Step 2 – the full assessment. The CCG will choose someone to co-ordinate
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, 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 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
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
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,
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,
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.)
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
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
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,
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
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:
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,
1. Breathing – This is about your needs with any breathing difficulties you may have,

like breathlessness, asthma, or Chronic Obstructive Pulmonary Disease.
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
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.
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
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
this, or if you need help with things like managing constipation, catheters, urinary

tract infections, and so on.
tract infections, and so on.

4. Skin Integrity– This is about looking after your skin. Some people are more at risk
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
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.
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
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
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
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
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.
of pictures or Braille, hearing aids or other communication technology.

7. Psychological and emotional needs – This is about your mental and emotional health,
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
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
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.
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,
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
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.
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
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
being frustrated because you have difficulty communicating with others. Some behaviour

is difficult for others to cope with, which is called ‘challenging’ behaviour, or
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
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
support and care. 10. Drug therapies and medication – This

is about your experience of your symptoms and the medication you need. This could mean
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
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
and supervision with medication. 11. Altered states of consciousness – This

is about the conditions that affect consciousness, like having epilepsy or Transient Ischaemic
is about the conditions that affect consciousness, like having epilepsy or Transient Ischaemic

Attacks (TIAs) which are like mini strokes.
Attacks (TIAs) which are like mini strokes.

Section 12 is for ‘other significant care needs’ that are not described in the other
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.
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
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
‘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:
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’,
‘No needs’, ‘Low’, ‘Moderate’, ‘High’ and – for some domains – ‘Severe’,

or ‘Priority’. The domains and weightings are shown in a
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
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
together. If all your care needs are measured as ‘No

need’ or ‘Low need’, this shows that you are not eligible for CHC.
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
However, if your care needs include one ‘Priority’, or two or more ‘Severe’ weightings, then

you are very likely to be eligible for CHC.
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
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.
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
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.
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
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.
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
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
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.
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
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 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
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.
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
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
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
out if they think you have a primary health need, and should therefore be eligible for

CHC. This is called their recommendation.
CHC. This is called their recommendation.

When the Assessment of your needs and Decision Support Tool are complete, you need to check
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.
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
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
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
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
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
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.
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
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
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
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
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
‘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.
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
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,
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
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’.
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
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
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 for the NHS care you need. If you’re not eligible for joint funding,

you may be eligible for support from your local authority.
you may be eligible for support from your local authority.