CHC Checklist Scores Explained: What A, B and C Mean

Most families are handed a Checklist outcome and shown a row of letters they've never seen before. A, B and C aren't grades — they're a triage code. And one missing A can be the difference between £50,000 a year of NHS-funded care and the sale of a family home. The letters look simple. What they trigger is anything but.

TL;DR: The NHS Continuing Healthcare Checklist is the Stage 1 screen. It scores 11 domains as A (high/priority), B (moderate) or C (low/none). You're referred for a full Decision Support Tool assessment if you score any of: two or more As; five or more Bs, or one A and four Bs; or one A in an asterisked priority domain. The threshold is set low on purpose — yet eligibility at full assessment has fallen to around 17% (Healthwatch England, 2025), and a low score is often about who is assessing.

What this post does NOT cover. It explains Checklist scoring only. For broader CHC eligibility see our guide to CHC funding criteria. For the next stage — the DST/MDT assessment, which uses different domains and a different scoring scale (Priority / Severe / High / Moderate / Low / No Needs, not A/B/C) — see the CHC MDT assessment process. A/B/C is used only at Checklist stage.

By the end of this guide you'll know exactly what each letter means, the rule that triggers a full assessment, what a fair score looks like, and what to do if a Checklist comes back low.

Reviewed by legal professionals and social care professionals.

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What Is the CHC Checklist?

The Checklist is the Stage 1 screening tool in the NHS Continuing Healthcare process — the gate between "this person might need NHS-funded care" and the full assessment that decides it. Its threshold is set deliberately low, designed to screen people in rather than out (Department of Health & Social Care, National Framework, 2022).

It can be completed by a registered nurse, a GP, a social worker, or a hospital discharge team member. A family can't score it themselves, but they can request one in writing at any time, and can hand the assessor evidence to inform it. And the Checklist is not the assessment — it's a triage form, a fast filter, nothing more.

That distinction matters because families often treat a negative Checklist as a final "no". It isn't. It's the first of several stages, and it's the one most open to challenge. For the full route from screening to outcome, see the NHS CHC pathway; for where eligibility sits in the wider picture, our continuing healthcare funding guide sets it out.

Citation capsule: The NHS Continuing Healthcare Checklist is a Stage 1 screening tool with a deliberately low threshold, designed to identify anyone who might be eligible and refer them for full assessment (NHS Checklist guidance, 2022). It is completed by a health or social care professional and does not, by itself, decide eligibility.

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The 11 Checklist Domains

The Checklist scores 11 care domains, each capturing a different area of need. Four of them — marked with an asterisk below — carry extra weight, because they can reach "Priority" level in the later Decision Support Tool. A single high score in one of those four is enough to trigger a full assessment on its own.

The 11 domains, in official order:

1. Behaviour *
2. Cognition
3. Psychological & Emotional Needs
4. Communication
5. Mobility
6. Nutrition (food and drink)
7. Continence
8. Skin (including tissue viability)
9. Breathing *
10. Drug Therapies & Medication: Symptom Control *
11. Altered States of Consciousness *

One point of frequent confusion: the DST adds a 12th domain — "Other Significant Care Needs" — that is not on the Checklist. So the Checklist has 11 domains, the DST has 12. (Altered States of Consciousness is on both; it is not the "extra" DST domain, despite what some guides claim.) For the full set, see the CHC Decision Support Tool.

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What Do A, B and C Actually Mean?

Each domain is scored with a single letter against the official descriptors: A marks a high level of need (and, in the asterisked domains, severe or priority-level needs record as A), B marks a moderate level, and C marks low or no need. That's the whole scale — three letters, no numbers, no points to add up.

The Checklist scale is deliberately blunter than the one that follows. At the full assessment, the DST uses six levels — Priority, Severe, High, Moderate, Low and No Needs. The Checklist compresses all of that into A/B/C. On the Checklist, both "Priority" and "Severe" needs fold upward into an A in the asterisked domains. Here's how the two scales line up:

Keeping these straight is half the battle. If you've read advice that talks about "Priority" or "Severe" scores on a Checklist, it has muddled the two stages — and that confusion costs families ground.

Citation capsule: On the CHC Checklist, each of 11 domains is scored A (high or priority need), B (moderate) or C (low or none). This is simpler than the Decision Support Tool's six-level scale (Priority to No Needs); the A/B/C scale exists only to decide whether a person proceeds to that full assessment (NHS Checklist guidance, 2022).

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The Threshold Rule: What Triggers a Full Assessment

This is the rule the whole Checklist turns on. The official guidance is precise, and worth quoting exactly rather than paraphrasing:

A full assessment for NHS Continuing Healthcare is required if there are:

• two or more domains selected in column A; or
• five or more domains selected in column B, or one selected in A and four in B; or
• one domain selected in column A in one of the boxes marked with an asterisk (i.e. those domains that carry a priority level in the Decision Support Tool), with any number of selections in the other two columns.

Source: NHS Continuing Healthcare Checklist guidance (Department of Health & Social Care, 2022), paragraph 19. The four asterisked priority boxes are Behaviour, Breathing, Drug Therapies & Medication, and Altered States of Consciousness.

Notice how low that bar sits. A single A in Behaviour — with everything else scored C — is enough. So is one A and four Bs. There's also a safety valve: the assessor can refer you for a full assessment even if none of these is numerically met, where professional judgement says the needs warrant it. The threshold is a floor, not a ceiling.

Citation capsule: A CHC Checklist is positive — requiring a full assessment — if it shows two or more domains in column A, or five or more in column B (or one A and four Bs), or one A in an asterisked priority domain (NHS Checklist guidance, paragraph 19, 2022). The assessor may also refer on professional judgement alone.

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Why the Threshold Is "Low" — and Why Checklists Still Fail

Here's the paradox. The threshold is set low to screen people in — yet getting a positive Checklist is far from guaranteed, and the reason often has little to do with the person's actual needs. The latest Nuffield Trust analysis found a nearly five-fold variation between Integrated Care Boards in how many people are found eligible for CHC: from 20 to 95 per 50,000 adults (Nuffield Trust, September 2025).

Standard CHC alone ranges from 10 to 67 per 50,000 — a six-fold gap. And nationally, the share of people found eligible at full assessment has fallen from around 31% in 2017/18 to roughly 17% by 2025 (Healthwatch England, October 2025), while the total number of people receiving CHC dropped 9.1% between 2017 and 2024 (Nuffield Trust, 2025).

The implication is uncomfortable but worth stating plainly: a low Checklist score is more often a function of who is assessing and where than of how much care a person actually needs.

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Worked Example: A Real (Anonymised) Checklist

Most guides explain A, B and C in the abstract. None show you a full grid. So here's one — an anonymised composite drawn from cases we've supported. Meet "Margaret", 84: advanced vascular dementia, two-person hoist, PEG fed, polypharmacy including controlled analgesics, and occasional aggression during personal care.

Tally: 5 As, 4 Bs. Margaret clears the threshold several times over — two or more As, and an A in two separate asterisked domains (Behaviour and Drug Therapies). The outcome is unambiguous: positive Checklist, referred for a full DST assessment.

The value of seeing it laid out like this is what it reveals about borderline cases. Drop Behaviour from A to B and Margaret still passes on her other As. The grid shows you which scores are doing the work — and which ones an assessor might reasonably be challenged on.

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What Happens After a Checklist

A Checklist has two possible outcomes, and they lead in very different directions. A positive result obliges the ICB to arrange a full DST/MDT assessment, normally within the National Framework's target of 28 days from the positive Checklist to a Standard CHC decision (National Framework, 2022). When that clock is missed, families have rights — set out in our assessment delays and escalation playbook.

A negative result means a written outcome with reasons. It is not the end. You can request a reconsideration, and you can request a fresh Checklist at any time if needs have changed or new evidence has come to light. Either way, the outcome must be communicated in writing — a verbal "they won't qualify" is not a lawful Checklist outcome.

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How to Challenge a Low Checklist Score

If a score looks wrong, you can do something about it — and the descriptors are public, so you can check the assessor's work. Four steps:

1. Get the evidence. Request a copy of the completed Checklist and the records the assessor relied on. If they won't share them, a subject access request compels disclosure.
2. Compare to the descriptors. Score each domain against the official wording. The most common error: marking a need lower because it's "well managed". At Checklist stage, needs are scored as they are — "well-managed needs" is a DST-stage concept, not a Checklist one.
3. Write to the ICB. Ask for a fresh Checklist, attaching the additional evidence and pointing to the specific descriptors you think were misapplied.
4. Escalate if refused. If the ICB still won't budge, the formal local resolution and Independent Review Panel routes apply — see how to appeal a CHC decision.

Citation capsule: A low CHC Checklist score can be challenged by requesting the completed form and evidence, comparing each score to the official descriptors, and asking the ICB in writing for a fresh Checklist. A frequent assessor error is downgrading needs because they are "well managed" — a concept that belongs to the later DST stage, not the Checklist.

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Five Scoring Mistakes Families Spot

Across the cases we see, the same misjudgements recur. Knowing them turns a vague sense that "the score feels wrong" into a specific, evidenced challenge:

1. Discounting "well-managed" needs. A domain scored B because the need is currently controlled — the Checklist asks about needs as they are, not as they'd be without care.
2. Missing the Behaviour asterisk. Five-plus documented incidents of aggression scored as B, when the pattern supports an A in a priority domain.
3. Treating tube feeding as a C. PEG or NG feeding marked low because feeding is currently uneventful — ignoring the underlying clinical need and aspiration risk.
4. Scoring Cognition on orientation. Marked B because the person knows their own name, when the descriptor is about decision-making capacity, not orientation.
5. Refusing a Checklist outright. "They won't qualify, so there's no point" — procedurally indefensible, and one of the easiest refusals to overturn in writing.

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How to Prepare Evidence Before the Checklist

The single most useful thing a family can do is straightforward: before the Checklist meeting, map the records you already have against the 11 domains. Care notes, GP records, medication charts, incident logs — organised by domain, they make it far harder for a genuine need to be scored low by default.

If you'd rather not do that alone, the Checklist Evidence Pack is an expert-prepared evidence map of all 11 domains, in the same format assessors use. And if you're not yet at Checklist stage, start with our free CHC eligibility screener to see whether it's worth pursuing at all.

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The Bottom Line

The Checklist is a gate, not a verdict. If the result feels wrong, the descriptors are public — and so are your rights.

• The Checklist scores 11 domains as A, B or C — a Stage 1 screen, not an eligibility decision.
• You're referred for a full assessment with 2+ As, 5+ Bs (or one A and four Bs), or one A in an asterisked priority domain.
• The threshold is set low on purpose — yet eligibility at full assessment has fallen to around 17%, and ICB variation is nearly five-fold.
• A low score is often about who is assessing, not the level of need — and it can be challenged in writing.
• The most effective move is mapping your evidence to the 11 domains before the meeting.

This guide is for information only. It is advocacy support, not legal advice. It was reviewed by legal professionals and social care professionals. Information is correct as of June 2026 — verify against the current National Framework and Checklist guidance on GOV.UK before relying on it.

Frequently asked questions

What is a positive CHC Checklist?

A positive Checklist is one that meets the referral threshold: two or more domains scored A, or five or more scored B (or one A and four Bs), or a single A in one of the four asterisked priority domains. A positive result means a full Decision Support Tool assessment must follow — it is not an eligibility decision in itself.

Do I qualify for CHC funding if I score 2 As?

Two As mean you cross the Checklist threshold and must be referred for a full assessment — not that you qualify for funding. The Checklist is a Stage 1 screen. Eligibility is decided later at the multidisciplinary DST stage, where only around 17% of people assessed are found eligible (Healthwatch England, 2025).

What's the difference between Checklist scoring and DST scoring?

The Checklist (Stage 1) scores 11 domains as A, B or C. The Decision Support Tool (Stage 2) scores 12 domains on a six-level scale — Priority, Severe, High, Moderate, Low or No Needs. They are different stages with different scales. A/B/C is used only at the Checklist; it never appears at the DST.

Can a family member complete the Checklist?

No. The Checklist is completed by a health or social care professional — a nurse, GP, social worker or hospital discharge team member. A family can request one in writing at any time, and can supply evidence to inform it, but cannot score it themselves. The assessor must communicate the outcome in writing with reasons.

How long does a Checklist assessment take?

Completing the form itself takes under an hour. The National Framework sets a practice target of two weeks for the initial Checklist, and 28 days from a positive Checklist to a Standard CHC decision. These are guidance targets, not statutory deadlines, and ICBs frequently exceed them.

What happens if the Checklist score is wrong?

You can ask for the completed Checklist and the evidence used, compare each score against the official descriptors, and write to the ICB requesting a fresh Checklist with additional evidence. A common error is scoring needs as lower because they are 'well managed' — that reasoning belongs to the later DST stage, not the Checklist.