The CHC checklist and assessment: how to prepare

The CHC Checklist is the screening gate to NHS Continuing Healthcare — the NHS funding that pays for all of someone’s assessed care. Anyone can request one, from a nurse, social worker, GP or hospital discharge team, and the threshold is deliberately set low. If your parent is screened in, a full assessment follows, and that is where preparation makes a real difference: the families who keep a needs diary, gather evidence and attend the meeting give a genuine case its fair shot. This guide covers each step. It applies to England.

This guide is general information, not financial or legal advice. For advice about your own situation, speak to a regulated professional, or a free service such as Citizens Advice or Age UK.

What is the CHC Checklist and how do you get one?

NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS for people whose needs are primarily health needs — no means test, no age limit. We explain who qualifies and what it pays for in our complete guide to NHS Continuing Healthcare.

The Checklist is stage one: a short screening tool completed by a health or social care professional — a nurse, social worker or GP, for example. It does not decide eligibility. Its only job is to decide whether your parent should go through to a full assessment, and the bar is deliberately low so that people are not screened out wrongly.

You do not have to wait to be offered one. Ask directly:

• In hospital: ask the ward or discharge team for CHC screening before discharge is finalised — and before anyone agrees to pay for care privately. Our guide to hospital discharge for an elderly parent explains where this fits in the discharge process.
• In a care home: ask the manager or the visiting community nurse.
• At home: ask the GP or your parent’s social worker.

If the professional declines to complete a Checklist, ask for the reasons in writing. The official overview of the process is on nhs.uk.

One exception to the two-stage process: if your parent’s condition is deteriorating rapidly and may be entering a terminal phase, ask about the Fast Track route instead. A clinician completes a Fast Track tool — no Checklist, no full assessment — and the care package should be arranged urgently, usually within days.

What happens if your parent is screened in?

A multidisciplinary team (MDT) — professionals from health and social care who know or have assessed your parent — carries out the full assessment using the Decision Support Tool (DST), a national form that scores needs across twelve care domains:

1. Breathing
2. Nutrition
3. Continence
4. Skin integrity
5. Mobility
6. Communication
7. Psychological and emotional needs
8. Cognition
9. Behaviour
10. Drug therapies and medication
11. Altered states of consciousness
12. Other significant care needs

Each domain is scored from “no needs” up to “severe” or, in a few domains, “priority”. Broadly, one priority score or two severe scores indicates eligibility; other combinations need judgement about whether the needs, taken together, amount to a primary health need. The MDT then makes a recommendation, and the Integrated Care Board (ICB) — the local NHS body holding the budget — makes the decision.

The scores agreed in that meeting largely shape the outcome. That is why the rest of this guide is about arriving prepared.

How do you prepare for the assessment?

Keep a needs diary. Start today. Dates, incidents, and what intervention was needed: the 3am fall, the refused tablets, the afternoon your father tried to leave the house and could not say where he was going. Real, dated examples carry far more weight than “she needs a lot of help”.

Gather the paperwork. Care plans, medication lists, falls and incident reports, district nurse notes, letters from the GP or consultants. If an incident happens, ask the professionals involved to record it — the written record needs to show the hard days, because assessors work from what is documented.

Prepare worst-day evidence. Needs that are well managed and stable often score lower than families expect, so do not let a calm week on paper misrepresent a fluctuating condition. For each domain that applies, have two or three specific worst-day examples ready.

Decide who is coming. Families should be involved in the MDT meeting. Attend if you possibly can, and take someone with you — a sibling, a friend, or an adviser — to take notes and keep you steady. It is a long meeting about someone you love, and a second pair of ears helps.

What should you do at the meeting?

• Contribute. You know the day-to-day reality better than anyone in the room. Describe it plainly, worst days included.
• Challenge scores you disagree with — at the meeting. If cognition is scored “moderate” and you have diary entries showing otherwise, say so and give your examples. It is much easier to influence a score before it is finalised than to appeal it afterwards.
• Ask for disagreements to be recorded. If the MDT will not move on a score, ask for your disagreement and your reasons to be noted in the DST.
• Ask for everything in writing. Request a copy of the completed DST and the written reasons for the eventual decision.

What happens after the decision?

The ICB’s decision should normally arrive within 28 days of the referral for full assessment, though delays happen in practice. If CHC is awarded, the NHS arranges and funds the care package; the award is reviewed after three months and then at least annually.

If it is refused, that is not necessarily the end. You can seek local resolution with the ICB, then an Independent Review Panel, and ultimately the Parliamentary and Health Service Ombudsman — and people in nursing homes who miss out on CHC should still be assessed for NHS-funded nursing care. The full CHC guide explains the appeal routes and the fallback options, and if the answer stays no, paying for care runs through the council’s means test instead.

Where can you get free help?

You do not have to do this alone, and you do not have to pay anyone:

• Beacon provides free independent information and advice specifically on CHC, including on assessments and appeals.
• Age UK has clear factsheets and a national advice line.
• Alzheimer’s Society has guidance on CHC where dementia is involved.

And while the CHC process runs, make sure the easier money is not being missed — Attendance Allowance, Pension Credit and council tax support are far simpler to claim. Our free benefits check takes a few minutes and shows what your parent could be entitled to.