NHS Continuing Healthcare
The CHC Assessment Process
Checklist, Decision Support Tool, multidisciplinary team and Integrated Care Board decision, set out as one journey.
How does a CHC assessment work?
A CHC assessment runs in two stages. A Checklist screens whether a full assessment is needed. If it is positive, a multidisciplinary team completes the Decision Support Tool, scoring need across twelve care domains and recommending whether the person has a primary health need. The Integrated Care Board then makes the eligibility decision and confirms it in writing.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
The process looks administrative from the outside, but each stage narrows what the next stage is allowed to consider. Evidence that is missing at the Checklist is rarely recovered later, and a Decision Support Tool completed from thin records will produce a thin outcome. Understanding the sequence is the practical advantage.
The stages in order
Timescales vary between Integrated Care Boards, but the sequence itself is set by the national framework.
- Referral: anyone involved in a person's care can ask for a Checklist
- Checklist: a screening tool that decides only whether a full assessment follows
- Evidence gathering: records, care plans, clinical input and family accounts
- Decision Support Tool: the multidisciplinary team scores the twelve care domains
- Recommendation: the team records reasoning on primary health need
- Decision: the Integrated Care Board confirms eligibility in writing
How to prepare
The single biggest determinant of outcome is what the team has in front of it on the day.
- Confirm the date, venue and who will attend, in writing
- Ask for the evidence pack in advance and read it before the meeting
- Prepare a written account of a typical week, including nights
- Bring incident logs, medication charts and continence records
- Ask for reasoning to be recorded against each domain as you go
Where people often go wrong
- Letting a Checklist be completed over the phone without preparation
- Attending the Decision Support Tool meeting without seeing the evidence first
- Accepting domain levels that are agreed quickly and without discussion
- Not asking for disagreement between professionals to be minuted
- Waiting for the written decision before raising a procedural concern
- Letting a Checklist be completed over the phone without preparation
- Attending the Decision Support Tool meeting without seeing the evidence first
- Accepting domain levels that are agreed quickly and without discussion
- Not asking for disagreement between professionals to be minuted
- Waiting for the written decision before raising a procedural concern
Who sits on the multidisciplinary team
The team must include at least two professionals from different healthcare professions, or one healthcare professional and one person responsible for assessing social care needs. In practice that usually means a nurse assessor alongside a social worker, with input from a GP, therapist or specialist. The person and their representative should be given proper notice and the chance to take part.
A social work led multidisciplinary practice
We prepare the evidence, attend the Decision Support Tool meeting and put the case in the framework's own language. Where the process departs from the national framework, we record it at the time, which is what makes a later challenge straightforward rather than uphill.
Frequently Asked Questions
Who can request a CHC assessment?
Anyone involved in a person's care can raise it, including the person themselves, a family member, a GP, a hospital discharge team or a social worker. There is no need to wait to be offered one. Asking in writing is sensible, because it creates a dated record of when the request was made.
Can I attend the Decision Support Tool meeting?
Yes. The person being assessed and their representative should be given the opportunity to take part, with reasonable notice. You are entitled to see the evidence beforehand, to contribute to each domain, and to ask for your comments and any disagreement to be recorded in the completed tool.
What happens after a positive Checklist?
A positive Checklist means a full assessment must follow. It does not mean the person will be found eligible. A multidisciplinary team gathers evidence, completes the Decision Support Tool across the twelve domains, and makes a recommendation to the Integrated Care Board, which then issues the decision in writing.
How long should a CHC decision take?
The national framework expects a decision within 28 days of a positive Checklist. In practice delays are common, particularly where evidence is outstanding or a meeting has to be rearranged. Delay is not a reason to accept a rushed assessment, and it can itself be raised through local resolution.
This page explains the NHS Continuing Healthcare assessment process in England. It is general information rather than legal advice, and it does not replace an assessment of an individual's needs.