NHS continuing healthcare is a two-step process. The first step is an initial assessment called a checklist. The second step is a full assessment for NHS continuing healthcare.

Step 1: Checklist

Your NHS health practitioner or social worker will consider whether it is appropriate to complete a checklist. There are many situations where it is not necessary to complete a checklist. These include:

If a checklist is needed it will be completed. Before a checklist is completed the process should be discussed with you and you should be provided with the public information leaflet produced by the Department of Health & Social Care. You or your family, carers or other representative should be included in its completion.

You will also be asked to provide consent in order that NHS Dorset can share information with your family or representative. If you would like further information about how we use and share your data please visit our information and sharing page.

Depending on the outcome of the checklist, you will either be told that you don’t meet the criteria for a full assessment of NHS continuing healthcare, or you’ll be referred to NHS Dorset for a full assessment of NHS continuing healthcare eligibility. If you are referred for a full assessment this does not mean you are eligible for NHS continuing healthcare only that you should be considered.

NHS Dorset will arrange an appointment to complete the NHS continuing healthcare full assessment. NHS Dorset is required to undertake and complete the assessment within 28 days of being notified that an assessment is due, and your appointment date will reflect this. If you are unable to make this appointment, we would ask that you discuss this with us as soon as possible. Only in exceptional circumstances will this appointment be rearranged.

Step 2: Full assessment

The assessment does not take place in hospital as this is not the best place to make long-term decisions about your ongoing care. A full assessment is only undertaken when your condition is stable and your ongoing health care needs are clear. If you are being discharged from hospital further information is available at Home First – helping you recover at home.

Seven key things to know:

  • The assessment will involve contributions from a range of professionals. As part of the eligibility consideration for NHS continuing healthcare, your needs will be considered by a multidisciplinary team

  • The multidisciplinary team is made up of two or more professionals and will usually include both health and social care professionals who are knowledgeable about your health and social care needs, and, where possible, have recently been involved in your assessment, treatment or care

  • NHS Dorset will collate evidence from people involved in your care such as your GP, social worker, carer or specialist nurse to build an overall picture of your needs. The multidisciplinary team will then use the information to complete a document called a decision support tool

  • The purpose of the decision support tool is to help the multidisciplinary team to assess the nature, complexity, intensity and unpredictability of your needs – and so recommend whether or not you have a ‘primary health need’. You should be fully involved in the assessment process and kept informed and have your views about your needs and support taken into account

  • NHS Dorset will make available a family views form that you can complete and return to us. This is especially important for you to return if you are unable to attend the allocated appointment time for the decision support tool to be completed

  • The multidisciplinary team will then make a recommendation to NHS Dorset as to whether or not you have a primary health need, which will determine your eligibility for NHS continuing healthcare. NHS Dorset will decide whether you are eligible for NHS continuing healthcare following a review of the multidisciplinary team’s recommendation

  • A decision about eligibility for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment being received by NHS Dorset. The team will inform you in writing, with a copy of the decision support tool as soon as they can, giving clear reasons for NHS Dorset’s decision on whether you are eligible. The Personal Health Commissioning Team will also explain your right to request a review of the decision

Review of the decision

You can ask NHS Dorset for a review of your eligibility decision. This needs to be done within six months from the date of your decision letter.

The Department of Health & Social Care guidance states that if someone is determined as not eligible the ‘not eligible’ decision stands until the review process is completed which may or may not uphold the initial decision.

NHS Dorset will cease funding from the date of the decision but will give 28 days’ notice from the date of the decision letter to cease funding.

If after completing the review you still remain unhappy with the eligibility decision, you can make a referral to NHS England who will independently review the decision. NHS England have produced a public information guide.

What happens if I am eligible for support?

If you’re eligible for NHS continuing healthcare, the next stage is to arrange a care and support package that meets your assessed needs. Depending on your situation, different options could be suitable, including:

  • Support in your own home and the option of a personal health budget (PHB)

  • A care home

NHS Dorset will work collaboratively with you and consider your views when agreeing your care and support package and the setting where it will be provided. However, NHS Dorset can also take other factors into account, such as the cost and value for money of different options.

It can take some time to source care, which is dependent on individual circumstances, the level of care required and the availability of care in the area in which you live. There is a national shortage of care workers across all health and care services which may impact on the availability and choice of care offered to you.

The care that NHS Dorset offers will always be determined as clinically safe. Due to the restricted availability of care, the option provided will be the best that NHS Dorset is able to offer. You always have the right to decline care and to source and fund an alternative yourself should you decide to do so.

If NHS Dorset agrees to fund your care, you will be asked to provide copies of relevant invoices/receipts and corresponding bank statements in order to arrange reimbursement for any care you have paid for from the date of the eligibility decision until we have arranged to fund the package of care.

NHS Dorset will only meet direct care costs. Other incidental costs such as hairdressing, chiropody and newspapers will not be met.

Personal health budgets

From April 2014 anyone eligible for NHS continuing healthcare wanting to have their care provided outside of a care home setting, may be able to receive the money they need to meet their healthcare needs as a personal health budget, in the form of a direct payment. This gives people a greater choice over how, when and who provides their care and support.

Healthcare reviews

If you’re eligible for NHS continuing healthcare, your needs and support package will normally be reviewed within three months and thereafter at least annually. This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you’re still eligible for NHS continuing healthcare.

If your needs change in the future, you may cease to be entitled to NHS continuing healthcare funding. If this happens and care and support is still required, NHS Dorset will refer you to the local authority for an assessment of your community care needs.

Fast-track funding

If your health is rapidly deteriorating and you may be entering the terminal phase, you should be considered for fast-track funding so that an appropriate care and support package can be put in place as soon as possible. In the fast-track pathway, there is no requirement to complete a checklist or the decision support tool. Instead, an appropriate clinician will complete the fast-track tool to establish your eligibility for NHS continuing healthcare.

This clinician will send the completed fast-track tool directly to NHS Dorset to assess whether you meet the criteria. If so, NHS Dorset will arrange for a care package to be provided for you.