse of process (e.g. you weren’t included), you can request another Checklist assessment. Contact the local NHS Continuing Healthcare Department/Team in writing, stating your reasons and insist that you would like the Checklist to be repeated.
Keep the Checklist safe. Even if your relative doesn’t qualify, it may still prove a useful exercise and give you peace of mind that their healthcare needs have been properly assessed and are not at a sufficiently high level to trigger a full assessment.
It may also become a useful benchmark for comparison purposes should their needs change (increase) and a further reassessment is required in due course.
When can I request another Checklist Assessment?
If you believe that the Checklist has been completed incorrectly, or the process was not carried out robustly, complain and insist that the Assessment is repeated.
If your relative’s healthcare needs change or fluctuate as time goes by, you can always request that another Checklist assessment is carried out, as and when appropriate.
Alternatively, if the change in needs clearly warrants it, a decision could be made to bypass the Checklist and go straight to full assessment for CHC.
Summary
Remember, the Checklist assessment is just a preliminary screening tool to see if a full assessment is required. It is not the actual assessment for eligibility for CHC itself.
Share your experiences of a Checklist assessment below and help others avoid any pitfalls you have encountered…
We’ve done a checklist assessment which mum passed at least until someone went back 3 months after the very detailed meeting we attended and changed the scores. They are saying she gets FNC. It’s taken 8 months to get this far. If I challenge the CHC assessment and fail, will the FNC be backdated? The CCG take so long to do anything I’m worried there will be months and months where mum would have got FNC had I not tried for CHC. Does anyone know the answer to this?
Can anyone enlighten me about the difference in funding Continuing Health Care in Scotland. My understanding is the recipient has to go directly from hospital to nursing home and for that reason, Social work insists on trying the patient at home first thus marking any claim for CHC null and void
I have just discovered that the care home completed a checklist (after I happened to ask a passing nurse assessor about FNC. There were 5 B scores (which meant a full assessment should be carried out) however the cognition domain was doctored & reduced conveniently to a C. Ironically my Mum had dementia. The comments written by the care home manager said Mum could communicate her needs. This was not the case. This checklist was a cover up and definitely not in line with the National Framework. Furthermore the handwritten comments in Behaviour and Psychological & Emotional did not fit with the suggested criteria. Mum did not have capacity, I held LPA’s but the care home did not ask me to attend. They also got my Mum to consent & sign the declaration even though the previous page said she was unable to consent. Has anyone else experienced this and what did you do? Thanks.
Hi Wondering if someone can help please.
My Mum was sectioned and therefore is eligible for 117 aftercare. She had a checklist for CHC done (covertly without my knowledge etc) and it said she failed this checklist (quite clearly from your detailed blog she should have passed with flying colours). My question is when someone gets 117 aftercare who decides the level/cost at which they get this and do they rely on the checklist?? I have tried asking SW/CCG ec but they refuse to answer this question and just give me a load of waffle. Thanks
Hi Steph,
I’m sorry to hear that your mum & you are at the beginning of this process.
It is a very stressful time and a time that families should be supported through. Sadly they aren’t.
My advice remains the same as I have previously documented on CTBD.
It can be daunting to begin with, but the more you research and read about CHC the better chance you will have of securing funding.
There is so much information on here from others that have experienced this process and are willing to offer advice. You’ve started in the right place!
You can get specialist advice too, but that will come at a cost, that isn’t recoverable if you are successful.
As your mother’s advocate (I trust you have Power of Attorney for Health and Finance – You will be asked to produce them) you cannot be denied access to any meeting or documents appertaining to your mum.
Remember the checklist is just a screening tool that kick starts this process, so if all the evidence from the health professionals and those caring for her aren’t considered in full, then it’s likely that she will be screened out. This is where I would say it’s up to you you to make sure that the person completing the checklist has all that information. Ask them, “Have you got the Care notes/plans? Have you got her report from her Hospital Consultant ….. Have you the report from the Occupational Therapist….as an example.” Unfortunately, in many cases the checklist fails because those completing it don’t always know the person they are assessing (which they should do!) and so often reports and care notes are missing.
Remember also if you mum is rapidly deteriorating then you can ask for the Fast Track to be completed.
Again, there is lots of information on here about the Fast Track.
Good Luck!
I have waited now 14 months for a checklist to be completed. It is to be done next week, finally. It should have been done when my father in law’s D2A expired but the ICB have never said when this occurred. They should have instituted one of their own volition when it was clear from the psychiatrist’s final report that he had stabilised which was in early January. I had to ask at the beginning of february for a checklist to be done but my recorded delivery letter was not replied to until a follow up in early April. And then contact was made with me two months later. Now we are in September and the ICB have only just got round to fixing a date. I have an LPA for finance but as yet they have not asked me for a penny for care home fees despite him being in care since August 2022 with 2 hospital stays in the interim. They will have to provide chapter and verse as to why they think that I should pay when they have singularly failed to do the checklist and thus failed to determine whether the NHS or social services have responsibility for paying for care. There is no suggestion that a checklist is not required in this matter and indeed I have been told that there will be a DST completed no matter what the checklist outcome. Highly unusual or what? Maybe because I have been an absolute thorn in their side for the past few months and they are aware that I am a lawyer.
The checklist is a fraud. Many thousands of pounds are at stake and yet the checklist assessment is a peremptory look at needs carried out by one person. Not only that but the Framework says that the bar to success is set deliberately low and yet the questions themselves set the bar very high. There are clearly instances in the checklist which require well managed needs to be taken into account, whereas paras 66 and 162 of the Framework states they cannot unless the needs have been permanently reduced or removed. It also appears to ignore the legal position in Coughlan and other cases by virtue of the bar to success required.
I’m currently in discussion with an ICB about a Checklist for my aunt after she came out of hospital. She was denied CHC in early 2024, but her health has deteriorated a lot since then. The ICB agreed to do a Checklist on her and appointed someone to do it, I attended the Checklist and the scores were 4 As, 3 Bs and 4 Cs, i.e. a ‘positive’ Checklist. The ICB then wrote to me as follows: “Having received a positive CHC Checklist, following a review of the available evidence and consulting with the referrer, we advise that the checklist was completed at an inappropriate time. The previous DST and Checklist have been viewed by NHS Dorset PHC Triage Team, and we are not able to establish a significant change in need that would warrant a new CHC assessment, we will therefore not be progressing with the referral at this time.” At a meeting with their CHC team, they told me that they are relying on paragraph 283 in the National Framework that says “Where a Checklist and/or DST has previously been completed (with the result that the individual was not found eligible for NHS Continuing Healthcare), and it is clear that there has been no material change in need then it will not be necessary to repeat the Checklist and/or DST and this should be recorded.” This paragraph is in the context of a review for NHS-funded Nursing Care! I told them that the correct paragraph to refer to about a change in needs is paragraph 121, which says “There will be many situations where it is not necessary to complete a Checklist. These include where: . . . 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.” In other words, they are relying on paragraph 283 to say ‘material’ change in needs, whereas paragraph 121 simply states ‘no’ change in needs. In fact, the ICB is using the word ‘significant’ change in needs which to me is even higher than ‘material’. It appears to me that they simply don’t like the result of the Checklist and want to avoid a full assessment at all costs as she might be eligible for CHC! They also hadn’t reviewed all the evidence that the person appointed to do the Checklist referred to and hadn’t bothered to ask for my input either as her next of kin. I await a further letter from the CHC team to see if they will finally agree to a full DST assessment. All very bizarre!
My mum had a positive checklist but the NHS have refused to proceed to the next stage MDT.
I complained but the complaints team upheld the decision.
I have been forced to make a complaint to the parliamentary ombudsman.
My mum is now bed ridden hardly eating and drinking. She is too frail to be weighed and so I requested another checklist be carried out (care home was copied into email) They have ask the care home to call them and unfortunately they haven’t called as yet but they should, in my opinion, carry out the checklist on the information I have provided. If my mum was not in a care home she would be in hospital.