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. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. Department of Health and Social Care (2022) NHS Continuing Healthcare Checklist.
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains the breathing domain of the NHS Continuing Healthcare Decision Support Tool. It covers what the domain includes, the levels available including priority, the interventions that indicate higher levels, common examples at each end of the range, where needs are under-recorded, and the evidence that supports an accurate level.
The breathing domain in the CHC Decision Support Tool
Breathing is one of only four domains that can reach a priority level, which makes it one of the most significant in the whole Decision Support Tool. Where breathing needs are present, this domain deserves particularly careful attention.
What the domain covers
Breathing covers respiratory function and any intervention required to maintain it. That includes breathlessness and its effect on daily activity, oxygen therapy, nebulisers and inhalers, suction, chest physiotherapy, tracheostomy care, non-invasive ventilation and full ventilation. It also covers the monitoring required to recognise deterioration and the skill needed to respond to it.
Why it can reach priority
Breathing is one of four domains that carry a priority level, alongside behaviour, drug therapies and medication, and altered states of consciousness. A single priority level would be expected to indicate a primary health need. That reflects the immediacy of the risk, since respiratory compromise can become life threatening within minutes rather than hours.
What indicates the higher levels
The higher levels are indicated by the degree of intervention required and the immediacy of risk. Regular suction, tracheostomy management, ventilation requiring trained intervention, and unpredictable episodes needing urgent skilled response all point upward. So does a need for continuous monitoring by someone competent to recognise and act on deterioration.
Common examples
At the lower end, occasional breathlessness managed with an inhaler used independently. In the middle, breathlessness limiting activity with prescribed oxygen and periodic review. Towards the top, a tracheostomy requiring regular suction by trained staff, or ventilation where the person cannot survive without trained intervention being immediately available at all times.
Where it is under-recorded
The most common problem is recording the stable presentation. Someone on well managed oxygen with a settled routine may look unremarkable on the day, while the underlying need is significant and the consequence of interruption severe. The well-managed need principle applies directly here. Night time breathing difficulties and episodic distress are also routinely missed because the assessment happens during the day.
Evidence that helps
Oxygen saturation records, prescription and administration records for oxygen and nebulisers, suction frequency logs, respiratory review letters, hospital admission records for respiratory causes, tracheostomy care plans and any record of emergency response. Records of what happened during any period when equipment failed or a routine lapsed are particularly valuable.
Key takeaway
Breathing can reach priority, and a properly evidenced priority level would be expected to indicate a primary health need. Record the need without the intervention in place, capture night time and episodic difficulty, and evidence the skill and frequency of what is required.
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Frequently asked questions
Can the breathing domain reach priority?
Yes. It is one of four domains carrying a priority level, alongside behaviour, drug therapies and medication, and altered states of consciousness. A single priority level would be expected to indicate a primary health need.
Does being on oxygen mean a high level?
Not automatically. What matters is the degree of need, the skill required to manage it and the consequence of interruption. Well managed oxygen with a settled routine may sit lower than an unstable picture requiring frequent skilled response.
Should stable breathing be recorded as no need?
No. A need controlled by intervention remains a need. The record should describe the position without the oxygen, nebuliser or suction in place, alongside the intervention required to maintain stability.
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.