Primary care trusts (who manage local health services) must carry out an assessment for NHS continuing healthcare if it seems that someone may need it. For example, the assessment should be carried out:
- if someone’s physical or mental health worsens significantly
- before someone is awarded NHS-funded nursing care
- when someone is discharged from hospital. This should happen before the person is assessed for help from their local authority.
You can also ask for an assessment for the person you look after by talking to a health or social care professional working with them or the NHS continuing healthcare coordinator at the primary care trust. You can find out the name of your local co-ordinator by asking your GP, contacting your local Patient Advice and Liaison Service (PALS), or contacting your Clinical Commissioning Group directly.
For most people, there’s an initial checklist assessment, which is used to decide if they need a full assessment. However, if someone needs care urgently, for example if they are terminally ill, they should be assessed under the "fast track pathway" (see below).
Initial assessment
The initial assessment consists of a checklist, which can be completed by a nurse, doctor, other healthcare professional or social worker. The person you look after should be told what’s happening, and be asked for their consent.
Depending on the outcome of the checklist, the person you care for will either be told that they’re not eligible for NHS continuing healthcare, or be referred for a full assessment. It’s important to remember that being referred for a full assessment doesn’t necessarily mean that someone will be found eligible for NHS continuing care.
Whatever is decided, the professional completing the checklist should record written reasons for their decision, and sign and date the checklist. The person you care for should be given a copy of the completed checklist. You can download a blank copy of the NHS continuing care checklist from GOV.UK.
See disputes, below, for details of what to do if you don’t agree with a decision about eligibility for NHS continuing healthcare.
Full assessment
When someone has a full assessment for NHS continuing healthcare, a multi-disciplinary team will assess their care needs. This team is made up of health and social care professionals who are already involved in their care. You should be told who is co-ordinating the assessment.
The multi-disciplinary team will use a "decision support tool" to decide whether the person you look after is eligible for NHS continuing care. The assessment looks at the following areas:
- behaviour
- cognition (understanding)
- communication
- psychological/emotional needs
- mobility
- nutrition (food and drink)
- continence
- skin (including wounds and ulcers)
- breathing
- symptom control through drug therapies and medication
- altered states of consciousness
Those carrying out the assessment should look at what help is needed, how complex these needs are, how intense and unpredictable these needs can be, as well as any risks that would exist if adequate care was not provided. For each of these issues a decision is then made about the level of need. The levels are marked "priority", "severe", "high", "moderate" or "low".
If the person you look after has at least one priority need, or severe needs in at least two areas, they should be able to get NHS continuing healthcare. Someone can also qualify if they have a severe need in one area plus a number of other needs, or a number of high or moderate needs. In these cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.
The assessment should take your views and the views of the person you look after into account. As with the checklist, you should be given a copy of the completed decision support tool document. You should also be given clear reasons for the decision.
You can download a blank copy of the continuing care decision support tool document from GOV.UK.
Fast-track assessment
If someone’s condition is deteriorating quickly and they are nearing the end of their life, they should be assessed under the NHS continuing care fast track pathway so that an appropriate care package can be put in place as soon as possible.
Government guidance says that care should be put in place within 48 hours of someone being found eligible under the fast track pathway.
