The NHS and Continuing Healthcare Funding assessments 

NHS Continuing Healthcare (CHC) is available to those with a primary health need who meet certain criteria. It is worth being clear from the outset that it is entirely different from the funding provided by the Local Authority, which is means-tested. CHC is not, but assessed purely on the level and type of a person’s care needs. 

The difficulty is that there is no fixed, clean definition of what actually constitutes a ‘primary health need’. The concept comes from case law and the National Framework for NHS Continuing Healthcare rather than from any single test set out in statute, so, in practice, it falls to a structured assessment process to determine whether someone qualifies.  

The Checklist Assessment 

The first stage is the Checklist Assessment, carried out by a trained health or social care professional, typically a nurse, doctor or social worker. It looks at eleven areas of a person’s care needs and scores each one A, B or C, with A representing the highest level of need and C the lowest. Those eleven areas are: 

• Breathing 
• Nutrition (food and drink) 
• Continence 
• Skin (including wounds and ulcers) 
• Mobility 
• Communication 
• Psychological and emotional needs 
• Cognition (understanding) 
• Behaviour 
• Drug therapies and medication 
• Altered states of consciousness 

Reaching certain combinations of those scores, generally two or more A’s, five or more B’s (or one A and four B’s), or a single A in one of the domains that carries priority status, means the person will be referred to their local Integrated Care Board (ICB) for a full assessment. 

Fall short of that threshold and the process ends, but if the person’s family disagrees with the outcome, there is a route to ask the ICB to review the Checklist scoring, so a negative result is not necessarily the final word. 

It is worth remembering, too, that even where the Checklist does not lead to a full CHC assessment, a person may still be entitled to Funded Nursing Care, a smaller weekly NHS contribution towards the nursing element of their care, which sits alongside but separate from full CHC funding. 

Full Assessment 

When the Checklist result crosses that threshold, the case moves on to a full assessment using the Decision Support Tool, completed this time by a multidisciplinary team rather than a single assessor. It covers the same broad areas as the Checklist but in far more detail and the scoring is more nuanced, running from Priority and Severe down to No Needs across twelve domains rather than the simpler three-point scale used at Checklist stage. The outcome of that assessment is what ultimately determines whether CHC funding is awarded. 

One point that can catch families out is what happens when the individual being assessed passes away while a Checklist or full assessment is still underway, or even before either has been completed. This does not automatically bring the process to a close and it is possible for CHC funding to be awarded retrospectively, covering care costs already incurred before the person died. 

Fixed-price support from specialist lawyers 

For those seeking advice on, or looking to challenge, an NHS Continuing Healthcare assessment, Coodes Solicitors offers fixed-price support so that clients and their families have clarity from the outset about the likely cost of each stage. Our fixed fees are agreed for each piece of work and will be confirmed before we begin. 

The initial CHC advice consultation is available at a fixed price of £750 plus VAT. It includes specialist advice on how the CHC process works, the assessment stage reached, the likely next steps and whether a challenge may be appropriate. Where a case moves forward, further fixed-price services are available depending on the stage the assessment has reached, including a full review of the assessment itself, advice on the grounds available for a challenge, and representation throughout any review or appeal. 

If you would like to discuss a case, call us on 0800 328 3282 or get in touch through our contact form. 

About the Author: Melanie Grose heads up Coodes’ Personal Disputes Team and specialises in contentious trusts and probate matters. A strong advocate of mediation, Mel regularly represents clients in mediated negotiations to secure practical and balanced solutions.

Get in Touch: mel.grose@coodes.co.uk  01872 246 227