NHS Continuing Healthcare checklist: what happens at each stage

By CareFinder Team · Published 2026-09-17 · Last reviewed 2026-09-17

The NHS Continuing Healthcare Checklist is a short screening tool used in England to decide whether someone should have a full CHC assessment. A nurse, doctor or social worker scores 11 areas of need as A, B or C. If the threshold is met, a multidisciplinary team completes the Decision Support Tool, and the integrated care board should normally decide eligibility within 28 days of receiving the Checklist.

NHS Continuing Healthcare (CHC) is fully funded NHS care for adults whose main need for care is a health need. Before anyone is assessed properly, most people go through a short screening step called the Checklist. This page walks through what happens at each stage, who does what, how long it should take and where families can realistically influence the outcome.

This article covers the process in England. Wales runs a similar but separate system, and Scotland and Northern Ireland do things differently — see the section near the end.

What is the NHS Continuing Healthcare Checklist, and who completes it?

The Checklist is a short screening tool set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Its job is not to decide whether someone gets funding. Its only job is to decide whether a full assessment should happen.

It can be completed by a range of trained health and social care staff, including:

• a hospital nurse or discharge coordinator
• a community nurse or district nurse
• a GP or hospital doctor
• a social worker or care manager
• other registered professionals, such as a therapist

The threshold is deliberately low. The Framework is clear that the Checklist should err on the side of referring people on, so a positive Checklist is common and does not mean funding is likely. Equally, a negative Checklist is not a judgement that someone's needs are minor — only that they do not appear to meet a primary health need.

You can ask for a Checklist. If a relative's health needs have changed — after a stroke, a fall, a new diagnosis, or a clear deterioration in dementia — you can ask the ward, the GP, the district nurse or the local authority to complete one. It is reasonable to put the request in writing.

When a Checklist should not be used

A Checklist is not always the first step:

• Where someone has a rapidly deteriorating condition that may be entering a terminal phase, the Fast Track Pathway Tool should be used instead (see below).
• The integrated care board (ICB) can go straight to a full assessment if it is obvious that one is needed.
• The Framework says assessments should not usually be carried out in an acute hospital bed, because someone's needs immediately after an illness or operation are not a fair picture of their long-term needs. A Checklist may still be done in hospital to plan discharge, but the full assessment should ideally happen once the person is stable, often after a period of rehabilitation or reablement.

Stage 1: the Checklist itself — how scoring works

The Checklist covers 11 areas of need, known as domains:

• Behaviour
• Cognition
• Psychological and emotional needs
• Communication
• Mobility
• Nutrition (food and drink)
• Continence
• Skin integrity, including wounds and pressure damage
• Breathing
• Drug therapies and medication, including symptom control
• Altered states of consciousness

Each domain is scored A, B or C, with A indicating the highest level of need described in that domain and C the lowest. The assessor chooses the description that best fits the person's needs as they actually are, with the care they currently receive stripped out of the picture — in other words, what the person needs, not how well a good care home happens to be managing it.

A referral for full assessment should be made where there are:

• two or more domains scored A; or
• five or more scored B, or four Bs plus one A; or
• one A in any of the four domains where the highest level of need can later be scored as "priority" — behaviour, breathing, drug therapies and symptom control, or altered states of consciousness.

A professional can also refer on below these thresholds if their judgement says the person may be eligible. The reasons must be recorded.

Your rights at this stage

• The person (or their representative) should be told that a Checklist is being completed and be given the chance to be involved.
• Where the person has capacity, their consent is needed before a full assessment goes ahead and before information is shared. If they lack capacity, a best interests decision applies under the Mental Capacity Act 2005.
• The completed Checklist, with the reasons for each score, should be given to the person in writing, whatever the outcome.

Stage 2: what happens if the Checklist is positive?

A positive Checklist triggers a full assessment of eligibility, carried out by a multidisciplinary team (MDT) of at least two professionals from different professions — typically a nurse assessor and a social worker, sometimes with input from a therapist, GP or specialist.

The MDT completes the Decision Support Tool (DST). This covers 12 domains (the 11 above, plus "other significant care needs") and uses a finer scale: no needs, low, moderate, high, severe and, in four domains, priority.

The MDT then has to weigh up whether the person has a primary health need, looking at four key characteristics of their needs:

• Nature — the type of need and the sort of skill required to meet it
• Intensity — how much care is needed and how continuous it is
• Complexity — how the needs interact and how difficult they are to manage
• Unpredictability — how much the needs fluctuate, and the risk if they are not met promptly

As a rule of thumb, one "priority" score, or two or more "severe" scores, usually indicates eligibility. Other combinations require careful professional judgement, and the written rationale matters more than the pattern of ticks.

The person and their representative should be invited to the MDT meeting and given a chance to contribute. Ask for the draft DST in advance if you can.

Stage 3: who makes the final decision, and how long should it take?

The MDT makes a recommendation. The formal decision is made by the integrated care board. The Framework says ICBs should only rarely go against an MDT recommendation, and must give clear reasons in writing if they do.

On timing: in most cases, the ICB should make an eligibility decision within 28 days of receiving the completed Checklist or the request for a full assessment. Delays beyond that should be explained, and if funding is later awarded the ICB should consider backdating to the 29th day where the delay was theirs.

The outcome should be sent in writing, with the reasons and details of how to ask for a review.

Stage 4: what happens after the decision?

If your relative is found eligible, the NHS pays for their whole package of assessed care — including the full cost of a care home place, if that is where their needs are best met. It is not means-tested. You can ask about a personal health budget so the family has more say over how care is arranged.

Eligibility is reviewed around three months after the initial decision, then at least annually. Needs can improve, and funding can be withdrawn — but only after a proper reassessment using the same process, not by a phone call or a letter out of the blue.

If your relative is found not eligible, the local authority becomes responsible for assessing their care and support needs, and a financial assessment will follow. Two things are worth checking:

• If they live in a nursing home, they may qualify for NHS-funded Nursing Care, a flat weekly NHS contribution towards the registered nurse element of their care. It is a single national rate, set out in the Standing Rules and amended each financial year by the Department of Health and Social Care, so ask the ICB or the care home for the current figure.
• If they were previously detained under section 3 of the Mental Health Act, section 117 aftercare may cover relevant services free of charge, regardless of CHC.

What about the Fast Track pathway?

Where someone has a rapidly deteriorating condition that may be entering a terminal phase, an "appropriate clinician" — usually a consultant, GP or specialist nurse responsible for their care — can complete the Fast Track Pathway Tool. No Checklist, no MDT, no scoring.

A properly completed Fast Track must be accepted by the ICB and acted on urgently, so care can be put in place in days rather than weeks. If a hospital or hospice is talking about end of life care and no one has mentioned Fast Track, ask about it directly. Marie Curie has practical guidance on care at the end of life.

How can families prepare for each stage?

You cannot change the criteria, but you can change the quality of the evidence in front of the assessors.

1. Ask for the paperwork in advance — the Checklist, and later the draft DST and the "needs portrayal" that sits behind it.
2. Keep a two-week diary of what actually happens: night-time waking, refusals of food or medication, falls, distress, wound care, how often staff intervene.
3. Request the care home's daily records, MAR charts, body maps and incident logs. These often show far more need than a single assessment visit.
4. Describe difficult days as well as good ones. Unpredictability is one of the four key characteristics, and a need that is well managed is still a need.
5. Bring someone with you. A second pair of ears helps, and Age UK and local advocacy services can support you.
6. Ask for the reasons for each domain score to be read out and recorded at the meeting, rather than written up afterwards.

What if you disagree with the outcome?

There is no formal appeal against a negative Checklist, but you can write to the ICB and ask it to reconsider and to explain its reasoning. ICBs are expected to respond and, where appropriate, arrange a full assessment.

Against a negative eligibility decision, there is a two-stage process in England:

1. Local resolution by the ICB. Every ICB must publish its own local resolution process, including its timescales, so check the deadline given in your decision letter. Set out which domain scores you disagree with and why, with evidence.
2. Independent review by NHS England, if you remain dissatisfied. A panel considers whether the process was followed properly and whether the eligibility decision was correct.

After that, the Parliamentary and Health Service Ombudsman can look at complaints about how the process was handled.

Does this apply across the whole of the UK?

The Checklist described above, and the 28-day timescale, apply in England.

Frequently asked questions

Can I ask for a Checklist myself, or does a professional have to suggest it?

You can ask. Contact the ward, the GP, the district nurse or the local authority social work team and ask for a CHC Checklist to be completed, ideally in writing. If they decline, ask for the reason in writing and take it up with the ICB's continuing healthcare team.

Does a positive Checklist mean my mother will get funding?

No. The Checklist is a low-threshold screening tool, designed to catch anyone who might be eligible. Many people who screen in are later found not eligible at full assessment. It does mean she is entitled to a proper multidisciplinary assessment.

Does a dementia diagnosis on its own qualify someone?

No. Eligibility is never based on a diagnosis, a setting or who provides the care. It is based on the nature, intensity, complexity and unpredictability of the person's day-to-day needs. Alzheimer's Society and Dementia UK have guidance on presenting dementia-related needs at assessment.

What if my relative lacks capacity to consent?

A decision is made in their best interests under the Mental Capacity Act 2005. If there is no appropriate family member or friend to consult, the ICB should instruct an independent mental capacity advocate. An attorney or deputy for health and welfare can consent on their behalf.

Can funding be taken away once it has been granted?

Yes, if a proper review finds the person no longer has a primary health need — for example after recovery or rehabilitation. The review must use the full process, the person and family should be involved, and there should be a planned handover to local authority arrangements rather than an abrupt stop.

Can we claim back care fees paid while we waited?

Sometimes. If the ICB caused the delay beyond 28 days and the person is found eligible, funding should normally be backdated to the 29th day after the Checklist or referral was received. Ask about this explicitly when the decision is confirmed.

Key takeaways

• The Checklist is a screening step, not a funding decision, and the threshold is deliberately low.
• It scores 11 domains as A, B or C; specific combinations trigger a full assessment.
• A positive Checklist leads to a multidisciplinary assessment using the 12-domain Decision Support Tool and the four key characteristics of need.
• The ICB should normally decide within 28 days of receiving the Checklist, and should rarely go against the MDT's recommendation.
• Fast Track replaces the whole process where someone is rapidly deteriorating and may be approaching the end of life.
• Negative decisions can be challenged through local resolution and then NHS England independent review.
• Care records, a needs diary and attendance at the MDT meeting are the most useful things families can bring.

This page is general information about how the process works in England, not advice about an individual case. For personal help, speak to the ICB's continuing healthcare team, or contact Age UK, Citizens Advice or Carers UK. For decisions involving significant money — selling a home, deprivation of assets, deferred payment agreements — take independent financial or legal advice; MoneyHelper is a good starting point.