Written by Tom Clements, Paramedic Legal Intern
Za svakoga tko ima kroničnu progresivnu bolest i izložen je riziku od potencijalnog tereta rastućih troškova skrbi, NHS Continuing Healthcare može biti spas. Ovo je u potpunosti financiran NHS paket skrbi za odrasle osobe sa složenim i dugoročnim zdravstvenim potrebama.
For more than two decades, tens of thousands of people with various conditions, including dementia, stroke and Parkinson's disease, have rejected the claims. Based on our fifteen years of experience, we know that thousands of people and their families lose due to misjudgment and misunderstanding. If they are aware of this process, families will have difficulty navigating the system and will feel intimidated and discouraged by the complex process.
This series aims to raise awareness about funding and help families make the right decisions on behalf of their loved ones.
The first step in getting NHS Continuing Healthcare funding is to create a checklist.
What is a checklist?
The checklist is a screening tool used by the NHS to determine whether a person is eligible for a full NHS continuing care assessment.
The threshold for passing the checklist assessment is deliberately set low to ensure that everyone who might be eligible for continuing NHS care is correctly identified and assessed. If you pass the checklist, you will be eligible for a full assessment using the Decision Support Tool (DST). However, we often find that checklist criteria are not applied correctly, resulting in NHS Continuing Healthcare being unfairly denied full assessment.
The main aim of the checklist is to identify people with care needs that go well beyond the NHS eligibility criteria for continuing care and to 'opt out' these people from the process at an early stage. On the other hand, a checklist is designed to identify those with more extensive health needs, allowing you to perform a full assessment.
Successfully completing a checklist assessment does not mean you are entitled to NHS care. This is simply the first step in the evaluation process. If you think you or a family member/friend may be eligible for a full NHS Continuing Healthcare Assessment, you should ask your local Clinical Commissioning Group (CCG) to complete an assessment checklist.
How it works?
The needs of the individual are assessed in 11 different areas (domains of care):
- mental and emotional needs
- medicinal therapies and drugs
- different states of consciousness
Each area of care is graded A, B or C depending on the specific needs of the individual. A checklist-based assessment provides detailed criteria within each domain of care as to which specific needs correspond to A, B or C needs.
"A" is reserved for more significant needs, while "C" is awarded when a person has less significant needs in that specific area of care.
A full NHS assessment of ongoing care (through STDs) is required if the checklist identifies:
- two or more domains, A-score
- five or more B-rated domains or one A-rated domain and four B-rated domains
- And in any of the following areas of care: breathing, behavior, medication, or altered states of consciousness
A case study
David can breathe normally, feeds himself properly, is consistent, communicates well, has no cognitive impairment, no defiant behavior, has not had a stroke or seizure. However, David is completely immobilized and unable to cooperate with transfers, there is a risk of skin damage that requires regular repositioning, he suffers from depression that increasingly affects his well-being and requires medication by a trained professional due to the nature of the medication.
After applying the checklist criteria, David would get:
Therefore, David is not eligible for a full DST assessment as his needs are not sufficient to pass the checklist assessment.
Maria can breathe normally, has no skin problems, is mobile, has no psychological and emotional needs, does not behave demandingly, has not had a stroke or seizure. However, it takes staff 40 minutes to feed Maria, she is doubly incontinent, completely unable to communicate, suffers from severe dementia and is non-adherent to her medication.
After applying the checklist criteria, Maria would have:
Therefore, Maria's needs are sufficient to pass the checklist assessment. Maria is eligible for a full DST evaluation.
How to dispute a checklist note
If you are not satisfied with the result of the checklist evaluation, you can request a reconsideration. Each NHS clinical commissioning group has an individual procedure for challenging checklist assessments. However, this usually includes:
- lodge a complaint with the CCG detailing the reasons for questioning the checklist; and/or
- forward the complaint to the parliamentary ombudsman and the Health Service.
The ombudsman will not consider the complaint until the CCG gives a final answer to the submitted complaint. However, the deadline for submitting a complaint to the CCG and/or the Ombudsman is one year from the date of completing the checklist. However, the request(s) must be submitted as soon as possible.
You cannot dispute the outcome of the checklist just because you disagree with it. You must provide reasons for contesting the results.
Tips for Examining the Checklist
- proof of trust– If possible, ask for copies of medical and medical certificates. Compare the notes with the contents of the checklist. If any specific evidence is omitted or overlooked, this must be detailed in the complaint. If necessary, attach copies of relevant notes/complaint records to substantiate the concerns raised. If you cannot obtain or share copies of care and treatment records, prepare a written first-hand summary of the person's needs.
- Always check the results- It is common for individuals to be denied a full assessment even if the checklist results meet the criteria. It is common practice to decline a full review if the reviewer considers it highly unlikely that the eligibility criteria will be met if the case undergoes a full review. If the results of the checklist indicate the need for a full assessment (see above), remind the CCG that they are required to complete the TSD under the NHS National Continuing Care Framework.
- Review the scoring criteria carefully– We often encounter incorrect application of checklist criteria. For example, in the case of David (see Case Study 1 as described above), if he had received an "A" in medication, he would have been eligible for a full evaluation. Therefore, the misapplication of checklist criteria in the field of care can be of great importance. Negative inventory scores can often be reversed by simply examining scores in one or two areas of care. Always read carefully the criteria within each domain of care. Pay particular attention to the distinction between the use of the words "and"/"or" within the checklist criteria, as it may not be necessary to meet all aspects of the descriptor to reach a higher level.
- Ensure funding is allocated 28 days after checklist- If you pass the checklist assessment, the NHS must complete a full STD assessment. If you test positive for an STD, you qualify for NHS care. However, permits will generally be granted on or after the DST end date. The National Framework states that for a positive ISD, eligibility must be retroactive to 28 days after completion of the checklist (as this is the time frame within which the ISD must normally be completed). For example, if you pass a checklist assessment on January 1, 2022 and are found to be eligible for the next DST ending on March 1, 2022, then your eligibility must be retroactive to January 28, 2022 (28 day checklist ). If the CCG does not apply this principle, it should be referred to the National Board.
In theory, checklist-based assessments are a useful tool for determining who should be fully assessed in NHS long-term care. Unfortunately, however, it is common for checklist criteria to be misapplied, resulting in people being unfairly refused admission to NHS Continuing Healthcare.