Continuing NHS Healthcare information booklet for individuals, families and carers - Assessment process

Your needs assessment and following that consideration of eligibility should take place in the right place and the right time for you.

It should normally take place when you are in a community setting such as a community hospital, your home or your care home. It should only take place in an acute hospital setting in exceptional circumstances.

If you have spent time in hospital, you should have any rehabilitation or reablement you may require, before you have your CHC assessment. You should be supported to recover before your CHC assessment takes place so that you can regain the ability to look after yourself independently as much as possible.

When it has been identified that you might have on-going healthcare needs, your LHB becomes responsible for carrying out your CHC assessment, and it will assign you a care co-ordinator, sometimes called a Lead Professional.

In keeping with a person-centred approach for the CHC eligibility assessment process, it may also be acceptable for a social worker with a long-standing relationship with you and your family to act as your care co-ordinator. The local health board and local authority would need to agree this approach, with the final decision being with the local health board.

Your care co-ordinator is the person responsible for coordinating the whole CHC assessment process. They are your point of contact if you have any questions or concerns. They must keep you informed of what’s going on and make sure you are invited to any meetings where decisions are made on your eligibility so that you are fully involved in the discussions and decision making process. You should be given your care co-ordinator’s name, contact number and email address to ensure swift communication.

It is the responsibility of the MDT to:

• undertake a robust assessment of your needs
• provide the LHB with consistent expert advice on your CHC eligibility
• develop a care plan to meet your needs, and
• make recommendations regarding the setting, and what provision of care staff would be required to most effectively deliver your care plan

Your CHC eligibility assessment will involve a team of health and social care professionals from different disciplines, working together to decide what your needs are, and how they should be met. This is the multi-disciplinary team, often called the MDT.

Your Care-Coordinator will make sure the right professionals, who have direct knowledge of you and your needs, are part of the MDT.  As a minimum, the MDT must include:

• at least two professionals from different healthcare professions. For example nurses, doctors, occupational therapists, other specialists, such as speech and language or behavioural specialists
• a social worker

And could include the following where required:

• care home staff
• domiciliary care staff

They will look at all your physical health, mental health and social care needs, individually and together. This is to get an accurate picture of your needs and to give expert recommendations on how your needs can best be met. They may visit you separately before everyone meets together to get a full picture of your needs. Any meeting you have should be in the language of your choice.  

Your own views and what you want your outcomes to be are an important part of the assessment. You are the expert of your own life, and nothing should be decided about you, without you.

This information is then used at an MDT meeting where the Decision Support Tool (DST) will be completed. The DST is a tool for recording information to support the assessment process.

The Multi-Disciplinary Team (MDT) meeting

Once the MDT has done a thorough assessment of all the information and evidence gathered, your Care Co-ordinator will organise and invite you and any representative you choose to bring with you, to an MDT meeting. This meeting must be in the language or communication method of your choice.  

Your Care Co-ordinator will explain the format of the MDT meeting to you and how you and/or your representative can be fully involved. You should be given sufficient notice of the date of the MDT meeting so that you can make arrangements to attend should you wish to. You should be offered the opportunity to attend in person or virtually. To attend virtually, you would need a computer and an internet connection.  The meeting invitation would be sent to you by email and you would need to click on the link in that email to join the meeting.

If you or your representative are not able to attend, your views should be obtained and considered.  The DST allows the MDT to bring together and record their assessment of your various needs in 12 care domains (See section Eligibility for Continuing NHS Healthcare').

When completing all domains of the DST, the MDT team should use the assessment evidence and professional judgement to select the level that most closely describes your needs, e.g. low need or severe need.

The assessment should result in a comprehensive picture of your needs that captures the nature, complexity, intensity and/or unpredictability of your needs – and whether you have a primary health need. It will also capture the quality and/or quantity (including continuity) of care required to meet your needs.

A clear recommendation of eligibility would be expected if you have:

• priority level of need in any of the three domains with that level, or
• two or more instances of severe needs across all domains, or
• one domain recorded as severe together with needs in a number of other domains
• a number of domains with high and/or moderate needs

Your needs should not be placed between levels. If, after considering all the relevant evidence, it proves difficult to decide or agree on the level, the MDT should choose the higher of the levels under consideration and record the evidence in relation to both the decision and any significant differences of opinion.

Your needs should not be marginalised because they are successfully managed. Well-managed needs are still needs and should be recorded appropriately.

If it can reasonably be anticipated that your condition will deteriorate and your needs in certain domains will increase in the near future, this should be recorded and taken into account when the final recommendations are made.

The MDT meeting should be arranged in a way that enables you to give your views on the completed domain levels before you leave the meeting. In the DST there is a section at the end of the domain tables for you or your advocate to give your views that have not already been recorded elsewhere in the document, including whether you agree with the domain levels selected. It also asks for reasons for any disagreement to be recorded.

If you or your representative have concerns about any aspect of the assessment process, the Care Coordinator should discuss this matter with you and seek to resolve your concerns. If your concerns remain unresolved, they should be noted within the DST so that they can be brought to the attention of the LHB making the final CHC eligibility decision.

Following discussion with you or your representatives and completion of the DST, the MDT members will immediately make their recommendation to the LHB on whether you have a primary health need, based on the 4 key indicators.

This recommendation will be made separately from any discussions with you and your representatives but even if you are not present on the day it should be communicated to you as soon as possible.

In the majority of cases, the LHB will accept the MDT’s recommendations. In exceptional circumstances, and for clearly set out reasons, the LHB may request additional evidence to support the MDT’s recommendations. For example, this might be because the DST is incomplete, or there are significant differences between the evidence in the assessment, the DST and the recommendation being made.

LHBs and LAs must have systems in place to make sure the professionals involved in the MDT have the right skills, knowledge and competency to carry out assessments to the standards expected. LHBs must have robust quality assurance mechanisms in place to ensure consistency of decision-making.

You will be informed of the outcome of your eligibility assessment in writing as soon as possible (you may also be informed verbally where appropriate). The correspondence sent to you should be in the language / method of communication of your choice and should include: 

• the decision on primary health need, and therefore whether or not you are eligible for CHC
• the reasons for the decision
• a copy of the completed DST
• details of who to contact if you need further information
• how to request a review of the eligibility decision

If you are not eligible your decision letter may also include, where applicable and appropriate, information regarding Funded Nursing Care or a joint package of care. You can find further information on this in the section Continuing NHS Healthcare: what happens if I am not eligible.