The Assessment Process Now Using The National Framework
When a PCT or local authority identifies that a patient may qualify for continuing care, they use the National Framework and its tools to assess the patient’s health needs, draw up a care plan and arrange a care package. The three tools are the Fast Track Tool, the Checklist and the Decision Support Tool.
The Fast Track Tool
This is used in urgent cases to obtain immediate continuing care funding, for example, if a patient’s condition is rapidly deteriorating and could be terminal. Where possible, it should be followed by the full assessment process.
The Checklist is a basic screening tool that flags up any serious health needs that justify a full multidisciplinary assessment (MDA) for continuing care funding. The Checklist covers 11 areas of patient need and groups them into three categories: A (the patient meets or exceeds that need), B (borderline) or C (the patient does not meet the need).
The patient will be referred for a full MDA if they score:
- Two or more As
- Five or more Bs
- One A and four Bs.
The Checklist can be used by a nurse, doctor, other healthcare professional or a social worker. It is usually completed when the patient is about to be discharged from hospital.
The Decision Support Tool (DST)
The DST is used during the multidisciplinary assessment, which involves at least two staff members from different NHS and local authority disciplines, such as a nurse and a social worker.
The MDA looks in detail at the patient’s health needs as identified in the Checklist. The team uses the DST to evaluate these in depth, in terms of their nature, complexity, intensity and unpredictability.
The patient’s health needs are then graded on the DST as None, Low, Moderate, High, Severe or Priority, although some needs have a maximum of High or Severe. The DST indicates that a patient may have a Primary Health Need if:
- They have one or more Priority needs
- Two or more Severe needs
- One Severe need together with needs in several other areas
- Several High and/or Moderate needs
To make their final decision about whether the patient has a Primary Health Need, and therefore qualifies for NHS Continuing Healthcare, the assessing team must combine the results from the DST with other factors such as the patient’s medical notes, their own experiences of the patient and their professional judgement.
What Happens Next?
After the MDA, the PCT should confirm their funding decision within 28 days. Possible outcomes include:
- Continuing care is awarded. Please read our Factsheet 4 to find out what happens next.
- Another type of funding is awarded. This could be NHS-funded Nursing Care or another type of care. The care could be funded by the NHS, local authority or both. Please read our Factsheets 5 and 6 for more details.
- Care funding is denied. The patient may need to pay for their own care. Please visit our Funding Your Own Care page to find out about funding options. You should also read our Factsheets 7.
Whatever the outcome of the continuing care assessment, the patient will be re-assessed after three months in case their needs change, and every 12 months after that.
Continuing Care Funding Wrongly Denied?
If you or a relative feel that you should have been awarded continuing healthcare funding, now or in the past, please contact us so we can review your case.