NHS Continuing Healthcare
The CHC Checklist Explained
The screening tool that decides whether a full NHS Continuing Healthcare assessment goes ahead, and how to prepare for it.
What is the CHC Checklist?
The NHS Continuing Healthcare Checklist is a screening tool used to decide whether a person should be referred for a full assessment of eligibility for CHC funding. It can be completed by a nurse, doctor, other qualified healthcare professional or a trained social worker, in any setting, including at home, in hospital or in a care home. It screens need across eleven care domains, marking each at one of three levels. If enough domains reach the relevant level, a full assessment must follow.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
The Checklist is the first gate in the NHS Continuing Healthcare process. It is a short screening tool, not an assessment of eligibility, and its only job is to decide whether a full assessment should follow. The threshold is deliberately low, so a positive Checklist is common and says nothing yet about whether funding will be granted. What matters is that a Checklist which should have been positive is not wrongly marked negative, because a negative Checklist stops the process before the real assessment begins.
When a Checklist should be completed
A Checklist can be requested at any point where NHS Continuing Healthcare might be relevant. Common trigger points include:
- A hospital discharge where ongoing care needs are significant
- A move into, or a change of, a care home placement
- A noticeable deterioration in health or an increase in the level of care needed
- A review of an existing care and support package
- A family member or professional simply asking for one to be considered
How to prepare
The outcome turns on the evidence available when the Checklist is completed. A little preparation changes what the screener can see:
- Ask for the Checklist in writing, so the date of the request is recorded
- Gather care records, medication charts, continence and skin-care records
- Write a short account of a typical day and night, including anything that is not routinely written down
- Note any recent falls, infections, hospital admissions or changes in behaviour
- Ask for the reason behind each domain mark to be recorded as you go
Where people often go wrong
- Letting a Checklist be completed over the phone or in a rush, without any preparation
- Assuming a positive Checklist means funding is agreed
- Accepting a negative Checklist without asking why, or without seeing the marks
- Describing a good day rather than a typical week when needs fluctuate
- Not keeping a copy of the completed Checklist and the evidence it was based on
- Letting a Checklist be completed over the phone or in a rush, without any preparation
- Assuming a positive Checklist means funding is agreed
- Accepting a negative Checklist without asking why, or without seeing the marks
- Describing a good day rather than a typical week when needs fluctuate
- Not keeping a copy of the completed Checklist and the evidence it was based on
The domains the Checklist screens
The Checklist covers eleven care domains, including breathing, nutrition, continence, skin integrity, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, and altered states of consciousness. Each domain is marked A, B or C, where A indicates the highest level of need and C the lowest. The person completing it should base each mark on the evidence in front of them rather than a general impression, which is why the records available on the day matter so much.
Frequently Asked Questions
Who can complete a CHC Checklist?
A nurse, doctor, other qualified healthcare professional or a trained social worker can complete it. It can be done in any setting, and the person and their representative should be told it is happening.
How many domains trigger a full assessment?
The bar is intentionally low. A full assessment should follow where, for example, two or more domains are marked at the highest level, five or more at the middle level, or a single high mark appears in one of the domains that can signal the most serious needs.
Can I challenge a negative Checklist?
Yes. If you think the screening understated the person's needs you can ask for it to be reconsidered and request a fresh Checklist supported by better evidence. Putting the request in writing creates a clear record.
Is the Checklist the same as the Decision Support Tool?
No. The Checklist is a short screening tool with eleven domains and three levels. The Decision Support Tool is the fuller assessment that follows a positive Checklist, scoring twelve domains in more detail.
This page explains the NHS Continuing Healthcare Checklist in England. It is general information rather than legal advice, and it does not replace an assessment of an individual's needs.