How to request a CHC assessment
Anyone can request a CHC screening — you, your family, a GP, a nurse, or a social worker. You do not need a referral from a doctor or permission from the local authority. If you believe your loved one has a “primary health need,” you have the right to request a Checklist screening from the local Integrated Care Board (ICB).
The process has three stages, and the NHS target is to complete all three within 28 days. In practice, 76% of assessments meet this target, though some ICBs take considerably longer. If the assessment is delayed, chase the ICB in writing citing the NHS Framework target.
Stage 1: Checklist screening
A brief screening using the CHC Checklist. This determines whether the person's needs are complex enough to warrant a full assessment. The Checklist can be completed by any healthcare professional — you can request one from the GP, district nurse, hospital ward, or care home.
Stage 2: Full DST assessment
If the Checklist is positive, a multidisciplinary team (MDT) carries out the full assessment using the Decision Support Tool (DST). This examines needs across 12 care domains and scores each from 'no needs' to 'severe'. The meeting usually lasts 2-3 hours.
Stage 3: Eligibility decision
The ICB panel reviews the completed DST and makes the final eligibility decision. If approved, the NHS pays for all care costs — the person stops paying care home fees. If refused, you can request a local review and, if necessary, escalate to an Independent Review Panel.
Important: NHS England data shows that 1,730 CHC referrals were delayed in the most recent reporting period — often because families weren't told they could request a screening. If your loved one was discharged from hospital without being screened, you can request a Checklist at any time. Read our guide to hospital discharge rights for more information.
What is the DST and how does it work?
The Decision Support Tool (DST) is the assessment document used during the full CHC assessment. It's completed by a multidisciplinary team (MDT) — typically a nurse assessor, a social worker, and other relevant professionals — and examines your loved one's care needs across 12 domains.
Each domain is scored at one of five levels: no needs, low, moderate, high, or severe. There is also a “priority” level for the most extreme cases. Crucially, the DST is not a simple points-based system. The panel must consider the overall pattern of needs, how they interact, and whether the dominant reason for care is a health need.
In practice, a person with one “severe” domain, or two or more “high” domains, is generally considered to have a primary health need. But even people with multiple “moderate” scores can qualify if the interaction between their needs creates an overall level of complexity that requires healthcare oversight.
Key point:The DST is a tool to support the decision — not a calculator. The panel must use clinical judgement to consider the whole picture. If your loved one's needs are complex but spread across multiple domains, make sure the panel considers the interaction, not just individual scores.
The 12 DST domains — what assessors look for
Here is a summary of all 12 domains. For each one, we've highlighted what the assessors are looking for and what evidence matters most.
Behaviour
Challenging behaviour including aggression, wandering, non-compliance
Key evidence: Frequency of episodes, staff required, risk to self/others
Cognition
Awareness, memory, decision-making, orientation
Key evidence: Ability to recognise people/places, capacity for decisions
Psychological & Emotional
Depression, anxiety, psychosis, emotional distress
Key evidence: Impact on engagement with care, psychiatric medication
Communication
Speech, comprehension, use of communication aids
Key evidence: Ability to express needs, staff interpretation challenges
Mobility
Walking, transfers, repositioning, falls risk
Key evidence: Staff needed for transfers, equipment used, fall frequency
Nutrition
Eating assistance, modified diet, PEG feeding, choking risk
Key evidence: Level of supervision, swallowing difficulties, SALT involvement
Continence
Bladder/bowel control, catheter care, stoma management
Key evidence: Frequency of care, clinical management needed
Skin & Tissue Viability
Pressure sores, wound care, prevention measures
Key evidence: Wound grade, repositioning frequency, prevention regime
Breathing
Oxygen therapy, suction, ventilation, respiratory conditions
Key evidence: Hours of oxygen, chest infection frequency, aspiration risk
Drug Therapies & Medication
Medication complexity, administration, monitoring
Key evidence: Non-oral administration, refusal, clinical oversight needs
Altered States of Consciousness
Seizures, diabetic emergencies, loss of consciousness
Key evidence: Episode frequency, emergency intervention needs
Other Significant Needs
Needs not captured elsewhere, overall interaction of needs
Key evidence: Combined complexity, coordination between services
Want detailed evidence prompts for every domain? Our free DST Domain Evidence Builder worksheetgives you specific questions to answer for each domain, plus guidance on scoring levels and the “well-managed needs” trap.
How to prepare evidence for the MDT meeting
Preparation is the single biggest factor in whether a CHC assessment succeeds or fails. The families who get the best outcomes are the ones who arrive at the MDT meeting with written evidence covering every domain. Here's how:
Gather clinical records
Request copies of care home daily logs, hospital discharge summaries, GP letters, nursing assessments, and any specialist reports. These form the clinical evidence base. Care homes must provide these within a reasonable time under GDPR.
Write a personal statement
For each of the 12 domains, write down what you observe about your loved one's needs. Focus on specific examples: dates, times, what happened, how many staff were needed, what the consequences were. This is your evidence — the panel may not have it from any other source.
Focus on bad days, not average days
The assessment must consider the full range of your loved one's needs — including their worst days. If they have episodes of severe agitation twice a week, that's relevant even if they're calm most of the time. Unpredictability is itself a care need.
Use the right language
The assessors are trained to look for the four criteria: nature, intensity, complexity, and unpredictability. Frame your evidence using these terms. Instead of "Mum gets confused sometimes," write: "Mum experiences daily episodes of severe disorientation (nature: cognitive impairment, intensity: multiple times daily, unpredictability: no warning or trigger pattern)."
Identify gaps and fill them
Review your evidence against all 12 domains. If any domains are thin, ask the care home or GP for specific records. Our Case Strength Report (£97) can map your evidence against all 12 domains and identify exactly where the gaps are.
The four criteria: nature, intensity, complexity, unpredictability
The NHS National Framework requires assessors to consider four characteristics when determining whether someone has a primary health need. Understanding these is essential for framing your evidence effectively.
Nature
What type of care is needed? Does it require clinical knowledge, specialist skills, or healthcare oversight? Care that goes beyond what a social care worker can provide points towards a health need.
Example: Requires nursing assessment of skin integrity, clinical management of seizure medication, or PEG tube care.
Intensity
How much care is needed, and how often? Needs that require frequent, sustained, or round-the-clock intervention indicate a high-intensity care need.
Example: Needs repositioning every 2 hours day and night, requires 1:1 supervision during waking hours, or needs 4+ episodes of personal care daily.
Complexity
How do different needs interact with each other? When multiple conditions create a combined care challenge that requires skilled coordination, this indicates complexity.
Example: Dementia causes refusal of medication for diabetes, leading to unpredictable blood sugar levels that require clinical monitoring.
Unpredictability
How quickly can the person's condition change? Needs that are unpredictable — where the person can deteriorate rapidly or behave in unexpected ways — require a higher level of preparedness.
Example: Sudden episodes of severe agitation with no warning, breakthrough seizures despite medication, or rapid deterioration in swallowing ability.
The “well-managed needs” trap
This is the most common argument used to refuse CHC funding — and it's legally flawed. The ICB argues that because your loved one's needs are being “well-managed” by their current care package, they don't demonstrate a primary health need.
The logic is circular: the care is working, so they don't need it. The Supreme Court rejected this reasoning in the Coughlan case (1999), and paragraphs 162–163 of the 2022 National Framework make this explicit:
“The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs.”
— NHS National Framework for NHS Continuing Healthcare, paragraph 162 (July 2022)
If anyone uses this argument during your loved one's assessment, challenge it immediately. Ask the panel to assess what would happen if the current care package were removed. That is the true measure of need. For more on this and other common pitfalls, read our guide to 7 mistakes that get CHC applications rejected.
What to do on the day of the assessment
Frequently asked questions about CHC assessments
What is a CHC assessment?
A CHC assessment is the formal process used to determine whether someone has a 'primary health need' that qualifies them for fully-funded NHS Continuing Healthcare. The assessment is carried out by a multidisciplinary team (MDT) using the Decision Support Tool (DST), which examines 12 care domains. If the assessment shows that health needs are the main reason for care, all costs are paid by the NHS.
What is the Decision Support Tool (DST)?
The Decision Support Tool is the document used during the full CHC assessment. It covers 12 care domains — behaviour, cognition, psychological needs, communication, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other significant needs. Each domain is scored at one of five levels: no needs, low, moderate, high, or severe. The overall pattern of scores, not a simple points total, determines the outcome.
How long does the CHC assessment take?
The NHS target is 28 days from the initial Checklist screening to the DST decision. In practice, it often takes 2-3 months, and some ICBs take even longer. If the process is delayed beyond 28 days, write to the ICB citing the NHS Framework target and requesting an update. If your loved one's needs are urgent or they are approaching end of life, ask about the Fast Track pathway.
Can I attend the MDT meeting?
Yes. You and your loved one have the right to be involved in the assessment. The NHS National Framework states that the person being assessed and their family/representatives should be invited to contribute to the DST process. You can attend meetings, provide written evidence, and challenge any scoring you disagree with. Always bring someone with you for support.
What happens if I disagree with the DST scores?
You can challenge individual domain scores during the MDT meeting itself — ask for the scoring to be discussed and provide your evidence. If the final decision is negative, you can request a local review from the ICB, providing additional evidence and explaining which scores you believe are incorrect. If the local review is unsuccessful, you can escalate to an Independent Review Panel through NHS England.
How should I describe my loved one's needs?
Focus on the four criteria the assessors must consider: nature (what type of care is needed), intensity (how much and how often), complexity (how needs interact), and unpredictability (how quickly things can change). Always describe worst-case scenarios and bad days, not average days. Use specific examples with dates and times. The assessors need to understand what would happen if care were withdrawn.
What if CHC was never offered at hospital discharge?
If your loved one was discharged from hospital without being screened for CHC, you can request a CHC Checklist screening at any time — even months or years later. If they should have been screened at the time of discharge, you can also request a retrospective assessment covering the period since discharge. If the review finds they should have been eligible, the NHS must refund care fees paid during that period.
Do I need professional help for the CHC assessment?
You don't need a solicitor — CHC advocacy is not a regulated legal activity. However, the process is complex and ICB panels deal with these cases daily, which puts unprepared families at a disadvantage. At minimum, prepare written evidence for all 12 domains and bring someone to the meeting. For more support, our Case Strength Report (£97) uses AI plus expert review to map your evidence against all 12 domains and identify gaps before the assessment.
Related guides
Checklist Preparation Guide
How to prepare for the CHC Checklist screening — what the A, B, C scores mean and how to present your case.
The 12 Care Domains Explained
Every DST domain explained with Severe vs High scoring examples and assessor criteria.
CHC Evidence Templates
Domain-by-domain evidence templates, example phrases, and a care diary format for the MDT meeting.
NHS Continuing Healthcare Funding Guide
The complete guide to CHC — who qualifies, the assessment process, and what to do if refused.
7 CHC Mistakes to Avoid
The most common mistakes families make during the CHC process — and how to avoid each one.
Case Strength Report — £97
AI plus expert review of your evidence against all 12 DST domains. Identifies gaps before the assessment.