Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. Mental Capacity Act 2005, c. 9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
Copywright
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Abstract
This guide addresses NHS Continuing Healthcare from the position of a care home manager or registered manager. It covers when to raise the question, how to request a Checklist, the records that determine outcomes, the recording practices that undermine residents, the conflict of interest concern and how to handle it, supporting families through the process, and the position at review.
Care home managers and CHC referral
Care home managers hold most of the evidence that decides NHS Continuing Healthcare cases, and they are frequently the first to notice that a resident's needs have moved. That puts you in a position no family member or assessor can occupy.
When to raise it
On admission where needs are already substantial, following a significant deterioration or clinical event, where the package has increased materially, where a resident is returning from hospital with new needs, or where staffing for that resident has had to be increased. Any of those is a reasonable point to ask whether a Checklist should be completed.
How to request a Checklist
Contact the Integrated Care Board's continuing healthcare team, or raise it with the resident's GP, district nurse or social worker. Put the request in writing with a short summary of the needs prompting it. A registered manager raising it carries weight, since it comes from the professionals delivering the care daily.
Your records decide the outcome
Daily notes, repositioning charts, food and fluid records, behaviour support plans, incident logs, as required medication records and night records are the evidence base for any assessment. What is written contemporaneously by your staff will carry more weight than anything said in the meeting, including by you.
Recording practice that undermines residents
Entries such as settled, no concerns, slept well and personal care given describe outcomes rather than needs. They are efficient to write and they are how a resident with substantial needs comes to look straightforward on paper. Recording what was required, how many staff, how long it took and what was difficult produces a fairer record.
Night records specifically
Night entries are frequently the thinnest in any file and are the most commonly missing evidence at assessment. Where a resident needs repositioning, continence care, reassurance or supervision overnight, that should be recorded with the same detail as daytime care. It is the single most valuable recording improvement most homes can make.
The conflict of interest question
Managers sometimes hesitate because raising CHC can appear to be advocating for a funding outcome that benefits the home commercially. The answer is to record and report factually rather than argue eligibility. Describe what the resident needs and what your staff provide. The eligibility conclusion belongs to the Board, and your role is to give it accurate material.
Supporting families and at review
Families frequently do not know the process exists. Signposting them is appropriate and helpful. At review, the same risks apply as at first assessment: a resident stable under a good package can be recorded as improved. Ensure the records show what maintains that stability rather than only the result.
Key takeaway
Raise it when needs change and put the request in writing. Improve recording so it describes need rather than outcome, particularly overnight. Report factually rather than arguing eligibility, and the conflict concern resolves itself.
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Frequently asked questions
Can a care home request a CHC Checklist?
Yes. Contact the Integrated Care Board's continuing healthcare team or raise it with the GP, district nurse or social worker, in writing with a short summary of the needs prompting the request.
Is it a conflict of interest for us to raise it?
Not where you record and report factually rather than arguing eligibility. Describe what the resident needs and what staff provide. The eligibility conclusion belongs to the Board.
Which records matter most?
Daily notes, repositioning charts, food and fluid records, behaviour support plans, incident logs, as required medication records and night records. Night records are the most commonly missing evidence.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.