The process surrounding continuing healthcare funding is set out by the government in a document called The National Framework for NHS continuing healthcare assessments and NHS-funded nursing care. It is a Department of Health policy document first introduced in October 2007.
A continuing healthcare checklist is the first stage in determining whether an individual is entitled to free care. A PDF of an example checklist is available here.
An assessment for Continuing Healthcare Funding should not be undertaken whilst a patient is in an acute hospital setting, but should take place once the patient has been discharged to a nursing home or into health and social care. If the patient is already in a nursing home or remains in their own home, then the responsibility for conducting an assessment lies with the Integrated Care Board for the area.
A nurse assessor or social worker will consider the individual’s needs across a range of 12 domains or areas of need and score them on the basis of A (high moderate), B (moderate) or C (low/none).
The next stage and a full assessment are required if an individual is scored as having two or more A scorings, 5 or more B scorings or 1 A and 4 B scorings.
If the result of the CHC checklist clarifies the patient’s condition is serious or long term enough to warrant progressing to the next stage in the continuing healthcare funding assessment process, then a full “Decision Support Tool” should be carried out. This should be conducted by a multi-disciplinary team of clinicians (referred to as an MDT), often a social worker, social healthcare professional, a GP and a nurse assessor.
The Multi-disciplinary team will again assess the patient against a series of domains and score them on a spectrum consisting of no needs up to low, moderate, high and severe, priority.
Having then scored the various domains the multi-disciplinary team will consider all of those needs as a whole result in sufficient nature, intensity, complexity and unpredictability. Resulting in the individuals needs being primarily a health need that should result in continuing healthcare funding being awarded.
A link to the blank decision support tool document can be found here.
Stage 3
A separate panel will convene to consider the recommendation of the multi-disciplinary team resulting from the decision support tool.