The NHS Continuing Healthcare checklist and assessment
NHS Continuing Healthcare is decided in two stages: a screening checklist, then a full assessment against twelve care domains. Knowing how each stage is scored helps you prepare.
The CHC process starts with a screening checklist, usually completed by a nurse or social worker, which scores eleven care areas A, B or C. Enough high scores trigger a full assessment, where a multidisciplinary team uses the Decision Support Tool to score twelve care domains from no needs to priority. Broadly, one priority score or two severe scores indicates eligibility, and other combinations are judged on the overall picture of complexity, intensity and unpredictability. The threshold at the checklist stage is deliberately low, so do not be discouraged by a referral that later fails: ask for the assessment, attend it, and bring evidence.
At a glance
- Stage 1Screening checklist, 11 care areas scored A, B or C
- Stage 2Full assessment with the Decision Support Tool, 12 domains
- Decided byA multidisciplinary team, commissioned by the NHS
- Key testA primary health need: nature, complexity, intensity, unpredictability
- Cost to youNothing. CHC assessment and funding are free
- If refusedYou can challenge the decision, see our appeals guide
What the CHC checklist is
The checklist is a screening tool, not the decision. It exists to decide one thing: whether you should have a full Continuing Healthcare assessment. It is usually completed by a nurse, GP, social worker or other professional involved in your care, and it can be done in hospital, at home or in a care home. You, or a family member with authority, should be invited to take part and you are entitled to a copy of the completed form.
The checklist looks at eleven care areas, including behaviour, cognition, mobility, nutrition, continence, skin integrity, breathing, medication, altered states of consciousness and psychological needs. Each is scored A for the highest level of need, B for moderate, or C for low or no need.
What scores trigger a full assessment
The threshold is intentionally set low so that anyone who might qualify gets a proper look. As a guide, a full assessment follows when the checklist shows two or more A scores, five or more B scores, one A plus four Bs, or an A score in certain priority areas. A professional can also refer you straight to a full assessment without a checklist where needs are clearly substantial, and a fast track route exists for people who are deteriorating rapidly or approaching the end of life.
If the checklist is negative you can ask the integrated care board to reconsider, and you can ask for it to be redone if needs change. Keep a copy, note anything you think was underscored, and put your reasons in writing.
The full assessment and the Decision Support Tool
The full assessment is carried out by a multidisciplinary team, which must include at least two professionals from different healthcare professions or one health and one social care professional. They complete the Decision Support Tool, which scores twelve care domains from no needs through low, moderate, high and severe to priority. Four domains, breathing, behaviour, drug therapies and altered states of consciousness, carry the top priority level.
| Indicative outcome | What it usually means |
|---|---|
| One priority score | Eligibility for CHC is indicated |
| Two or more severe scores | Eligibility for CHC is indicated |
| One severe plus several high or moderate | Possible eligibility, judged in the round |
| Lower combinations | Decided on complexity, intensity and unpredictability |
Scores alone do not decide it. The team must judge whether, taken together, your needs show a primary health need by weighing their nature, complexity, intensity and unpredictability. That is why the evidence you bring matters: care home daily notes, hospital discharge summaries, medication charts, falls and behaviour logs, and specialist letters all feed the picture.
How to prepare for an assessment
- Ask for the assessment in writing and keep copies of everything
- Gather care notes, medication records and incident logs before the meeting
- Describe the worst days and nights, not just a good day
- Attend the assessment, or have a family member or advocate attend
- Ask the team to record any disagreement with a score in the document
- Get the completed Decision Support Tool and the written decision
The decision should normally arrive within 28 days of the referral for a full assessment. If you qualify, the NHS pays the full cost of your assessed care, including a care home placement where that is the setting, and the funding is not means-tested. If you are turned down, our guide to CHC appeals explains the next steps, and our main NHS Continuing Healthcare guide covers who qualifies.
The NHS Continuing Healthcare checklist and assessment: common questions
What are the four criteria for CHC?
Assessors judge whether your needs show a primary health need by weighing four characteristics: their nature, their complexity, their intensity and their unpredictability. The Decision Support Tool scores feed that judgement rather than replacing it.
What scores do you need on the CHC checklist?
A full assessment usually follows from two or more A scores, five or more B scores, one A plus four Bs, or an A in certain priority areas. The screening threshold is deliberately low so that borderline cases get a full assessment.
How difficult is it to get NHS Continuing Healthcare?
The full assessment has a high bar: most people assessed are not found eligible, because the test is a primary health need rather than a diagnosis. Cases with priority or multiple severe level needs, strong day-by-day evidence and family advocacy stand the best chance.
What are the common CHC pitfalls?
The frequent ones are going into the assessment without care notes and logs, describing a good day rather than the hardest days, not attending the multidisciplinary team meeting, and accepting underscored domains without asking for the disagreement to be recorded. All are avoidable with preparation.
Who carries out the CHC assessment?
A multidisciplinary team commissioned by your local integrated care board completes the Decision Support Tool and recommends a decision. The team must include professionals from at least two disciplines who know about your needs, and you and your representatives are entitled to take part.
Does a CHC assessment cost anything?
No. The checklist, the full assessment and any funding awarded are free. CHC is NHS funding and is not means-tested, so your savings, income and home are irrelevant to the decision.
Related guides
Need help with your own situation?
We can introduce you to an FCA-authorised care funding specialist who will look at your circumstances and the options.