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 Checklist.
3. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
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 sets out which combinations of Decision Support Tool levels would be expected to indicate a primary health need for NHS Continuing Healthcare. It explains the priority and severe thresholds, the less clear-cut combinations of high and moderate levels, why the combinations are indicators rather than a scoring system, and how the levels feed the four key characteristics analysis.
Which domain scores trigger CHC eligibility
Families frequently ask what score is needed for NHS Continuing Healthcare. There is no score and no pass mark, but there are recognised combinations of domain levels that would be expected to indicate a primary health need. This guide sets them out and explains their limits.
The clear indicators
Two combinations are treated as clear. A single priority level in any domain that carries one would be expected to indicate a primary health need. So would two or more severe levels. These are the most straightforward routes to eligibility, and where either is present and properly evidenced, a decision to the contrary requires a great deal of explanation.
Which domains carry priority
Only four domains can be scored at priority: behaviour, breathing, drug therapies and medication, and altered states of consciousness. These are the areas where need can carry the most immediate risk to life or safety. If the main concern sits in one of these four, the descriptors repay very careful reading, because the difference between severe and priority can be decisive.
The less clear-cut combinations
Beyond the two clear indicators, a range of combinations may indicate eligibility. One severe level alongside a number of high or moderate levels is a common pattern in successful cases. So is a larger spread of high and moderate levels across several domains, particularly where the needs interact. In these cases the outcome turns much more heavily on the four key characteristics analysis than on the levels themselves.
Why there is no pass mark
The levels are not added and there is no total that produces automatic eligibility. The Framework deliberately avoids a scoring threshold, because eligibility depends on the totality of need rather than on the count of qualifying entries. This is why two people with identical domain levels can properly reach different outcomes, and why a recommendation must explain its reasoning rather than pointing at the levels alone.
How levels feed the characteristics
Domain levels are structured evidence. They feed the analysis of nature, intensity, complexity and unpredictability, which in turn supports the primary health need judgement. A high level in mobility tells you about intensity. Interacting needs across cognition, behaviour and medication tell you about complexity. A pattern of sudden deterioration tells you about unpredictability. The levels are the raw material, the characteristics are the reasoning.
Where families are misled
Two claims are common and both are wrong. The first is that a specific number of severe levels is required, which turns indicators into a formula. The second is that levels below severe cannot produce eligibility, which is plainly not the case, since spreads of high and moderate levels regularly do. If either is stated in a decision letter, that is worth challenging directly, because it misdescribes the test.
What to check on a completed tool
Read each level against its descriptor and against the need as it would be without the intervention in place. Then check whether the narrative under each domain supports the level recorded, and whether the four key characteristics have been reasoned rather than named. Most successful challenges come from one of those three checks rather than from disputing the outcome as a whole.
Making the argument
Where you say a level is wrong, name the domain, quote the descriptor you say applies and provide dated evidence. Where you say the levels have been recorded correctly but the conclusion does not follow, make that as a separate point about the characteristics analysis. Keeping the two arguments distinct is more effective than merging them, because they call for different responses.
Key takeaway
One priority level, or two or more severe levels, would be expected to indicate a primary health need. Other combinations may also do so. There is no total and no pass mark, and the decision rests on the characteristics analysis that the levels feed.
Frequently asked questions
Is there a minimum score for CHC?
No. The levels are not added and there is no pass mark. The Framework describes combinations that would be expected to indicate a primary health need, but the decision rests on the overall judgement rather than a total.
Which domains can be scored priority?
Behaviour, breathing, drug therapies and medication, and altered states of consciousness. A single priority level in any of these would be expected to indicate a primary health need.
Can moderate levels alone lead to eligibility?
It is possible where there are many of them and the needs interact strongly, though it is less common. The four key characteristics analysis carries much more weight in these cases than the levels themselves.
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.