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NHS Continuing Healthcare Checklist: October 2018 (Revised)
NHS Continuing Healthcare Checklist: October 2018 (Revised)
Checklist
October 2018 (Revised)
Published March 2018
Author:
SCLGCP-SCP 25370
Document Purpose:
Guidance
Publication date:
1 March 2018
Target audience:
Health and social care professionals
Public
Contact details:
NHS Continuing Healthcare and NHS-funded Nursing Care team
Department of Health and Social Care
39 Victoria Street
London SW1H 0EU
You may re-use the text of this document (not including logos) free of charge in any format or
medium, under the terms of the Open Government Licence. To view this licence, visit
www.nationalarchives.gov.uk/doc/open-government-licence/
© Crown copyright 2016
Published to gov.uk, in PDF format only.
www.gov.uk/dh
Note:
All these tools are available electronically (as Word documents) and pages or boxes
can be expanded as necessary.
It is important to note that these are national tools and the content should not be
changed, added to or abbreviated in any way. However, CCGs may attach their logo
and additional patient identification details if necessary (e.g. adding NHS number,
etc.).
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NHS Continuing Healthcare Checklist
one domain selected in column A in one of the boxes marked with an asterisk (i.e.
those domains that carry a priority level in the Decision Support Tool), with any number
of selections in the other two columns.
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NHS Continuing Healthcare Checklist
16. There may very occasionally be circumstances where a full assessment of eligibility for NHS
Continuing Healthcare is appropriate even though the individual does not apparently meet
the indicated threshold as set out above. A clear rationale must be given in such
circumstances and local protocols followed.
17. The principles in relation to ‘well-managed need’ (outlined in the Assessment of Eligibility
section of the National Framework, paragraphs 142-146) apply equally to the completion of
the Checklist as they do to the Decision Support Tool.
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NHS Continuing Healthcare Checklist
Name D.O.B.
Gender _____________________________
Please ensure that the equality monitoring form at the end of the Checklist is completed
Was the individual involved in the completion of the Checklist? Yes/No (please delete
Yes/No as appropriate)
Was the individual offered the opportunity to have a representative such as a family
member or other advocate present when the Checklist was completed? Yes/No
(please delete as appropriate)
If yes, did the representative attend the completion of the Checklist? Yes/No (please
delete as appropriate)
Please give the contact details of the representative (name, address and telephone
number).
Did you explain to the individual how their personal information will be shared with the
different organisations involved in their care, and did they consent to this information
sharing? Yes/No (please delete as appropriate)
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NHS Continuing Healthcare Checklist
There will be many situations where it is not necessary to complete the Checklist.
Practitioners should review the statements below on when it may not be appropriate to screen for NHS Continuing Healthcare before
they start the process of completing the Checklist.
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NHS Continuing Healthcare Checklist
C B A
Breathing* Normal breathing, no issues with shortness Shortness of breath or a condition, which may require Is able to breathe independently through a
of breath. the use of inhalers or a nebuliser and limit some daily tracheotomy that they can manage
living activities. themselves, or with the support of carers or
OR
care workers.
OR
Shortness of breath or a condition, which
OR
may require the use of inhalers or a nebuliser Episodes of breathlessness that do not consistently
and has no impact on daily living activities. respond to management and limit some daily activities. Breathlessness due to a condition which is
not responding to therapeutic treatment and
OR OR
limits all daily living activities.
Episodes of breathlessness that readily Requires any of the following:
OR
respond to management and have no impact
- low level oxygen therapy (24%);
on daily living activities. A condition that requires management by a
- room air ventilators via a facial or nasal mask; non-invasive device to both stimulate and
other therapeutic appliances to maintain airflow where maintain breathing (non-invasive positive
individual can still spontaneously breathe e.g. CPAP airway pressure, or non-invasive ventilation)
(Continuous Positive Airways Pressure) to manage
obstructive apnoea during sleep.
Brief Write A, B or C
description of below:
need and
source
of evidence to
support the
chosen level
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Name of individual Date of completion
C B A
Nutrition Able to take adequate food and drink by Needs feeding to ensure adequate intake of Dysphagia requiring skilled intervention to ensure
mouth to meet all nutritional requirements. food and takes a long time (half an hour or adequate nutrition/hydration and minimise the risk
OR more), including liquidised feed. of choking and aspiration to maintain airway.
Needs supervision, prompting with meals, or OR OR
may need feeding and/or a special diet (for Unable to take any food and drink by mouth, Subcutaneous fluids that are managed by the
example to manage food but all nutritional requirements are being individual or specifically trained carers or care
intolerances/allergies). adequately maintained by artificial means, for workers.
OR example via a non-problematic PEG. OR
Able to take food and drink by mouth but Nutritional status ‘at risk’ and may be associated
requires additional/supplementary feeding. with unintended, significant weight loss.
OR
Significant weight loss or gain due to an identified
eating disorder.
OR
Problems relating to a feeding device (e.g. PEG)
that require skilled assessment and review.
C B A
Continence Continent of urine and faeces. Continence care is routine but requires Continence care is problematic and requires
monitoring to minimise risks, for example timely and skilled intervention, beyond routine
OR
those associated with urinary catheters, care. (for example frequent bladder wash
Continence care is routine on a day-to-day double incontinence, chronic urinary tract outs/irrigation, manual evacuations, frequent re-
basis. infections and/or the management of catheterisation).
OR constipation or other bowel problems.
AND
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NHS Continuing Healthcare Checklist
C B A
Skin integrity No risk of pressure damage or skin condition. Risk of skin breakdown which requires Pressure damage or open wound(s),
OR preventative intervention several times each pressure ulcer(s) with ‘partial thickness skin
Risk of skin breakdown which requires day, without which skin integrity would break loss involving epidermis and/or dermis’,
preventative intervention once a day or less than down. which is not responding to treatment.
daily, without which skin integrity would break OR OR
down. Pressure damage or open wound(s), pressure Pressure damage or open wound(s),
OR ulcer(s) with ‘partial thickness skin loss pressure ulcer(s) with ‘full thickness skin loss
Evidence of pressure damage and/or pressure involving epidermis and/or dermis’, which is involving damage or necrosis to
ulcer(s) either with ‘discolouration of intact skin’ responding to treatment. subcutaneous tissue, but not extending to
or a minor wound. OR underlying bone, tendon or joint capsule’,
OR An identified skin condition that requires a which is responding to treatment.
A skin condition that requires monitoring or minimum of daily treatment, or daily OR
reassessment less than daily and that is monitoring/reassessment to ensure that it is Specialist dressing regime in place which is
responding to treatment or does not currently responding to treatment responding to treatment.
require treatment.
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NHS Continuing Healthcare Checklist
C B A
Mobility Independently mobile. Not able to consistently weight bear. Completely unable to weight bear and is unable to
assist or cooperate with transfers and/or
OR OR
repositioning.
Able to weight bear but needs some Completely unable to weight bear but is able to
OR
assistance and/or requires mobility assist or cooperate with transfers and/or
equipment for daily living. repositioning. Due to risk of physical harm or loss of muscle
tone or pain on movement needs careful
OR
positioning and is unable to cooperate.
In one position (bed or chair) for majority of the
OR
time but is able to cooperate and assist carers or
care workers. At a high risk of falls (as evidenced in a falls
history and risk assessment).
OR
OR
At moderate risk of falls (as evidenced in a falls
history or risk assessment) Involuntary spasms or contractures placing the
individual or others at risk.
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NHS Continuing Healthcare Checklist
C B A
Communication Able to communicate clearly, verbally or non- Communication about needs is difficult to Unable to reliably communicate their needs at
verbally. Has a good understanding of their understand or interpret or the individual is any time and in any way, even when all
primary language. May require translation if sometimes unable to reliably communicate, practicable steps to assist them have been
English is not their first language. even when assisted. Carers or care workers taken. The individual has to have most of their
may be able to anticipate needs through non- needs anticipated because of their inability to
OR
verbal signs due to familiarity with the communicate them.
Needs assistance to communicate their individual.
needs. Special effort may be needed to
ensure accurate interpretation of needs or
additional support may be needed either
visually, through touch or with hearing.
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NHS Continuing Healthcare Checklist
C B A
Psychological/ Psychological and emotional needs are not Mood disturbance, hallucinations or anxiety Mood disturbance, hallucinations or anxiety
Emotional having an impact on their health and well- symptoms or periods of distress which do not symptoms or periods of distress that have a
being. readily respond to prompts, distraction and/or severe impact on the individual’s health and/or
reassurance and have an increasing impact on well-being.
OR
the individual’s health and/or well-being.
OR
Mood disturbance or anxiety symptoms or
OR
periods of distress, which are having an impact Due to their psychological or emotional state the
on their health and/or well-being but respond Due to their psychological or emotional state individual has withdrawn from any attempts to
to prompts, distraction and/or reassurance. the individual has withdrawn from most engage them in care planning, support and/or
attempts to engage them in support, care daily activities.
OR
planning and/or daily activities.
Requires prompts to motivate self towards
activity and to engage them in care planning,
support and/or daily activities.
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NHS Continuing Healthcare Checklist
C B A
Cognition No evidence of impairment, confusion or Cognitive impairment (which may include Cognitive impairment that could for example
disorientation. some memory issues) that requires some include frequent short-term memory issues and
supervision, prompting and/or assistance with maybe disorientation to time and place. The
OR
basic care needs and daily living activities. individual has awareness of only a limited range
Cognitive impairment which requires some Some awareness of needs and basic risks is of needs and basic risks. Although they may be
supervision, prompting or assistance with evident. able to make some choices appropriate to need
more complex activities of daily living, such on a limited range of issues, they are unable to
The individual is usually able to make choices
as finance and medication, but awareness of do so on most issues, even with supervision,
appropriate to needs with assistance.
basic risks that affect their safety is evident. prompting or assistance.
However, the individual has limited ability even
OR with supervision, prompting or assistance to The individual finds it difficult, even with
Occasional difficulty with memory and make decisions about some aspects of their supervision, prompting or assistance, to make
decisions/choices requiring support, lives, which consequently puts them at some decisions about key aspects of their lives, which
prompting or assistance. However, the risk of harm, neglect or health deterioration. consequently puts them at high risk of harm,
individual has insight into their impairment. neglect or health deterioration.
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NHS Continuing Healthcare Checklist
C B A
Behaviour* No evidence of ‘challenging’ behaviour. ‘Challenging’ behaviour that follows a ‘Challenging’ behaviour of type and/or frequency
predictable pattern. The risk assessment that poses a predictable risk to self, others or
OR
indicates a pattern of behaviour that can be property. The risk assessment indicates that
Some incidents of ‘challenging’ behaviour. managed by skilled carers or care workers who planned interventions are effective in minimising
A risk assessment indicates that the are able to maintain a level of behaviour that but not always eliminating risks. Compliance is
behaviour does not pose a risk to self, does not pose a risk to self, others or property. variable but usually responsive to planned
others or property or create a barrier to The individual is nearly always compliant with interventions.
intervention. The individual is compliant care.
with all aspects of their care.
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NHS Continuing Healthcare Checklist
C B A
Drug therapies Symptoms are managed effectively and Requires the administration of medication (by Requires administration and monitoring of
and medication: without any problems, and medication is a registered nurse, carer or care worker) due medication regime by a registered nurse, carer or
symptom control* not resulting in any unmanageable side- to: care worker specifically trained for this task
effects. because there are risks associated with the
– non-compliance, or
potential fluctuation of the medical condition or
OR
– type of medication (for example insulin); or mental state, or risks regarding the effectiveness
Requires supervision/administration of of the medication or the potential nature or
– route of medication (for example PEG).
and/or prompting with medication but severity of side-effects. However, with such
shows compliance with medication regime. OR monitoring the condition is usually non-
OR Moderate pain which follows a predictable problematic to manage.
pattern; or other symptoms which are having a OR
Mild pain that is predictable and/or is
moderate effect on other domains or on the
associated with certain activities of daily Moderate pain or other symptoms which is/are
provision of care.
living; pain and other symptoms do not having a significant effect on other domains or on
have an impact on the provision of care. the provision of care.
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NHS Continuing Healthcare Checklist
C B A
Altered states of No evidence of altered states of Occasional (monthly or less frequently) Frequent episodes of ASC that require the
consciousness* consciousness (ASC). episodes of ASC that require the supervision of supervision of a carer or care worker to
a carer or care worker to minimise the risk of minimise the risk of harm.
OR
harm.
OR
History of ASC but effectively managed and
there is a low risk of harm. Occasional ASCs that require skilled
intervention to reduce the risk of harm.
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NHS Continuing Healthcare Checklist
Contact details of assessors (name, role, organisation, telephone number, email address)
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NHS Continuing Healthcare Checklist
Male A White
Female English/Welsh/Scottish/Northern
Irish/British
In another way
Irish
Prefer not to answer
Gypsy or Irish Traveller
Any other White background, write below
65-74 Indian
75-84 Pakistani
85+ Bangladeshi
Prefer not to answer Chinese
Any other Asian background, write below
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NHS Continuing Healthcare Checklist
5 What is your religion or belief?
Tick one box only.
None
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Prefer not to answer
Any other religion, write below
Heterosexual or Straight
Gay or Lesbian
Bisexual
Prefer not to answer
Other, write below
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