Free checklist
Five CHC questions to use before the next conversation
The guide stays free to read. Add your email and we will send a practical Checklist meeting summary you can keep with your notes.
Checklist evidence
What evidence do you need for a CHC Checklist meeting?
The Checklist is a screen, but the assessor still needs enough evidence to see why a full DST assessment is justified.
Care home notes
Daily records, incident forms, turning charts, nutrition and fluid charts, continence notes.
GP records
Problem list, medication history, referrals, consultation notes, and recent letters.
Hospital records
Discharge summaries, admissions, falls or infection notes, SALT, OT, tissue viability input.
Medication charts
PRN use, pain relief, antipsychotics, insulin, rescue medication, and missed/refused doses.
Family observations
Bad days, night needs, choking, agitation, refusal of care, falls, and what happens if care is delayed.
Ready
Use the Checklist Evidence Pack if the meeting is booked and records are available.
This is the paid route when you already have documents and need them mapped to the 11 Checklist domains.
Not ready
Request records first if you only have verbal concerns or partial paperwork.
If the evidence is thin, start by requesting GP, hospital, and care home records. A stronger file makes any paid preparation more useful.
Checklist evidence often includes sensitive medical and care records
If you use the Checklist Evidence Pack, your records are encrypted, processed in UK/EU regions, and not used for advertising or public AI model training.
- Medical records are stored in AWS London and processed in UK/EU regions.
- Files are encrypted at rest and transferred over HTTPS.
- Access is limited to the reviewer handling your case.
- Medical records and case data are normally deleted 90 days after report delivery.
- Your medical data is not sold, shared for advertising, or used to train public AI models.
Key Facts
- The CHC Checklist is an 11-domain screening tool — the gateway to a full CHC assessment (gov.uk Checklist guidance, July 2022)
- Scoring uses A / B / C levels per domain — not the DST's Priority/Severe/High scale
- A full assessment is required if there are two or more A's, OR five or more B's (or one A plus four B's), OR one A in a starred priority domain (Checklist guidance, paragraph 19)
- The Checklist is a legal obligation, not guidance — its statutory basis is the Coughlan judgment ([1999] EWCA Civ 1871) and section 22 of the Care Act 2014
- Only 17% of full assessments now grant funding — down from 31% in 2017/18 (Healthwatch England, October 2025)
- A positive Checklist triggers a full assessment within a 28-day target — yet 1,730 referrals had exceeded that target at March 2024 (Nuffield Trust, June 2024)
TL;DR: The CHC Checklist is a legal NHS screening tool that decides whether your relative gets a full Continuing Healthcare assessment. It scores need across 11 domains as A/B/C — two A's, five B's, or one A in a starred domain triggers a full assessment within 28 days (Checklist guidance, 2022, paragraph 19). Only 17% of full assessments grant funding (Healthwatch, October 2025) — so the evidence the assessor sees at the Checklist meeting matters more than the screening itself.
The CHC Checklist is not a favour — it is a legal obligation. If your relative has a primary health need, NHS Continuing Healthcare means the NHS pays 100% of care costs with no means test. The Checklist is the mandatory first step. Care home fees of £1,000+ per week fall to zero. Request it in writing before signing anything.
Reviewed by legal professionals and social care professionals.
What is the CHC Checklist?
The CHC Checklist is a national NHS screening tool that decides whether a person should have a full Continuing Healthcare assessment. It scores need across 11 care domains using A/B/C levels (NHS Continuing Healthcare Checklist guidance, July 2022). A positive Checklist outcome triggers a full assessment with the Decision Support Tool, completed by a multidisciplinary team. The Checklist itself does not award funding — it decides who gets assessed.
Two tools, two scoring scales. The Checklist (screening) uses A/B/C across 11 domains. The Decision Support Tool (full assessment) uses Priority / Severe / High / Moderate / Low / No-needs across 12 domains. They are deliberately different instruments — the Checklist is intentionally lower-threshold so that anyone who might be eligible gets the chance of a full assessment (Checklist guidance, paragraph 3).
The Checklist's statutory roots reach back to a 1999 Court of Appeal judgment. R v North & East Devon HA, ex parte Coughlan [1999] EWCA Civ 1871 set the legal test the screening tool screens against. That test — the primary health need test — is codified in section 22 of the Care Act 2014. For the deeper legal context, see our explainer on the primary health need legal test and on the underlying CHC funding criteria.
Every Integrated Care Board (ICB) in England must follow this binding process. The Checklist is not guidance. It is not best practice. It is a requirement. The ICB must screen any person who may have a primary health need before treating a placement as self-funded.
The 11 domains the Checklist scores
The Checklist screens 11 care domains, each scored A, B, or C. A represents the highest level of need at the screening threshold. B is moderate. C is low or routine. Four of the 11 domains carry an asterisk because they correspond to priority-capable domains on the Decision Support Tool — a single A in a starred domain is enough to trigger a full assessment.
The 11 domains are:
- Breathing* — from independent breathing through to tracheostomy or non-invasive ventilation
- Nutrition (food and drink) — from oral intake to dysphagia or PEG feeding
- Continence — from continent or routine care through to skilled intervention beyond routine
- Skin and tissue viability — from intact skin to pressure damage requiring specialist regimes
- Mobility — from independent mobility to high falls risk or involuntary spasms
- Communication — from clear communication to unable to communicate needs even when assisted
- Psychological and emotional needs — from no impact through to severe mood disturbance affecting health
- Cognition — from no impairment to high-risk cognitive impairment requiring constant guidance
- Behaviour* — from no challenging behaviour to challenging behaviour posing predictable risks
- Drug Therapies and Medication* — from managed symptoms to administration with risk-monitoring needs
- Altered States of Consciousness* — from no ASC to frequent episodes requiring skilled intervention
(*) Asterisked domains are the four starred priority domains. The full domain descriptors for A, B and C are in the official Checklist guidance (July 2022).
A common confusion: the DST has 12 domains — the Checklist has 11. The DST's "Other significant care needs" is an open box on the full assessment, not a domain on the screening tool. If you see a competitor page describing the Checklist as having 12 domains, they are confusing the two instruments. For the full DST breakdown, see the 12 care domains in detail.
How the Checklist is scored — A, B, C, and what triggers a full assessment
A full assessment for NHS Continuing Healthcare is required where the Checklist records any one of three combinations (NHS Continuing Healthcare Checklist guidance, paragraph 19): two or more A's; five or more B's (or one A plus four B's); or one A in a starred priority domain, regardless of the other scores. The threshold is intentionally set low so anyone who might be eligible gets a full assessment.
What A, B and C mean in practice
What does each level mean in plain English? A signals the person's needs are at or above the highest descriptor for that domain at the screening level — for example, problematic continence care requiring skilled intervention beyond routine, or challenging behaviour posing predictable risks. B is mid-range. C is routine or no-need. The Checklist guidance is explicit at paragraph 18: if the person's needs match anything in the A column, A should be selected — not B as a "safer" middle choice.
Why one A in a starred domain triggers full assessment
The four starred domains — Breathing, Behaviour, Drug Therapies, Altered States of Consciousness — are the ones where a single severe need can constitute a primary health need on its own. If a person has frequent episodes of altered consciousness requiring skilled intervention, the framework doesn't wait for accumulation. One A triggers full assessment.
Paragraph 20: the discretion safety valve
There's also a safety valve. Paragraph 20 of the guidance allows a full assessment even where the indicated threshold isn't met — provided the assessor records a clear rationale. The screening bar is low and discretionary in favour of the patient.
Who completes the CHC Checklist — and who can't refuse
Any registered nurse, allied health professional, or social worker trained in its use can complete the Checklist (NHS Continuing Healthcare Checklist guidance, paragraph 9). A GP referral is not required. The ICB cannot refuse to complete the Checklist when a clinical indication of primary health need exists. Where families are told the Checklist "cannot be arranged," that is not the law.
Families are often told things that amount to a refusal without being phrased as one. Common versions:
- "Your relative doesn't meet the criteria" — said before any formal screening has taken place
- "CHC is very hard to get" — true statistically, but irrelevant to whether your relative must be screened
- "We don't have the resources to do the Checklist right now" — staffing problems do not override the legal duty
- "The consultant hasn't referred them" — a consultant referral is not required
If you are told the Checklist will not be done, put your request in writing immediately. Address it to the ICB. Include your relative's name and NHS number. Say plainly that you are requesting a CHC Checklist under the National Framework. Verbal refusals are hard to challenge. Written requests that go unanswered are evidence of systemic failure.
If your relative has a Lasting Power of Attorney for health and welfare, the attorney should submit the request. If no LPA exists and your relative lacks capacity, request that an Independent Mental Capacity Advocate (IMCA) be appointed.
When the NHS must offer the Checklist
The ICB has a duty to screen for CHC eligibility at specific trigger points (National Framework for NHS Continuing Healthcare, 2022). These are duties, not suggestions. A hospital cannot lawfully discharge your relative to a self-funded care placement without first completing or offering the Checklist.
The Checklist must be offered in the following circumstances:
- Before discharge from hospital to a care home or nursing home
- When a person already in a care home experiences a significant change or deterioration
- When a person's existing care package is being reviewed and their health needs have increased
- When any professional involved in the person's care identifies that their needs may be primarily health-driven
There are also six specific situations where the Checklist need not be completed (Checklist guidance, "When not to screen"):
- Clear absence of health need
- Short-term recovery from a temporary condition
- ICB-agreed direct referral to full assessment
- Rapidly deteriorating terminal phase — use the Fast Track Pathway instead
- Section 117 Mental Health Act needs being met
- Previously decided ineligible with no change in needs
Outside those six, the Checklist applies.
If a Checklist has not been offered at one of the trigger points, the ICB has failed to meet its legal duty — and you have grounds for a formal complaint and a retrospective assessment. Our guide on unsafe discharge from hospital explains your rights in detail.
The 28-day deadline — and what to do when the NHS misses it
The ICB must complete the full assessment (DST/MDT) within 28 days of a positive Checklist. At March 2024, 1,730 referrals had exceeded this target nationally, with 40 cases waiting over 26 weeks (Nuffield Trust, June 2024). Every day of delay is a day your family may be paying care costs the NHS should be covering.
Once the Checklist returns a positive result, the ICB must arrange a full multidisciplinary team (MDT) assessment using the Decision Support Tool. The target is not aspirational — ICBs are expected to meet it in the vast majority of cases.
Do not sign any care home admission paperwork. Do not sign social care funding agreements. Do not agree to self-funding. None of those documents should be in front of you until the Checklist has been completed and you have seen the outcome.
If the 28-day target passes without a scheduled MDT assessment:
- Write to the ICB's CHC team requesting written explanation for the delay and a confirmed assessment date
- Cite the 28-day target in the National Framework
- Copy the ICB's complaints department so the delay is formally recorded
- If the ICB does not respond within 14 days, escalate to NHS England
Written communication creates a paper trail that strengthens any future complaint. In our work preparing CHC evidence for families, the Checklist is the cheapest stage to win. Every later stage — full assessment, Local Resolution, Independent Review, Ombudsman — is more work and more cost. Families who documented every delay from the outset are the ones whose retrospective claims succeed.
Check whether your relative qualifies for CHC funding
Check eligibility nowWhat a negative Checklist means — and how to challenge it
A negative Checklist does not mean ineligible for CHC. It means the clinician did not find enough A or B scoring to recommend a full assessment. Roughly 13% of local resolution requests result in eligibility being granted (Nuffield Trust, June 2024) — about one in eight ICB Checklist decisions are overturned at first review. Same evidence. Different reasoning.
That overturn rate exists because Checklist outcomes depend on what evidence the clinician had on the day. If your relative was having a better week, or if key needs were not documented, the scoring won't reflect their actual condition. Family observations of day-to-day care needs often capture detail that clinical records miss.
There's also an ICB-level pattern that compounds clinical variation. The number of adults found eligible for CHC ranges from 20 to 95 per 50,000 adults between English ICBs — an almost five-fold difference (Nuffield Trust, All or nothing?, September 2025). Which ICB applies the Checklist can matter as much as the strength of the underlying evidence.
You have several routes to challenge a negative Checklist:
- Request written reasons for each domain score. Per R (Grogan) v Bexley NHS Care Trust [2006] EWHC 44 (Admin), the ICB must give reasons, not labels — see our primary health need legal test guide for what this means in practice.
- Submit additional clinical evidence that wasn't available or considered. GP letters, care home daily records, nursing assessments, dated family observations all change the picture.
- Request a new Checklist if your relative's condition has deteriorated since the original screening.
- Complain formally to the ICB if the Checklist was completed without proper evidence or family consultation.
A negative Checklist is one clinician's scoring on one day. If the evidence was incomplete, the scoring will be wrong. Challenge it. The formal process for appealing a CHC decision follows a structured route protected under NHS complaints regulations.
Requesting a CHC Checklist when no one has offered one
The system does not volunteer this information. Most families are never told the CHC Checklist exists. You have to ask — and you have to ask in writing. Your right to request a Checklist sits in the National Framework for NHS Continuing Healthcare (2022). When you cite it, the hospital team knows you know the rules.
Use this language in your written request:
"I am requesting that a CHC Checklist assessment be completed for [full name], NHS number [number], before any discharge decision is made. I understand this is our right under the National Framework for NHS Continuing Healthcare (2022)."
Send this to the ward manager by email or in a letter handed to the ward. Copy the hospital social worker. Keep a record of when you sent it and who received it.
Written request sent? While you wait, check whether your relative qualifies for full NHS funding
Check eligibility nowIf the ward team refuses or fails to respond within 24-48 hours given an imminent discharge, escalate directly to the ICB. The ICB has oversight of CHC processes in your area, and a formal complaint tends to move things quickly.
Understanding the underlying CHC criteria before the Checklist is completed helps you articulate your relative's needs clearly during the process. The more specific you can be about care needs across the 11 domains, the harder it is for those needs to be scored down.
Do not be persuaded to defer. Do not agree that it can be sorted out after discharge. The Checklist must be completed before your relative leaves hospital for a care home. That is the law.
What happens after a positive Checklist — and what CHC actually funds
If the MDT confirms a primary health need following a positive Checklist, the NHS pays 100% of care costs — with no means test. Nursing care averages around £1,267 per week (Age UK, 2025), and specialist dementia care often runs above £1,500 per week. Those bills fall entirely to the NHS. Your family pays nothing.
A positive Checklist means the clinical team found enough A or B scoring to refer the case to the ICB for full assessment using the Decision Support Tool. The MDT will include a nurse, a social worker, and other professionals who know your relative. You and your relative have the right to attend and contribute. Bring written observations. Bring care records. The more specific you can be about daily care needs, the harder it is for needs to be scored down.
CHC funding covers:
- All care home or nursing home fees, including accommodation and board
- All personal care — washing, dressing, assistance with eating
- All nursing care provided within the placement
- Specialist equipment required for the person's care needs
- Continence supplies and other clinical consumables
There is no means test. The person's savings, property, pension, and income are irrelevant. A person with assets of £1 million receives the same entitlement as a person with no assets. The only question is whether the person has a primary health need.
If your relative has been paying as a self-funder and is later awarded CHC, the NHS must fund from the date the decision takes effect. Where the Checklist should have been completed earlier but was not — for instance, where the ICB failed to offer screening at hospital discharge — families can apply for the retrospective CHC claim route. A successful retrospective review can result in reimbursement of fees already paid, sometimes stretching back years.
Is your relative facing hospital discharge? Don't agree to self-fund care before the NHS Checklist has been done
Check eligibility nowHolding the NHS accountable when the Checklist process fails
The Parliamentary and Health Service Ombudsman reviewed 336 CHC complaints between April 2018 and July 2020 and found CCGs "misinterpreting and misapplying" the National Framework (PHSO, November 2020). The three-stage challenge route — ICB → NHS England → Ombudsman — turns on whether the Checklist applied the test with reasons (the Grogan requirement).
Stage 1: Formal complaint to the ICB
Write to the ICB's complaints team. State three things: what the ICB was required to do under the National Framework, what it failed to do, and what outcome you are seeking. The ICB must acknowledge the complaint within three working days. The full response timeframe is set out in the acknowledgement letter.
Stage 2: Escalation to NHS England
If the ICB's response is unsatisfactory, or if the ICB fails to respond, escalate to NHS England. NHS England oversees ICBs and can intervene where an ICB is not meeting its duties under the National Framework.
Stage 3: Parliamentary and Health Service Ombudsman
If NHS England does not resolve the matter, refer to the PHSO. The PHSO investigates cases where the NHS has failed to follow its own procedures. You must have exhausted the NHS complaints process before the PHSO will accept the referral. For the full appeal route, see our guide on how to appeal a CHC decision.
At every stage, written evidence is critical. Keep copies of every letter, email, and form. Record the dates of every phone call and the name of every person you speak to. The families who succeed in holding the NHS accountable are the families who document everything.
What does each CHC Checklist outcome mean for your family?
| Positive Checklist outcome | Negative Checklist outcome | |
|---|---|---|
| What it means | Two A's, five B's, or one A in a starred domain were recorded | Scoring did not meet any of the three threshold combinations |
| Next step | Referred to ICB for full DST assessment (28-day target) | No automatic referral — but you can challenge |
| Who decides funding? | ICB, following multidisciplinary DST assessment | No funding decision is made at this stage |
| Who pays for care if CHC awarded? | NHS pays 100% — no means test | Not applicable at this stage |
| Can the outcome be challenged? | Positive outcomes proceed directly to full assessment | Yes — ~13% are overturned at local resolution (Nuffield Trust, 2024) |
| Timeline | Full DST assessment within 28 days (target) | No formal timeline — act quickly if challenging |
| Should you sign care home paperwork? | No — wait for full assessment outcome | No — challenge the scoring before agreeing to self-fund |
For the wider cluster: see our family-side decision tree on who qualifies for CHC funding, and the continuing healthcare funding family guide for what CHC actually pays for once awarded — Personal Health Budgets, top-up rules, and retrospective PUPoC claims.
Preparing for a CHC Checklist? Our Checklist Evidence Pack (£597) is the structured evidence document the assessor reads — built around the 11 Checklist domains and the three threshold combinations above. It's our family-priced evidence preparation service, not legal advice.
Already had a Checklist or unsure if your case is worth pursuing? Our Case Strength Report (£97) triages your evidence and tells you whether to pursue, challenge, or stop — before you commit to a full Evidence Pack or formal appeal.
Reviewed by legal professionals and social care professionals.