Step 2 – the full assessment. The CCG will choose someone to co-ordinate
the full assessment, so that you have a named person to check things with.
The full assessment has two parts – an Assessment of Needs, and the Decision Support Tool.
The Assessment of needs must give accurate and up-to-date information about your health
and social care needs. This information should come from you and your family, and a multi-disciplinary
team involved in your care. (A multi-disciplinary team is a group of 2 or more professionals,
who are different types of health and social care workers, like psychiatrists, nurses,
social workers, care managers, occupational therapists, and so on, who work together.)
The multi-disciplinary team uses all of the information from your assessment of needs
to complete the Decision Support Tool. The finished Decision Support Tool helps the
CCG decide if you should get CHC or not. The Decision Support Tool has 12 sections,
called Domains. Each domain helps you think about a different care need, and consider
the sort of support and how much support is needed to manage it. The domains are:
1. Breathing – This is about your needs with any breathing difficulties you may have,
like breathlessness, asthma, or Chronic Obstructive Pulmonary Disease.
2. Nutrition – This is about whether you can eat and drink, and if you need help with
this, like feeding by PEG, or if you have problems swallowing, like dysphagia.
3. Continence – This is about your needs with using the loo, like whether you can control
this, or if you need help with things like managing constipation, catheters, urinary
tract infections, and so on.
4. Skin Integrity– This is about looking after your skin. Some people are more at risk
because they have a skin condition, which can break their skin down, or they may have
pressure damage or wounds that take a long time to heal.
5. Mobility – This is to do with how well you can move and control your body, and if
you can stand or walk. It’s important to think about your safety, and if you are at
risk of falling and need support. 6. Communication – This is about whether
you can express your needs and understand others, in ways like talking or signing, use
of pictures or Braille, hearing aids or other communication technology.
7. Psychological and emotional needs – This is about your mental and emotional health,
including things like mood disturbances, hallucinations, or anxiety. It’s also about the effects
of these, like when people have depression they may get very withdrawn and refuse to
accept help from others, which makes it harder for them to get better.
8. Cognition – This is to do with brain skills, like memory, understanding risks,
decision-making, understanding where you are, and road safety. This affects the type of
support you need to manage your day-to-day life and stay safe from harm.
9. Behaviour – This is about the way you behave, like being aggressive or noisy, or
being frustrated because you have difficulty communicating with others. Some behaviour
is difficult for others to cope with, which is called ‘challenging’ behaviour, or
some behaviours could be a risk to you, or other people, or things, and will need special
support and care. 10. Drug therapies and medication – This
is about your experience of your symptoms and the medication you need. This could mean
things like coping with pain, insulin injections, any side effects, or if you need prompting
and supervision with medication. 11. Altered states of consciousness – This
is about the conditions that affect consciousness, like having epilepsy or Transient Ischaemic
Attacks (TIAs) which are like mini strokes.
Section 12 is for ‘other significant care needs’ that are not described in the other
domains, if the care needs are really important for you.
The order in which you think about the domains doesn’t matter, as long as you think about
‘other significant care needs’ last. Workers from the multi-disciplinary team write
about your care needs for each domain. They also measure your needs with these weightings:
‘No needs’, ‘Low’, ‘Moderate’, ‘High’ and – for some domains – ‘Severe’,
or ‘Priority’. The domains and weightings are shown in a
chart, called the Assessment of needs table. This can give a good picture of all your needs
together. If all your care needs are measured as ‘No
need’ or ‘Low need’, this shows that you are not eligible for CHC.
However, if your care needs include one ‘Priority’, or two or more ‘Severe’ weightings, then
you are very likely to be eligible for CHC.
If your care needs show a mix of different weightings, you may still be eligible for
CHC because we also consider the Nature, Intensity, Complexity and Unpredictability of your needs.
Nature: This describes what your needs are like, and the effect they have on you, including
the type of support or treatment that works best to manage those needs.
Intensity: This describes how much (like how often) and how severe your needs are. It also
describes the support needed to help you, including the need for ongoing care.
Complexity: This is about how your needs affect each other, like if one of your needs makes
another need change or get worse, and become difficult to manage. It also describes the
level of skill needed to check your symptoms, treat the condition and/or manage your care.
Unpredictability: This is about how much and how often your needs can change, and what
the challenges are for the people who give you care and support. It should also explain
the risk to your health if the right care is not given at the right time. Someone with
an unpredictable healthcare need is likely to have a changeable and unstable condition.
The Decision Support Tool helps health and social care workers identify and describe
your needs. With this knowledge and their skills and professional judgement, they work
out if they think you have a primary health need, and should therefore be eligible for
CHC. This is called their recommendation.
When the Assessment of your needs and Decision Support Tool are complete, you need to check
if you agree with what has been written about you.
The multi-disciplinary team can give you a copy of all the forms and documents that have
been written. The documents and the recommendation are also
shared with the CCG, and the CCG decides if they agree with the recommendation. The CCG
usually agree with the recommendation from the multi-disciplinary team, unless there
are very strong reasons why they can’t. You will then get a letter from the CCG saying
whether you are eligible for CHC. If you are not eligible, the CCG should explain why.
If the CCG decides you should not have CHC but you have good reason to think this is
wrong, you can ask them to think again about their decision. The CCG will listen to you
to understand why you disagree with the decision. They will check the multi-disciplinary team
looked at all the important information to make the correct recommendation. This is called
‘local resolution’ and normally sorts out any disagreements. If you’re still unhappy
with the CCG decision, you can then ask for an independent review from NHS England.
If you aren’t eligible for CHC, the NHS may still have a responsibility to provide
you with care and support to help you manage your health needs, like by commissioning services,
or paying for some of your help and support. Care that is commissioned or paid for by a
local authority and a CCG is called ‘joint-funding’ or a ‘joint package’.
If your care is paid for by the CCG and the local authority together, you may have to
pay a contribution (or part of the cost) for your social care. The CCG will not charge
you for the NHS care you need. If you’re not eligible for joint funding,
you may be eligible for support from your local authority.