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. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. Mental Capacity Act 2005, c. 9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents
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 explains how professionals should instruct an independent NHS Continuing Healthcare assessor. It covers what a letter of instruction should specify, the documents to provide, defining the questions to be addressed, agreeing scope and cost, timescales and their relationship to deadlines, access arrangements, and what to check on receipt of the report.
Instructing an independent CHC assessor
A precise instruction produces a useful report. A vague one produces a general account of the person's needs that may not address the question actually in dispute.
Specify the questions
State what the report is to address. Whether the recorded domain levels reflect the assessed needs. Whether the well-managed need principle was applied correctly. Whether the four characteristics were reasoned. What the person's needs are and how they should be described by domain. A report answering defined questions is far more usable than a general assessment.
State the purpose and audience
Whether the report is for submission before a multidisciplinary assessment, for local resolution, for an Independent Review Panel, or to support a claim covering a past period. The purpose shapes structure, emphasis and the period the assessment must cover. A report written for a first assessment does a different job from one addressing a decision already made.
Provide the documents
The completed Decision Support Tool where one exists, the multidisciplinary recommendation, the written decision with reasons, and the care records for the relevant period including night records. Also any care plans, behaviour support plans, risk assessments and clinical correspondence. Incomplete disclosure is the most common cause of a report that underperforms.
Confirm access and consent
Confirm who can be contacted, whether a visit to the person is possible and who will arrange it, and the basis on which information is shared. Where the person may lack capacity, confirm what authority exists and whether a best interests decision has been recorded. Sorting this at instruction avoids delay later.
Agree scope and cost in writing
Define what is included: records review and its extent, visit, report, and whether attendance at any meeting or panel falls within scope or is charged separately. Agree what happens if the volume of records proves materially greater than expected. Both sides benefit from this being explicit at the outset.
Set timescales against the deadline
State the deadline the report must meet and work back from it. Local resolution and panel dates are fixed, and a report arriving after the submission date has limited value. Where the deadline is tight, say so at instruction rather than after the work has started.
Check the report on receipt
That it addresses the questions asked. That findings are sourced to records with dates. That fact and opinion are distinguishable. That the reasoning on the four characteristics is present rather than asserted. That limitations are declared. Raise any gap immediately rather than submitting a report that will be tested on it.
Key takeaway
Define the questions, state the purpose and deadline, disclose fully including night records, settle access and consent at instruction, and agree scope in writing. Then check the report answers what was asked before it goes anywhere.
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Frequently asked questions
What should a letter of instruction contain?
The questions to be addressed, the purpose and audience, the deadline, the documents provided, access and consent arrangements, and the agreed scope and cost.
What documents should we send?
The completed Decision Support Tool, recommendation and decision where they exist, and the care records for the relevant period including night records, plus care plans, behaviour support plans and clinical correspondence.
Does the assessor need to visit?
Usually it adds significantly, though much of the value comes from the records review. Confirm at instruction whether a visit is possible and who will arrange access.
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.