Key Facts
- The CHC checklist is a 12-domain screening tool — the gateway to full CHC assessment
- The checklist is a legal obligation, not guidance or best practice (National Framework, 2022)
- Must be completed before hospital discharge to a care home
- A positive checklist triggers a full assessment within 28 days (NHS target)
- Scoring: Priority or Severe in one or more domains, or a combination of Severe/High scores across multiple domains = positive outcome
- Anyone can request a checklist — no GP referral needed
- If positive, the NHS pays 100% of care costs with no means test
- A negative result can be challenged via the ICB complaints procedure
TL;DR: The CHC checklist is a 12-domain NHS screening tool that determines whether your relative gets a full Continuing Healthcare assessment. A positive checklist means the NHS could pay 100% of care costs — worth £50,000+/year. Only 18% of full assessments result in an award (NHS England, Q4 2024/25), so preparation matters. Request the checklist in writing before signing any discharge or self-funding paperwork.
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.
What is the CHC checklist?
Around 51,582 people in England were receiving CHC funding at March 2025 (NHS England, Q4 2024/25). Thousands more are never screened because nobody told their families the checklist existed or because the ICB failed to offer it.
The CHC checklist is the screening tool NHS Continuing Healthcare uses to decide whether your relative's care needs are serious enough to trigger a full funding assessment. Get that decision right, and the NHS pays 100% of care costs — including care home fees that can run to £1,000 or more per week. Your family pays nothing. The checklist is not the final decision. It is the gateway to one. Under the NHS National Framework (2022), it must be completed before any discharge to a care home is arranged.
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 ensure that any person who may have a primary health need is screened using the checklist before a care placement is treated as self-funded.
The checklist measures need across 12 clinical and care domains. Each domain is scored at one of five levels: Priority (the most severe), Severe, High, Moderate, or Low/No Need. The test is whether the person's needs are complex, intense, or unpredictable enough to warrant a full assessment. "Complex" means multiple interacting needs. "Intense" means needs that require frequent or sustained clinical intervention. "Unpredictable" means needs that fluctuate in ways that demand rapid professional response.
The 12 domains are:
- Behaviour
- Cognition
- Communication
- Psychological and emotional needs
- Mobility
- Nutrition, food, and drink
- Continence
- Skin integrity
- Breathing
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
A positive recommendation requires Priority in two or more domains, or Priority in one domain alongside a pattern of Severe scores across others. That positive recommendation does not award funding. It triggers the next stage: a full assessment using the Decision Support Tool (DST).
The NHS CHC checklist screens 12 care domains and triggers a full assessment if it identifies priority or severe needs. At March 2025, 51,582 people were receiving CHC funding in England, yet thousands more are never screened because their families are not told the checklist exists (NHS England, Q4 2024/25).
The checklist is not a bureaucratic hurdle designed to filter people out. It is a legal requirement designed to protect your relative's right to a full assessment before the NHS can hand responsibility for their care to your family or to a local authority.
Who completes the CHC checklist?
Under the National Framework (2022), paragraph 43, any registered nurse, allied health professional, or social worker can complete the checklist — yet families are routinely told otherwise. You do not need a CHC specialist. The ward nurse looking after your relative right now is qualified to complete it.
This matters because hospital teams sometimes tell families the checklist cannot be arranged quickly, or that it needs to be done by a specialist team that isn't available. That is not accurate. The National Framework 2022 is clear: the checklist can and should be completed by the clinical team responsible for the person's care.
Accordingly, if the ward team tells you the checklist cannot be arranged before discharge, put your request in writing immediately. Address it to the ward manager and copy the hospital social worker. A verbal request is easy to overlook. In contrast, a written one creates a record.
The act of writing forces the issue onto a formal track. The ward team cannot claim the request was never made. The social worker cannot say they were not informed.
When must the NHS offer the CHC checklist?
NHS England recorded 1,730 referrals that exceeded the 28-day target at March 2024, with 40 waiting over 26 weeks (Nuffield Trust, June 2024). These delays mean families pay for care the NHS should be funding.
The ICB is obligated to screen for CHC eligibility at specific trigger points (National Framework for NHS Continuing Healthcare, 2022). These are not suggestions. They are duties.
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 in their condition
- 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
A hospital cannot discharge your relative to a self-funded care home placement without first completing or offering the checklist. If this has happened to your family, the ICB has failed to meet its legal duty, and you have grounds for a formal complaint and a retrospective assessment. Under the Care Act 2014, local authorities also have a duty to assess care needs — the NHS screening obligation runs alongside this. Our guide on unsafe discharge from hospital explains your rights in detail.
What are the NHS's deadlines and what happens when it misses them?
The ICB must complete the MDT assessment within 28 days of a positive checklist (National Framework 2022, paragraph 44). At March 2024, 1,730 referrals had exceeded this target, with 40 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 (DST). This 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 any social care funding agreements. Do not agree to self-funding arrangements. 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, take the following steps:
- Write to the ICB's CHC team requesting a written explanation for the delay and a confirmed date for the MDT assessment
- State that you expect the assessment to proceed without further delay, citing the 28-day target in the National Framework
- Copy the ICB's complaints department on the letter 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 or appeal. We've helped families recover significant sums by ensuring they documented every delay from the outset.
We regularly see families who first encounter the CHC checklist only after they have already signed a care home contract and begun paying fees. Once you sign, the ICB treats your relative as self-funding under the Care Act 2014 means-test regime. Reversing that takes months and a formal appeal — and fees already paid may not be recoverable. The single most effective intervention is requesting the checklist in writing before any discharge conversation progresses.
Check whether your relative qualifies for CHC funding
Check eligibility nowCan the NHS refuse to complete the checklist?
No. The National Framework (2022) is unambiguous: where there is a clinical indication that a person may have a primary health need, the ICB cannot lawfully refuse to carry out the checklist. Refusal in those circumstances is a breach of the ICB's statutory duty. Yet only 18% of full assessments result in a CHC award (NHS England, Q4 2024/25), in part because families never get to the checklist stage.
However, families are often told things that amount to a refusal without being phrased as one. Common versions include:
- "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 to screen
- "The consultant hasn't referred them" — a consultant referral is not required; any registered nurse or social worker can complete the checklist
If you are told the checklist will not be done, put your request in writing immediately. Address it to the ICB and include your relative's name, NHS number, and a clear statement that you are requesting a CHC checklist under the National Framework. A written request creates a legal obligation for the ICB to respond. 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.
What happens after a positive CHC checklist?
If the MDT confirms a primary health need, the NHS pays 100% of care costs. Care home fees of £1,000–£1,500/week — £52,000–£78,000/year — fall to zero (Laing Buisson, 2024). Your family pays nothing.
A positive checklist outcome means the clinical team found evidence of sufficient need. Your case goes to the Integrated Care Board (ICB), which arranges a full multidisciplinary team assessment using the Decision Support Tool.
The MDT will include a nurse, a social worker, and other professionals involved in your relative's care. You and your relative have the right to attend and contribute. Bring written observations. Bring care records. The more specific you can be about your relative's daily care needs, the harder it is for those needs to be scored down.
The scoring pattern across all domains — not any single domain in isolation — determines whether a "primary health need" exists. If the MDT finds a primary health need, the ICB awards NHS Continuing Healthcare funding.
If NHS Continuing Healthcare is awarded following the full assessment, the NHS funds 100% of care costs. That means care home fees, personal care, and nursing care. Care home fees that run to £1,000–£1,200 per week for nursing care — or £1,400+ per week for specialist dementia care — fall entirely to the NHS (Laing Buisson Care of Older People UK Market Report, 2024). Your family pays nothing. There is no means test. Eligibility is based entirely on health need, not finances.
Is your relative facing hospital discharge? Don't agree to self-fund care before the NHS checklist has been done. See if the NHS must fund your relative's care
Check eligibility nowWhat happens if the CHC checklist comes back negative?
Only 18% of full assessments result in CHC eligibility nationally (NHS England, Q4 2024/25), but ICB approval rates vary from 7.3% to 42.5% (Nuffield Trust, December 2024). Where you live matters as much as how severe the need is.
A negative checklist outcome does not mean your relative is ineligible for NHS Continuing Healthcare. It means the person who completed the checklist did not find enough Priority or Severe scoring to recommend a full assessment. Those are two different things.
You have the right to request a copy of the completed checklist. Read it carefully. Look at how each domain was scored and ask whether the scores reflect your relative's actual condition — not just how they presented on the day the checklist was done.
Domain scoring depends on what evidence the clinician had in front of them. In our experience helping families through the checklist stage, if your relative was having a better week, or if key needs were not well documented, the scoring will not reflect your relative's actual condition. Family observations of day-to-day care needs often capture detail that clinical records miss. We've found that families who prepare domain-by-domain evidence before the checklist meeting consistently achieve better outcomes.
You can challenge a negative checklist in several ways:
- Request written reasons from the person who completed it. Ask them to explain the scoring for each domain.
- Submit additional clinical evidence that was not available or not considered. GP letters, care home daily records, nursing assessments, and detailed family observations can all change the picture.
- Request a new checklist if your relative's condition has changed or deteriorated since the original screening.
- Complain to the ICB if you believe the checklist was completed without proper evidence or without consulting the family.
A negative checklist is not a closed door. It is a scoring decision made by one clinician on one day. If the evidence was incomplete, the scoring will be wrong. Challenge it.
The process for appealing a CHC decision follows a formal route and your right to challenge is 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. Families with professional support achieve 70–75% eligibility rates at local review, compared with 13–25% without (Beacon CHC / Nuffield Trust, 2024). You have to ask — and you have to ask in writing.
Your right to request a checklist is grounded in the National Framework for NHS Continuing Healthcare (2022), paragraph 44. This document has statutory weight. 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), paragraph 44."
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 for a response, check whether your relative qualifies for full NHS funding. Check eligibility while you wait
Check eligibility nowIf the ward team refuses or fails to respond within 24 to 48 hours given the urgency of a pending discharge, escalate directly to the ICB. The ICB has oversight responsibility for CHC processes in your area. A formal complaint to the ICB tends to move things quickly.
Understanding the criteria for CHC funding before the checklist is completed will help you articulate your relative's needs clearly during the process. The more specific you can be about care needs across the 12 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 does the NHS fund after a successful CHC award?
CHC funding covers 100% of care costs with no means test — worth £52,000–£78,000+/year based on current nursing care rates (Laing Buisson, 2024). When the MDT assessment confirms a primary health need and the ICB awards CHC funding, the NHS becomes responsible for the full cost of the person's care. Full cost means exactly that.
CHC funding covers:
- All care home or nursing home fees, including accommodation and board
- All personal care, including washing, dressing, and 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 (National Framework for NHS Continuing Healthcare, 2022). A person with assets of £1 million receives the same entitlement as a person with no assets at all. The only question is whether the person has a primary health need.
If your relative has been paying care home fees as a self-funder and is subsequently awarded CHC, the NHS must fund care from the date the decision takes effect. In cases 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 a retrospective review. A successful retrospective review can result in reimbursement of fees already paid, sometimes stretching back years.
Holding the NHS accountable when the checklist process fails
The PHSO found failings in 37% of CHC complaints it investigated — 55 out of 150 cases (PHSO, November 2020). The NHS has a structured complaints and escalation process. When the ICB fails to screen, delays the assessment, or refuses the checklist without lawful grounds, you have several routes of challenge.
Stage 1: Formal complaint to the ICB. Write to the ICB's complaints team. State what the ICB was required to do under the National Framework, state what it failed to do, and state what outcome you are seeking. The ICB must acknowledge the complaint within three working days and provide a full response within a timeframe it will set out in its acknowledgement letter.
Stage 2: Escalation to NHS England. If the ICB's response is unsatisfactory, or if the ICB fails to respond at all, escalate to NHS England. NHS England has oversight of ICBs and can intervene where an ICB is not meeting its duties under the National Framework.
Stage 3: Parliamentary and Health Service Ombudsman (PHSO). If NHS England does not resolve the matter, you can refer the complaint 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 a referral. For a full breakdown of the 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.
Still unsure whether to push for a checklist? If your relative has ongoing health needs, the NHS may be legally required to fund their care entirely. Check CHC eligibility in 3 minutes
Check eligibility nowWhat does each CHC checklist outcome mean for your family?
| Positive checklist outcome | Negative checklist outcome | |
|---|---|---|
| What it means | Clinical team found evidence of Priority/Severe needs across domains | Clinical team did not find sufficient evidence for a full assessment |
| Next step | Referred to ICB for full DST assessment | No automatic referral — but you can challenge |
| Who decides funding? | ICB, following multidisciplinary DST assessment | No funding decision is made — case may go to local authority |
| Who pays for care if CHC awarded? | NHS pays 100% — no means test | Not applicable at this stage |
| Can the outcome be challenged? | No — positive outcomes proceed to full assessment | Yes — via ICB complaints and appeals procedure |
| 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 |
Need help building your evidence? Our Case Strength Report (£97) assesses your loved one's care needs across all 12 DST domains and shows you exactly where to strengthen your case before the checklist meeting.