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 mobility domain of the NHS Continuing Healthcare Decision Support Tool. It covers moving and handling, transfers and hoisting, falls risk, positioning and contracture management, the number of staff required, the interaction with skin integrity, where needs are under-recorded and the evidence that supports an accurate level.
The mobility domain in the CHC Decision Support Tool
Mobility captures far more than whether someone can walk. It covers transfers, the number of staff and equipment required, falls risk, and the positioning needed to prevent contractures and pressure damage.
What the domain covers
The ability to move and change position, transfers between bed, chair and toilet, walking and its limitations, the equipment and number of staff required, falls history and risk, positioning to maintain posture, and management of contractures or spasticity. It also covers the skill required to move someone safely where handling is complex.
Staff numbers and equipment
The number of staff required is one of the clearest indicators. A person requiring two staff and a hoist for every transfer has a substantially greater need than one who transfers with a single carer and a frame. Record the equipment used, the frequency of transfers across a day and night, and the competence required to use it safely.
Falls risk
Falls history, the circumstances and consequences all belong here. Frequent falls, falls resulting in injury or hospital admission, and falls occurring despite preventive measures being in place are all significant. Where preventive measures are working, the well-managed need principle applies, so record what those measures are and what happens when they are not followed.
Positioning and contractures
Where someone cannot reposition independently, the positioning regime required to maintain posture, prevent contractures and protect skin belongs in this domain and interacts directly with skin. Specialist seating, splinting, passive movement programmes and physiotherapy input are all relevant and are frequently omitted from the narrative.
Where it is under-recorded
The most common error is recording that a person is immobile and stopping there. Immobility itself says little. The need is in what immobility requires: how many staff, how often, with what equipment, with what risk if done incorrectly, and with what consequences for skin and comfort. Night time repositioning is routinely omitted.
Evidence that helps
Moving and handling assessments and risk assessments, falls records and incident logs, physiotherapy and occupational therapy assessments, equipment provision records, repositioning charts, and any record of injury during transfers. Records showing what happened when a transfer was attempted with fewer staff are particularly useful.
Key takeaway
Mobility is about what movement requires, not simply whether someone can move. Record staff numbers, equipment, frequency across day and night, falls history, and the positioning regime, together with the consequences when any of it is not delivered properly.
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Frequently asked questions
Does being immobile give a high level?
Not by itself. The level reflects what immobility requires: staff numbers, equipment, frequency of repositioning and transfers, risk during handling and the consequences for skin and comfort.
Do falls count if none have happened recently?
Yes. Where falls are prevented by measures in place, the well-managed need principle applies. Record the risk, the measures and any history of falls when those measures were not followed.
Does needing two carers matter?
Considerably. Staff numbers are one of the clearest indicators of intensity in this domain, and the requirement should be recorded together with how often transfers occur across the day and night.
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.