How is CHC assessed?
How is eligibility assessed and who makes the assessment?
For most people, the assessment process for CHC involves an initial screening and then a full assessment. After the full assessment, a recommendation will be made to the Clinical Commissioning Group (CCG) about whether the patient is eligible.
The initial screening is usually carried out by a health or social care professional who knows the individual.and uses the checklist to decide whether people need a full assessment. The person who completes the Checklist will send it to the CHC team.
The full assessment is usually carried out by a group of health and social care professionals who have been involved in the patient’s care. They are known as a multidisciplinary team.
The multidisciplinary team will then make a recommendation to the clinical commissioning group (CCG) about whether the person is eligible and the CCG will make the final decision. However, CCGs will also work with local authorities to make sure that they are able to contribute to the assessment process should the individual wish.
In most cases, the CCG carries out the assessment, but if demand is particularly high and cases are waiting to be assessedit can pay for another suitably qualified organisation to carry this out so assessments can be completed in a timely manner.
Where does the assessment take place?
Assessment of eligibility can take place at home, in a hospital or in an existing care or nursing home..
Will my financial situation impact the assessment?
Financial issues are not considered as part of the decision about an individual’s eligibility for CHC. CCGs can, however, take account of comparative costs and value for money when arranging care and should ensure the services provided reflect the individuals’ preference as far as possible.
Health and social care professionals must use their professional judgement at both the screening and full assessment stages when undertaking an assessment. They will consider the person’s combined healthcare needs across 11 domains (areas of need) to complete an initial checklist and across 12 domains to undertake the full assessment.
People will be assessed three months after their successful assessment and then annually. This is to ensure that the care provided is still relevant and providing the right support, as well as ensuing that continuing healthcare is still needed.
If you are not eligible for NHS CHC, you may appeal. To find out more about the appeals process, please click here.
NHS CHC - video step 2
Who is eligible for NHS continuing healthcare?
Take a look at the film below which explains more about the assessment for receiving CHC.
Eligibility for NHS continuing healthcare funding is determined by a detailed assessment which looks at all aspects of a person’s health and social care needs. As part of this, four key areas are considered:
- The type of condition or treatment required
- The complexity of the condition (symptoms that interact and are therefore difficult to manage or control)
- The intensity of the condition (one or more health needs so severe they require regular care and support)
- The unpredictably of the condition (unexpected changes in condition that are difficult to manage and present a risk to the individual or to others).