Practice Guidance Notes about the Checklist

Download a blank checklist here: 

These are the questions and answers about the use of the Checklist, taken from the Practice Guidance Notes.

PG 15 What is the NHS continuing healthcare  Checklist?

15.1   The Checklist is a screening tool used to help practitioners identify individuals who may need a referral for a full consideration of whether their healthcare needs qualify for NHS continuing healthcare funding. It is important to note that the completion of the Checklist does not indicate that an individual is eligible for NHS continuing healthcare and this should be clearly communicated to the individual and/or their representative prior to its completion.

PG 16 Does everyone need to have a Checklist completed?

16.1    No, there will be many situations where it is not necessary to complete a Checklist.

However, Standing Rules require CCGs to take reasonable steps to ensure that individuals are assessed for NHS continuing healthcare in all cases where it appears to them that there may be a need for such care. Local joint health and social care processes should be in place to identify individuals for whom it may be appropriate to complete a Checklist, including individuals in community settings within the context of the above duty. As a minimum, wherever an individual requires a care home placement or  has  significant  support  needs,  a  Checklist  would  be  expected  to  be  completed (unless the decision is made to go straight to the completion of a DST).

16.2    The Standing Rules state that the Checklist is the only screening tool that can be used. CCGs can choose not to use a screening tool, either generally or in individual cases, and instead directly use the DST but alternative screening tools cannot be used. For example, a CCG and LA might agree that everyone who moves from an acute hospital setting into a care home with nursing should automatically have a full DST completed without the need to complete a Checklist.

16.3   LAs must notify a CCG and invite them to assist in the completion of a community care assessment30  where a person appears to have health needs, identified as part of the community care assessment process, that could be met by the NHS. Completing a Checklist at the initial assessment or review stage will ensure that people presenting to the LA with health-related needs are properly considered for NHS continuing healthcare eligibility.

PG 17 Who can complete  a Checklist?

17.1   The aim is that a variety of  health and social care practitioners can complete the Checklist in a variety of settings. These could include NHS registered nurses, GPs, other clinicians or LA staff such as social workers, care managers or social care assistants, completing them in an acute hospital, an individual’s own home or in a community care setting. It is for each local CCG and LA to identify and agree who can complete the tool but it is expected that it should, as far as possible, include all staff involved in assessing or reviewing individuals’ needs as part of their day-to-day work. Such staff should be trained in the Checklist’s use and have completion of it as an identified part of their role.

PG 18 When should  a Checklist be completed if the individual is in hospital?

18.1   In a hospital setting the Checklist should only be completed once an individual’s acute care and treatment has reached the stage where their needs on discharge are clear. Paragraph  65  of  this  Framework  highlights  the  need  for  practitioners  to  consider whether the individual would benefit from other NHS-funded care in order to maximise their abilities and provide a clearer view of their likely longer-term needs before consideration of NHS continuing healthcare eligibility. This should be considered before completion of the Checklist as well as before completion of the DST.

18.2   In  certain  cases  it  can  be  appropriate  for  both  the  Checklist  and  the  DST  to  be completed within the hospital setting but this should only be where it is possible to accurately identify a person’s longer-term support needs at that time and there is sufficient time to identify an appropriate placement/ package of care/support that fully takes into account the individual’s views and preferences.

18.3   CCGs should ensure that NHS continuing healthcare is clearly built into local agreed discharge pathways. This should include identification of the circumstances when NHS continuing healthcare assessments and care planning will be carried out in the hospital setting.

30 See section 47(3) of the National Health Service and Community Care Act 1990 (c.19), as amended by the Health and Social Care Act 2012.

18.4   Checklists should not be completed too early in an individual’s hospital stay; this could provide an inaccurate portrayal of their needs as the individual could potentially make further recovery. As far as possible the individual should be ready for safe discharge at the point that the Checklist is undertaken and sent to the CCG. It should therefore be completed at the point where wider post-discharge needs are also being assessed (although before issue of delayed discharge notices). If at any point after a Checklist has been sent to the CCG the individual’s needs change such that he/she requires further  treatment,  the  completed  Checklist  will  no  longer  be  relevant  and  a  new Checklist should be undertaken once the treatment has been completed. The CCG and the individual should be kept fully informed of the changed position. This process will enable the CCG to redirect their resources to where they are most urgently required.

PG 19 When should  the Checklist be completed if the individual is in the community or in a care setting  other than hospital?

19.1   In a community setting or a care setting other than hospital it may be appropriate to complete a Checklist:

•   as part of a community care assessment

•   at a review of a support package or placement

•     when a clinician such as a community nurse, GP or therapist is reviewing a patient’s needs

•   where there has been a reported change in an individual’s care needs, or

•     in  any  circumstance  that  would  suggest  potential  eligibility  for  NHS  continuing healthcare.

PG 20 Who needs to be present when a Checklist is completed?

20.1    The individual should be given reasonable notice of the need to undertake the Checklist. What constitutes reasonable notice depends upon the circumstances of the individual case. In an acute hospital setting or where an urgent decision is needed, notice may only be a day or two days. In a community setting, especially where needs are gradually increasing over time, more notice may be appropriate. The amount of notice given should take into account whether the individual wishes to have someone present to act as an advocate for them or represent or support them, and the reasonable notice required by the person providing that support. It is the responsibility of the person completing the Checklist or coordinating the discharge process to make the individual aware that they can have an advocate or other support (such as a family member, friend or carer) present and of the local arrangements for advocacy support.

20.2    The  individual  themselves  should  normally  be  present  at  the  completion  of  the Checklist, together with any representative in accordance with the above.

PG 21 What  information  needs   to  be  given   to  the  individual  when   completing  a Checklist?

21.1   The individual and/or their representative should be advised in advance of the need to complete the Checklist and the reasons for this. The DH patient information leaflet on NHS continuing healthcare should be given to the individual. Opportunity should be given for an explanation of the NHS continuing healthcare process to the patient and for dealing with any questions about it. It should be made clear that completion of the Checklist does not indicate likelihood that they will be eligible for NHS continuing healthcare. Whatever the outcome of the Checklist, the individual should be provided with  confirmation  of  this  decision  as  soon  as  reasonably  practicable.  The  written decision should include the contact details and the complaints process of the CCG in case they want to challenge the Checklist decision (including any review processes available through the CCG as an alternative to making a complaint). Paragraph 21 of the user notes for the Checklist states that ‘the individual should be given a copy of the completed Checklist. The rationale contained within the completed Checklist should give enough detail for the individual and their representative to be able to understand why the decision was made.’ Therefore a copy of the completed Checklist, together with a covering letter giving the appropriate details for challenging the decision will be sufficient to constitute a written decision in many circumstances, provided that the completed Checklist  or  other  documentation  includes  sufficient  detail  for  the  individual  to understand the reasons why the decision was made. CCGs should consider making the decision available in alternative formats where this is appropriate to the individual’s needs.

PG 22 What should  happen once the Checklist has been completed?

22.1   If full consideration for NHS continuing healthcare is required the Checklist should be sent to the CCG where the individual’s GP is registered unless alternative arrangements have been made by the CCG. If the individual does not have a GP, the responsible CCG should be identified using the approaches set out in the ‘Who Pays’ guidance. Checklists should be sent in the fastest, but most appropriate, secure way, which could include e-mail (if secure) or fax. The use of either internal or external postal systems can delay the receipt of the Checklist and should only be used if no other referral mechanism is available. Each CCG should have appropriate secure arrangements for the receipt of Checklists and these should be publicised to all relevant partners. The CCG will then arrange for a case coordinator to be appointed who will ensure that an MDT (including those currently treating or supporting the individual) carries out an assessment and uses this to complete a DST.

22.2  CCGs have the responsibility for ensuring that arrangements are in place so that individuals who are screened out at the Checklist stage are informed of the outcome, are given a copy of the Checklist, are given details of how to seek a review of the outcome by the CCG and are offered the opportunity for their case to be referred to the LA for consideration for social care support. This could be delegated by agreement to other organisations that have staff completing Checklists but CCGs have the ultimate responsibility.

22.3   Where  a  Checklist  indicates  that  a  referral  for  consideration  for  NHS  continuing healthcare is not necessary, it is good practice for the Checklist to still be sent to the relevant CCG for information, as the individual may wish to request the CCG to reconsider the decision and the CCG will need a copy of the Checklist in order to do this.

PG 23 What evidence is required  for completion of the Checklist?

23.1   The Checklist is intended to be relatively quick and straightforward to complete. In the spirit of this, it is not necessary to submit detailed evidence along with the completed Checklist. However, the Checklist asks practitioners to record references to evidence that they have used to support the statements selected in each domain. This could, for example, be by indicating that specific evidence for a given domain was contained within the inpatient nursing notes on a stated date. This will enable evidence to be readily obtained for the purposes of the MDT if the person requires full consideration for NHS continuing healthcare.

23.2   A ‘rationale for decision’ box is also included in the Checklist that invites practitioners to give an overall explanation of why the individual should be referred for full assessment of NHS continuing healthcare eligibility. Where referral is based on the numbers of As, Bs and Cs scored, a statement to this effect will often be sufficient. However, an individual may be referred for full assessment despite the fact that the completed domains suggest their needs do not meet the levels required, and in this case a fuller explanation will be important.

23.3  Whether or not an individual is being referred for full assessment of eligibility, the completed Checklist should give sufficient information for the individual and the CCG to understand why the decision was reached. Providing as much information as possible will also support the CCG coordinator to put arrangements in place quickly when they receive the Checklist.

PG 24 Can registered nurses in care home settings complete  a Checklist Tool?

24.1   It is intended that a wide range of NHS and LA social care staff in roles that involve the assessing or reviewing of needs should be able to complete the Checklist. In a care home setting where potential eligibility for NHS continuing healthcare is identified, the care home should contact the relevant CCG NHS continuing healthcare team and ask for a Checklist to be completed, unless the CCG has protocols in place setting out other arrangements for completion of Checklists in these circumstances.

PG 25 Can someone self-refer  by completing a Checklist themselves?

25.1   No. If the individual is known to a health or social care practitioner, they could ask that practitioner to complete a Checklist. Alternatively, they should contact their CCG NHS continuing healthcare team to ask for someone to visit to complete the Checklist, or if they already have a care home or support provider, they could ask them to contact theCCG on their behalf. Where the need for a Checklist is brought to the attention of the CCG through these routes it should respond in a timely manner, having regard to the nature  of  the  needs  identified.  In  most  circumstances  it  would  be  appropriate  to complete a Checklist within 14 calendar days of such a request.

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