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 continence domain of the NHS Continuing Healthcare Decision Support Tool. It covers bladder and bowel needs, catheter and stoma management, bowel programmes, the interaction with skin integrity, the levels available in this domain, where needs are commonly under-recorded, and the evidence that supports an accurate level.
The continence domain in the CHC Decision Support Tool
Continence is frequently treated as a routine care task rather than a clinical need, which is why it is one of the more commonly under-recorded domains. Where catheters, stomas or managed bowel programmes are involved, the need is squarely clinical.
What the domain covers
Bladder and bowel function and the management required, including continence products, prompting and toileting programmes, indwelling and intermittent catheterisation, catheter maintenance and problems, stoma care, constipation and impaction management, and bowel programmes including manual evacuation where required.
Where it becomes clinical
The clearest clinical indicators are catheter management, stoma care and prescribed bowel programmes. Each requires trained delivery, monitoring for complications and a response when things go wrong, such as blockage, bypassing, infection or failure of a programme. These are not routine personal care tasks and should not be recorded as if they were.
The levels available
This domain does not carry a priority level, so the highest available levels are lower than in the four priority domains. That does not make it unimportant. Continence needs contribute to the overall picture, interact strongly with skin integrity and mobility, and frequently support the complexity element of the four key characteristics analysis.
Interaction with other domains
Continence rarely sits alone. Incontinence combined with immobility drives pressure damage risk, which belongs in skin. Distress or resistance during personal care may belong in behaviour. Recurrent urinary infection may affect cognition and medication. Describing those interactions matters, because interaction is what complexity means.
Where it is under-recorded
The most common error is recording that continence is managed with products and leaving it there. That describes the intervention outcome rather than the need. Night time frequency, the number of staff required, the time involved, and any skin consequence are all routinely omitted. Bowel programmes are sometimes recorded in a care plan but never reach the domain narrative.
Evidence that helps
Continence assessments, catheter care plans and change records, records of catheter blockage, bypassing or infection, stoma care plans, bowel charts and programme records, urinary tract infection history and antibiotic records, and body maps or wound records where skin has been affected. Include night time records specifically, as these are often held separately.
Key takeaway
Continence becomes clinical where catheters, stomas or managed bowel programmes are involved. Record the underlying need and the intervention, capture the night time picture, and describe the interaction with skin, mobility and behaviour rather than treating the domain in isolation.
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Frequently asked questions
Does having a catheter mean a high level?
It indicates a clinical need requiring trained management and monitoring, which points upward, but the level depends on stability, the frequency of problems and the skill required to respond to them.
Can the continence domain reach priority?
No. Only behaviour, breathing, drug therapies and medication, and altered states of consciousness carry a priority level. Continence still contributes to the overall picture and to the complexity analysis.
Is using pads enough to show need?
It shows a need is being managed, but the record should describe the underlying need, the frequency, the number of staff required and any consequence for skin, rather than stating that products are in use.
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.