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. National Institute for Health and Care Excellence. Clinical guidance. Available at: https://www.nice.org.uk
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 how tracheostomy care is treated in an NHS Continuing Healthcare assessment. It covers what the care involves, the breathing domain and its priority level, suction frequency and skill, emergency risk and the requirement for continuously available trained staff, ventilation, communication and swallowing, and the evidence that supports an accurate assessment.
Tracheostomy and NHS Continuing Healthcare funding
Tracheostomy care sits at the top end of what community services deliver. It engages the breathing domain, which is one of only four that can reach priority, and the risk profile is immediate.
What the care involves
Suctioning to clear secretions, inner cannula care and changes, stoma site care, humidification, tube changes, monitoring for blockage, displacement and infection, and the judgement about when intervention is required. Frequency varies from occasional to very frequent, and it is the frequency and skill that drive the assessment.
The breathing domain and priority
The breathing domain can reach priority, alongside behaviour, drug therapies and medication, and altered states of consciousness. Where a tracheostomy requires frequent skilled intervention and the consequence of delay is airway compromise, the priority level should be considered explicitly rather than passed over.
Emergency risk
A blocked or displaced tracheostomy is a medical emergency in which the person cannot breathe and deterioration is measured in minutes. That requires someone trained in emergency management to be present and available at all times, not merely on call. That requirement for continuous skilled availability is the strongest point in most tracheostomy cases.
Suction frequency and competence
Record how often suction is required across the day and night, who performs it, what training they hold and what happens if it is delayed. Frequent suction requiring registered or specifically trained staff, particularly overnight, is a substantial need. Suction records and night records are the evidence.
Ventilation
Where the tracheostomy is combined with ventilation, whether continuous or overnight, the requirement rises further. Record the ventilation regime, alarm response arrangements, back-up equipment and the competence required. Dependence on ventilation means the person cannot survive interruption, which is a nature point of the highest order.
Communication and swallowing
A tracheostomy commonly affects speech, engaging the communication domain, and may affect swallowing, engaging nutrition and aspiration risk. Where the person cannot call for help and cannot be heard, that compounds the emergency risk considerably and should be stated explicitly rather than left implicit.
Key takeaway
Record suction frequency across day and night, the training required, and the emergency response arrangements. The strongest point is usually the requirement for trained staff to be continuously present, and the priority level should be considered explicitly.
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Frequently asked questions
Does a tracheostomy reach priority?
The breathing domain can reach priority. Where the tracheostomy requires frequent skilled intervention and delay risks airway compromise, that level should be considered explicitly.
What is the strongest point to make?
The requirement for staff trained in emergency management to be continuously present rather than on call, because a blocked or displaced tube is an emergency measured in minutes.
What evidence matters most?
Suction records showing frequency across day and night, training records, night records, and any history of blockage, displacement or emergency intervention with dates.
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.