The CHC Assessment Process

NHS Continuing Healthcare

Checklist, Decision Support Tool, multidisciplinary team and Integrated Care Board decision, set out as one journey.

01How does a CHC assessment work?

The standard CHC route in England often begins with a Checklist. A positive result leads to comprehensive needs assessment, followed by a multidisciplinary team using the DST to record twelve domains and recommend eligibility. The ICB decides and gives written reasons. Direct full assessment and Fast Track can bypass the Checklist where appropriate.

Plain English

For families and professionals

England

England framework

Registered professionals

Written and reviewed

Each stage should draw on relevant evidence and the person's involvement. A Checklist is screening, not a restriction on which needs a later full assessment can consider. The DST brings together the comprehensive assessment; it is not the assessment itself. Missing or changed information should be addressed whenever it is identified.

02The 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

03How to prepare

Ask what records the team has obtained, identify gaps and offer the person's views and relevant information. Evidence should cover a representative pattern of needs, including nights and fluctuations, rather than only the meeting 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

04Where 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

05Who sits on the multidisciplinary team

The legal minimum is two professionals from different healthcare professions, or one healthcare professional and someone responsible for Care Act needs assessment. The MDT should usually include both health and social care professionals with relevant knowledge of the person. The individual and chosen representative should receive reasonable notice and support to participate.

06Preparing to take part

Ask the coordinator about the evidence, timing, participants and accessibility of the assessment. Offer relevant information and ask how the person’s contribution and any disagreement will be recorded.

07Related pages

NHS Continuing Healthcare ExplainedCHC Eligibility and Primary Health NeedChallenging a CHC DecisionNHS Continuing Healthcare services

08Frequently 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?

The person and their chosen representative should be invited or represented wherever practicable, with reasonable notice. Ask how relevant evidence will be shared and how contributions and disagreements will be recorded. Consent, confidentiality and any attorney, deputy or best interests authority must be addressed where applicable.

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?

In most cases, the decision should be made within 28 calendar days of ICB receipt of a positive Checklist or other notification of potential eligibility. If delayed, ask about interim support, missing steps and the expected date. A complaint about delay is different from an eligibility review; if eligibility is established, ask whether reimbursement is due.

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. Primary guidance: DHSC, NHS continuing healthcare decision support tool guidance. https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool/nhs-continuing-healthcare-decision-support-tool-guidance

09Before the meeting

Confirm the arrangements and records available, and ask for support or adjustments that help the person take part. Keep your summary and request the completed DST, recommendation and written decision.

10Primary sources and official guidance

National framework for NHS Continuing Healthcare (England)

Official NHS Continuing Healthcare Decision Support Tool