CHC Funding Guide
The 12 care domains that decide
whether the NHS pays.
Every CHC assessment comes down to one question: does this person have a primary health need? The answer is determined by scoring their care needs across 12 domains, using a tool called the Decision Support Tool (DST).
Each domain is scored on a scale from No needs to Priority. The pattern of scores across all 12 domains — not any single domain in isolation — determines whether the person qualifies.
How the scoring works
The MDT panel scores each domain using these levels:
When does the scoring indicate eligibility?
The NHS National Framework (2022) states that a recommendation of eligibility is likely where there is: one Priority rating in any domain, or two or more Severe ratings across different domains. However, a person can also qualify with a combination of High ratings if the overall picture — assessed through the four characteristics of nature, complexity, intensity, and unpredictability — demonstrates a primary health need. There is no fixed points threshold.
All 12 domains explained
Each card below opens a one-page reference you can print and take into the MDT meeting. Verbatim Annex C scoring, evidence checklists, and common ICB under-scoring traps for each domain.
How to use these cards
- Pick the domains that matter for your relative. Most cases pivot on three or four — typically the four Priority-eligibleones (Behaviour, Breathing, Drug Therapies & Medication, Altered States of Consciousness) plus any others where the needs are most intense.
- Open each card and use the “Print as PDF” button. Each card is a single A4 page with the Annex C scoring, the evidence that lifts the score, and the rebuttal template — designed to be carried into the meeting.
- Bring the printed cards to the Checklist or MDT meeting. Use them as a reference when the assessor proposes a level — check the exact descriptor wording and quote it back if the score is too low.
- Use the rebuttal template if you disagree. Each card includes a 4-line scaffold you can complete by hand on the day, with placeholders for the specific evidence (incident logs, MAR charts, wound charts, etc.) that supports the higher level.
New to CHC? Run the free 60-second screener first to see whether a formal assessment is worth pursuing.
Breathing
Priority-eligible
Respiratory function and any need for oxygen, nebulisers, suction, ventilation.
View card →Nutrition
Eating and drinking safely, weight maintenance, and dysphagia management.
View card →Continence
Bladder and bowel function, catheter and stoma care, and skin-integrity impact.
View card →Skin & Tissue Viability
Skin condition, pressure injuries, wounds, and the regime to maintain integrity.
View card →Mobility
Independent movement, transfers, posture, and falls risk.
View card →Communication
Ability to communicate needs, understand information, and interact meaningfully.
View card →Psychological & Emotional Needs
Mental health, mood, anxiety, hallucinations, and emotional distress.
View card →Cognition
Cognitive function, decision-making capacity, and recognition of risk.
View card →Behaviour
Priority-eligible
Challenging behaviour that poses risk to self, others, or property.
View card →Drug Therapies & Medication
Priority-eligible
Medication regime complexity, administration risks, and monitoring requirements.
View card →Altered States of Consciousness
Priority-eligible
Seizures, loss of consciousness, delirium, fluctuating awareness, clinical risk.
View card →Other Significant Care Needs
Clinical needs not captured elsewhere — tracheostomy, dialysis, palliative care.
View card →The four characteristics: nature, complexity, intensity, unpredictability
After scoring the 12 domains, the MDT panel must consider the totality of needs through four characteristics. This is where many assessments go wrong — panels sometimes focus only on individual domain scores without properly considering how needs interact.
Nature
What type of care is needed? Is it care that the NHS would normally provide (clinical, nursing, therapeutic), or is it social care that a local authority would arrange?
A person who needs regular suctioning, PEG feeding, and clinical wound care has needs that are 'healthcare' in nature, even if delivered in a care home.
Complexity
How do different needs interact? Does the combination of needs require skilled clinical coordination, or are they straightforward even if numerous?
A person with dementia (cognition), dysphagia (nutrition), and recurrent UTIs (continence) has needs that interact — the dementia makes the dysphagia harder to manage, and the UTIs trigger delirium that worsens the dementia. This complexity requires coordinated clinical management.
Intensity
How much care is needed, and how often? This is about quantity — how many hours per day, how many staff, how frequently interventions occur.
A person requiring two-hourly repositioning, 6 pad changes per day, 4 nebulisers daily, and full assistance with all meals has a high intensity of care needs.
Unpredictability
How much do needs fluctuate? Can care be planned in advance, or must staff be ready to respond to sudden changes at any time?
A person with epilepsy whose seizures are uncontrolled despite medication has unpredictable needs — staff must be trained to administer emergency medication at any time, day or night.
Common questions
How many domains need to be scored 'Severe' to qualify for CHC?
There is no fixed formula. The NHS National Framework (2022) states that a recommendation of eligibility is likely where there is at least one domain rated Priority, or two or more domains rated Severe. However, eligibility can also arise from a combination of High scores across several domains — the test is whether the totality of needs demonstrates a 'primary health need'.
What is the difference between High and Severe in CHC scoring?
A High score indicates needs that require regular, skilled clinical intervention or management. A Severe score indicates needs that are intense, unpredictable, or require constant skilled supervision — often with significant risks if care is not delivered. The distinction matters because Severe carries more weight in the overall eligibility decision.
Can CHC eligibility be based on one domain alone?
Yes, if a single domain is scored Priority (the highest level). Priority means the person's needs in that domain are so severe and unpredictable that they require immediate and continuous clinical intervention. In practice, Priority ratings are rare and typically involve life-threatening situations.
Do all 12 domains carry equal weight?
No. The NHS National Framework does not assign explicit weights, but the four characteristics — nature, complexity, intensity, and unpredictability — are used to assess whether the totality of needs constitutes a primary health need. Domains that involve direct clinical management (breathing, drug therapies, altered states) tend to carry more weight in practice than domains like communication or psychological needs, though this is not formally stated.
What are the four characteristics used in CHC eligibility?
Nature (the type and quality of care needed), Complexity (how needs interact and require skilled coordination), Intensity (the quantity and frequency of care), and Unpredictability (the degree to which needs fluctuate and create risk). These characteristics are applied to the totality of needs across all 12 domains, not to individual domains.
Take the next step
See how your evidence maps to the 12 domains
Our Case Strength Report uses AI plus expert review to score your medical records against all 12 DST domains — identifying where your case is strongest and where the evidence gaps are.