Understanding the Continuing Care Checklist Tool: A Comprehensive Guide

The Continuing Care Checklist Tool serves as an initial filter within various healthcare settings. Its primary function is to assist healthcare professionals in pinpointing individuals who might benefit from a complete evaluation for NHS continuing healthcare eligibility. This tool is not designed to determine eligibility itself but rather to identify those who should proceed to the next stage of assessment.
It is crucial that all professionals utilizing this checklist possess a strong understanding of the core principles outlined in the national framework for continuing healthcare and NHS-funded nursing care. Furthermore, familiarity with the decision support tool for NHS continuing healthcare is equally important for proper application and interpretation of the checklist.
The sensitivity of the continuing care checklist tool is intentionally set at a level to capture a broad range of individuals. This ‘low threshold’ approach is deliberate, aiming to ensure that everyone who genuinely warrants a comprehensive eligibility assessment for NHS continuing healthcare is given the opportunity to receive one. The goal is to be inclusive at this initial screening phase.

It’s vital for practitioners to clearly communicate to individuals undergoing the checklist assessment that a positive result does not automatically equate to NHS continuing healthcare eligibility. Instead, a positive checklist simply signifies the necessity for a more in-depth, full assessment to ascertain their eligibility.

Upon completing the continuing care checklist tool, there are two possible outcomes:

Negative Checklist: This outcome indicates that, based on the initial screening, the individual does not appear to require a full assessment of eligibility for NHS continuing healthcare. Consequently, they are unlikely to be eligible for this type of care.
Positive Checklist: A positive result from the checklist signifies that the individual should now proceed to a full assessment of eligibility for NHS continuing healthcare. It’s important to reiterate that this positive outcome does not guarantee eligibility; it merely triggers the next, more detailed stage of the evaluation process.

Important Note

These essential tools are conveniently accessible in digital formats, such as editable Word or ODT documents. This digital format offers the flexibility to expand pages and text boxes as needed, accommodating detailed information effectively.

It is imperative to recognize that these tools are standardized at the national level. Therefore, their content should remain unaltered. Modifications, additions, or abbreviations are not permitted. However, Integrated Care Boards (ICBs) are authorized to include their organizational logo and incorporate supplementary patient identification details, such as the NHS number, for administrative purposes.

Determining When to Utilize the Checklist Tool

The continuing care checklist tool should typically be employed in any situation where there is a potential indication that an individual may require NHS continuing healthcare. This proactive approach ensures that individuals who might be eligible are appropriately screened.
Conversely, there are numerous scenarios where using the checklist is not deemed necessary. For detailed guidance on these situations, refer to paragraph 121 of the national framework for continuing healthcare and NHS-funded nursing care and the section titled ‘When not to use the checklist’ provided below. These resources offer clarity on when to forgo the checklist process.
The timing and location of screening and assessment for NHS continuing healthcare should be carefully considered to best suit the individual’s needs. Ideally, these processes should occur when the individual’s ongoing healthcare requirements are more clearly defined.

While these assessments can take place in various settings, it is generally preferred that the comprehensive eligibility assessment is conducted when the individual is in a community environment, ideally in their own residence. This familiar setting can facilitate a more comfortable and accurate assessment process.

The fundamental principle guiding this process is to ensure individuals are supported in accessing and navigating the assessment pathway that is most appropriate for their current and future needs. This person-centered approach is key to accurately identifying individuals who genuinely require a full assessment for NHS continuing healthcare.

For specific insights into how NHS continuing healthcare procedures align with hospital discharge protocols, please consult paragraphs 101 to 108 of the national framework. This section of the framework provides detailed information on the interface between these two healthcare processes.

Who Is Qualified to Complete the Checklist?

A diverse range of health and social care practitioners are authorized to complete the continuing care checklist tool. The essential prerequisite is that these professionals must have received proper training in the correct application of the checklist. This training ensures accurate and consistent use of the tool across different practitioners and settings.

The Individual’s Role in the Screening Process

Individuals who are to undergo the checklist assessment should be informed in advance about the intention to use the tool. Furthermore, the process itself should be clearly explained to them, ensuring they understand its purpose and what to expect.

Whenever possible, individuals should be actively encouraged to participate in the checklist completion process. This includes offering them the opportunity to involve a representative, if they wish, allowing them to contribute their perspectives and insights regarding their own needs.

Several core principles underpin the NHS continuing healthcare process, with a central focus on the individual’s needs and a person-centered approach. Assessments and reviews should consistently prioritize the unique requirements of each person. Crucially, individuals must be kept fully informed and empowered to actively engage in both the assessment process and any subsequent reviews. Their opinions and preferences should be given due consideration throughout.

Additionally, there are specific legal requirements pertaining to an individual’s consent at various stages of the NHS continuing healthcare process. These legal considerations are designed to protect the rights and autonomy of the individual.

In line with the person-centered ethos, practitioners are expected to make every reasonable effort to involve the individual (or their representative) in the assessment and review stages of the NHS continuing healthcare process at each step. Active participation is key to ensuring the process is truly centered on the person receiving care.

To achieve a comprehensive assessment, the best available evidence at the relevant time should be taken into account. This evidence gathering should include considering the viewpoint of the individual (or their representative). They should be supported and enabled to participate fully. Throughout the entire process, this commitment to a person-centered approach should be integral to all decisions related to the individual’s needs assessment and their ongoing care planning.

Consent is a legal necessity for any physical intervention or examination performed on an individual who has the capacity to give consent. To the extent that screening for NHS continuing healthcare involves such physical interaction, informed consent must be obtained directly from the individual, provided they have the capacity to consent. This upholds their right to bodily autonomy and informed decision-making.

For detailed guidance on the requirements for valid consent, please refer to paragraph 85 of the national framework. This section provides comprehensive information on the legal and ethical aspects of consent in this context.

Explicit consent from an individual is legally required before sharing any of their personal data with third parties. This includes family members, friends, advocates, and other representatives. Data privacy and confidentiality are paramount, and consent ensures individuals maintain control over their personal information.
However, it is important to note that seeking consent from an individual is not necessary when sharing their personal data between health and social care professionals as part of their NHS continuing healthcare assessment (and subsequent reviews). This exemption is in place to facilitate effective communication and collaboration within the care team directly involved in the individual’s assessment and care.
If there are concerns that an individual may lack the capacity to consent to a physical intervention or examination during the assessment process, or to the sharing of personal data with third parties like family, friends, or advocates, this issue must be addressed in accordance with the Mental Capacity Act 2005 and its associated code of practice. This legal framework provides the necessary guidance for making decisions in situations where capacity is in question.

In such cases, it may be necessary to make a ‘best interests’ decision on behalf of the individual. This decision-making process must always be guided by the principle that everyone who is potentially eligible for NHS continuing healthcare should have the opportunity to be properly considered for eligibility. Paragraphs 86 to 96 of the national framework offer detailed guidance on applying the Mental Capacity Act 2005 in these specific circumstances.

How to Effectively Complete the Checklist Tool

The continuing care checklist tool is designed to be completed relatively quickly and without undue complexity. It is not intended to be a detailed assessment in itself. Therefore, it is not necessary to include extensive, supplementary evidence when submitting a completed checklist. The focus is on efficient screening.
Practitioners should carefully compare the domain descriptors within the checklist to the individual’s specific needs. Based on this comparison, they should select the level – A, B, or C – that most accurately reflects the individual’s needs in each domain. The choice should be the level that best aligns with the individual’s requirements.

If an individual’s needs equal or exceed the descriptions provided in column A for a particular domain, then level ‘A’ should be selected for that domain. This indicates a higher level of need.

Practitioners are also required to briefly summarize the individual’s needs that justify the chosen level for each domain. Where relevant, they should also record references to any evidence that supports their selections. This documentation provides a rationale for the checklist outcomes.

A full assessment for NHS continuing healthcare is mandated if the checklist results meet any of the following criteria:

Selection of level A in 2 or more domains. This indicates significant needs across multiple areas.
Selection of level B in 5 or more domains, or a combination of one level A selection and 4 or more level B selections. This also points to a substantial level of overall need.
Selection of level A in any of the domains marked with an asterisk. These asterisks denote domains that are designated as ‘priority’ levels within the decision support tool, signifying a critical area of need. If level A is selected in a priority domain, a full assessment is required regardless of the selections in other domains.

In rare and exceptional circumstances, a full assessment of eligibility for NHS continuing healthcare may be deemed appropriate even if the individual does not strictly meet the threshold criteria outlined above. In such instances, a clear and well-justified rationale must be documented to explain why a full assessment is necessary. Furthermore, local protocols should be followed to ensure appropriate decision-making in these exceptional cases.
The principles concerning ‘well-managed need’ (as detailed in paragraphs 162 to 166 of the national framework within the ‘Assessment of eligibility’ section) are equally applicable to the completion of the checklist as they are to the decision support tool. These principles ensure that the assessment process takes into account the effectiveness of current care management in mitigating needs.

Understanding the Next Steps

Regardless of the checklist outcome – whether or not a referral for a full assessment of NHS continuing healthcare eligibility is considered necessary – it is essential to communicate the result clearly and in writing to the individual or their representative. This communication should occur as soon as reasonably possible after the checklist completion. Prompt notification is a key aspect of a transparent process.

This written communication must include the reasons behind the checklist outcome. Typically, this is achieved by providing a copy of the completed checklist itself, which outlines the assessed needs and the resulting outcome.

Actions Following a Negative Checklist Result

A negative checklist outcome signifies that the individual, based on the initial screening, does not require a full eligibility assessment and is not currently considered eligible for NHS continuing healthcare. This outcome concludes the process for the individual at this stage.
However, if there is a reasonable expectation that the individual’s needs may escalate within the next 3 months – for example, due to an anticipated deterioration in their health condition – this potential change should be formally recorded. Furthermore, a decision should be made regarding whether a review of the checklist outcome should be scheduled within a specific timeframe. This proactive approach allows for timely reassessment if circumstances change.
If an individual has been screened out following a negative checklist result, they retain the right to request that the Integrated Care Board (ICB) reconsider the checklist outcome. This provides an avenue for individuals to challenge the initial decision if they believe it does not accurately reflect their needs.

The ICB is obligated to give such reconsideration requests due attention. This review should take into account all available information, and may also include any additional information provided by the individual or their carer. While the ICB must consider the request, there is no automatic obligation for them to undertake a further checklist assessment. The decision to conduct another checklist remains at the ICB’s discretion.

Actions Following a Positive Checklist Result

A positive checklist outcome indicates that the individual is required to undergo a full assessment of eligibility for NHS continuing healthcare. It is crucial to reiterate that a positive checklist does not automatically guarantee that the individual will be found eligible for NHS continuing healthcare. Eligibility is determined through the subsequent, more detailed full assessment process (refer to paragraphs 134 to 137 of the national framework for further details on the full assessment).
It is imperative that an individual is not left without appropriate support while they are awaiting the outcome of the full assessment and the subsequent decision-making process regarding NHS continuing healthcare eligibility. Continuity of care and support is essential during this waiting period to ensure their needs are met.

Situations Where Checklist Use Is Not Recommended

There are numerous situations where completing the continuing care checklist tool is unnecessary and may not be appropriate. It is important for practitioners to be aware of these situations to avoid unnecessary assessments.

Practitioners should carefully review the following statements outlining when it may not be suitable to screen for NHS continuing healthcare before initiating the checklist process. Understanding these exceptions ensures that the checklist is used effectively and efficiently.

Situations where it is not necessary to complete the checklist include:

When healthcare professionals working within the health and care system are confident that there is no current need for NHS continuing healthcare for the individual. In such cases, documenting this decision and the reasoning behind it is advisable. However, if there is any uncertainty or disagreement among practitioners, it is recommended that the checklist should be completed to ensure thoroughness.
When the individual has healthcare needs that are clearly short-term in nature, or they are in a recovery phase from a temporary condition and have not yet reached their maximum potential for improvement. However, if there is any doubt among practitioners regarding the short-term nature of these needs, it may be prudent to complete the checklist to err on the side of caution. Paragraphs 101 to 108 of the national framework provide further guidance on how NHS continuing healthcare interacts with hospital discharge processes in these scenarios.
When the Integrated Care Board (ICB) has already agreed that the individual should be directly referred for a full assessment of eligibility for NHS continuing healthcare. In these pre-agreed cases, the checklist screening stage is bypassed, and the individual proceeds directly to the comprehensive assessment.
When the individual has a rapidly deteriorating condition and may be entering a terminal phase of life. In these urgent situations, the fast-track pathway tool is the appropriate tool to use instead of the standard checklist. The fast-track pathway is designed for individuals with urgent and immediate needs due to a terminal illness.
When an individual is already receiving services under section 117 of the Mental Health Act 1983 that are comprehensively meeting all of their assessed health and social care needs. If existing Section 117 services are sufficient, a separate NHS continuing healthcare assessment may be redundant.
When it has been previously determined that the individual is not eligible for NHS continuing healthcare, and there is no evident change in their needs since that previous decision. If there has been no significant change in circumstances, reassessment via the checklist may be unnecessary.

If, after reviewing these exceptions, it is determined that screening for NHS continuing healthcare is not necessary at the present time, the decision not to complete the checklist, along with the reasons for this decision, should be clearly documented in the individual’s patient notes. This ensures a transparent and accountable record of the decision-making process.

Appropriate clinicians are required to complete the accompanying NHS continuing healthcare checklist referral form. Original and accessible versions of this form are available in PDF, Word, and ODT formats, alongside the guidance provided here. This referral form is a key part of the checklist process.