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 how to prepare for an NHS Continuing Healthcare multidisciplinary assessment. It covers the records worth gathering, how to describe needs in the terms the Decision Support Tool uses, the importance of describing needs without the current intervention, how to prepare a written summary, what to do during the meeting and what to check on the completed tool afterwards.
How to prepare for an NHS Continuing Healthcare assessment
The assessment usually lasts a few hours and covers twelve care domains. Most of what determines the outcome is decided by the quality of the evidence in front of the team rather than by anything said on the day. Preparation is therefore the most useful thing a family can do.
Understand what is being assessed
The team will work through twelve care domains, record a level in each and then analyse the needs through nature, intensity, complexity and unpredictability. Knowing that structure in advance lets you organise what you know into the same shape, which makes it far easier for the team to use. Reading the Decision Support Tool descriptors beforehand is the single most useful preparatory step available.
Gather the records
Useful records include care plans, risk assessments, behaviour support plans, repositioning and skin charts, food and fluid charts, medication administration records, incident and accident logs, body maps, falls records, GP and hospital correspondence, and any specialist reports. Care home daily notes are often the richest source. Ask the provider for copies in advance rather than relying on the team to obtain them, since gaps in the record tend to be filled with assumption.
Describe needs without the intervention
This is the point that most affects the outcome. Needs must be recorded as they would be without the care currently in place, alongside the intervention required to manage them. So rather than saying the skin is intact, describe the high risk of breakdown, the two-hourly repositioning and pressure relief that prevents it, and what happened historically when that lapsed. Apply the same structure to behaviour, nutrition, medication and continence.
Cover the whole picture, not the good day
Assessments tend to capture how the person presents at the time. Where needs fluctuate, describe the range and the frequency, not the average. Night time needs are consistently under-recorded, so set out what happens overnight explicitly. If the person is more settled in the presence of visitors, or rallies for professionals, say so, because that pattern is common and directly affects what the team observes.
Write a short summary in advance
Two to three pages, organised by domain, is ideal. For each domain state the need, the intervention, the frequency and what happens without it, referring to dated records where possible. Ask for the summary to be attached to the Decision Support Tool so it forms part of the evidence rather than a recollection. This is the single most effective thing families do, and it costs nothing but time.
Sort out consent and representation
Consent should be sought from the person for the assessment and for information sharing. Where they may lack capacity to consent, a best interests decision should be recorded and consideration given to whether an advocate is needed. If you hold a lasting power of attorney or deputyship, bring the documentation, as it avoids delay and clarifies who can receive information and correspondence.
On the day
Take notes, including who attended and in what capacity. Ask for the descriptors to be read out where a level is being discussed, and ask for your view to be recorded where you disagree. If the team is not properly constituted, or nobody present knows the person, say so at the time and ask for that to be recorded. Do not feel obliged to agree to a level simply to keep the meeting moving.
Afterwards
Ask for a copy of the completed Decision Support Tool and read it against the descriptors before the decision is issued. Check for domains that do not match the narrative recorded underneath them, narratives describing the managed presentation rather than the underlying need, thin or blank domains, and any absence of reasoning on the four key characteristics. Raise anything you find in writing straight away.
Key takeaway
Prepare by learning the twelve domains, gathering dated records, and writing a short summary that describes each need without the intervention in place. Ask for the summary to be attached, record disagreement at the time, and read the completed tool before the decision is made.
Frequently asked questions
How long does an assessment take?
Usually two to four hours, depending on the complexity of needs and how many people are contributing. It is reasonable to ask for a break, and to ask for the meeting to reconvene if key records or contributors are missing.
What is the most useful thing to bring?
A short written summary organised by care domain, stating each need, the intervention in place, its frequency, and what happens without it. Ask for it to be attached to the Decision Support Tool so it becomes part of the evidence.
Should I mention things that only happen occasionally?
Yes. Infrequent but serious events go directly to unpredictability, which is one of the four key characteristics. Record how often they occur, how much warning there is and what the consequences are.
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.