CHC Funding Guide
The assessors need evidence.
Here's exactly what to record.
A CHC assessment is won or lost on the quality of the evidence presented. The Multi-Disciplinary Team scores each of the 12 care domains based on what they can see in the records. If something isn't documented, it effectively didn't happen.
These templates show you what to record, how to phrase it, and why it matters — domain by domain.
The care diary: your most powerful tool
A care diaryis a dated, factual record of your loved one's care needs written by someone who sees them regularly — usually a family member. It is not a complaint, a narrative, or an opinion piece. It is evidence.
What makes a strong care diary entry
- +Date and time of the observation or incident
- +What happened — factual, specific, no editorialising
- +How long it lasted or how many staff were involved
- +What intervention was required (medication, restraint, two-person assist)
- +What the outcome was (did they settle? was it repeated later?)
- +Which DST domain it relates to (behaviour, cognition, mobility, etc.)
Avoid these common mistakes
- -Vague statements: "Mum had a bad day" tells the assessor nothing
- -Emotional language: "It's disgusting that nobody cares" undermines your credibility
- -Generalising: "She falls all the time" — how many times? When? What happened?
- -Mixing needs with complaints about the care home — keep these separate
Domain-by-domain: what to record
The Decision Support Tool has 12 care domains. For each one, the MDT panel scores the person's needs as No needs, Low, Moderate, High, Severe, or Priority. To qualify for CHC, a person typically needs at least one Severe rating or several Highs across multiple domains.
Below is what to record for each domain, with example phrasing you can adapt.
Behaviour
What to look for
Aggression, agitation, wandering, resistance to care, self-harm, sundowning episodes
What to record
Date, time, trigger (if known), duration, what staff had to do, was restraint or PRN medication used?
Example entry
Cognition
What to look for
Disorientation, inability to make decisions, failure to recognise family, getting lost in familiar environments
What to record
Specific instances where cognitive impairment created a risk or required intervention
Example entry
Communication
What to look for
Inability to express needs, difficulty understanding instructions, use of non-verbal cues only
What to record
How communication breakdown affected care delivery or caused distress
Example entry
Psychological / Emotional
What to look for
Depression, anxiety, hallucinations, delusions, emotional lability, withdrawal from activities
What to record
Frequency and impact on daily functioning, interventions required, mental health professional involvement
Example entry
Mobility
What to look for
Falls, inability to transfer, requirement for hoisting, unsafe walking, contractures
What to record
Number of falls per week/month, number of staff needed for transfers, equipment used, time taken
Example entry
Nutrition
What to look for
PEG feeding, thickened fluids, swallowing difficulties (dysphagia), weight loss, risk of aspiration
What to record
SALT assessment outcome, modified diet details, percentage of meals eaten, weight trajectory
Example entry
Continence
What to look for
Double incontinence, catheter management, skin breakdown from incontinence, frequency of pad changes
What to record
Number of incontinence episodes per day/night, skin condition, pad type and change frequency
Example entry
Skin Integrity
What to look for
Pressure sores, wound care, skin tears, requirement for pressure-relieving equipment
What to record
Wound assessments, grade of pressure sores, frequency of dressing changes, equipment in use
Example entry
Breathing
What to look for
Oxygen therapy, COPD management, nebulisers, suction, sleep apnoea requiring intervention
What to record
Oxygen saturation readings, nebuliser frequency, hospital admissions for respiratory issues
Example entry
Drug Therapies
What to look for
Complex medication regimens, injections, covert medication, monitoring requirements, adverse reactions
What to record
Number of medications, administration method, frequency, clinical monitoring needed
Example entry
Altered States of Consciousness
What to look for
Seizures, loss of consciousness, delirium, fluctuating awareness
What to record
Frequency, duration, post-episode recovery time, emergency interventions required
Example entry
Other Significant Needs
What to look for
Anything not captured above — e.g., tracheostomy care, stoma care, dialysis, complex pain management
What to record
Clinical procedures required, frequency, specialist involvement, impact on daily life
Example entry
The incident log: tracking patterns over time
An incident log differs from a care diary. While the diary captures daily observations, the incident log tracks specific eventsthat demonstrate the nature, complexity, intensity, and unpredictability of your loved one's needs — the four characteristics the MDT uses to determine a primary health need.
What counts as an incident
- +Falls (including near-misses)
- +Hospital or A&E admissions
- +Behavioural episodes requiring restraint or PRN medication
- +Choking or aspiration events
- +Seizures or loss of consciousness
- +Infections requiring antibiotics (UTIs, chest infections, wound infections)
- +Significant changes in condition (sudden deterioration, delirium)
- +Absconding or wandering incidents
The power of an incident log is in the pattern it reveals. Three falls in a month is a stronger statement about mobility needs than a single assessment snapshot. Seven UTIs in six months tells a story about continence management that a one-off observation misses. Assessors are trained to look at the totality of needs — your incident log makes that totality visible.
Template letters you may need
At various stages of the CHC process, you may need to write formal letters to the ICB, the care home, or your GP. Here are the most common situations and what each letter should include.
Requesting a CHC Checklist screening
When: When you believe your loved one may qualify for CHC but no screening has been done
Your letter should include:
- +The person's name, date of birth, and NHS number
- +A brief summary of their care needs (referencing DST domains)
- +A request for a Checklist screening under the NHS National Framework (2022)
- +Your relationship to the individual and contact details
Requesting access to care home records
When: When you need daily care records, incident logs, or care plans for the assessment
Your letter should include:
- +Cite the Data Protection Act 2018 and UK GDPR (Article 15)
- +Specify which records you need (daily notes, incident reports, care plans)
- +State your legal basis (LPA, next of kin, court-appointed deputy)
- +Give a reasonable deadline (30 days is the statutory maximum)
Submitting evidence to the MDT panel
When: Before the full assessment meeting, to ensure your evidence is on the record
Your letter should include:
- +A covering letter listing all enclosed documents
- +Your care diary (organised by domain)
- +Your incident log
- +Any supporting clinical documents you've gathered
- +A request for confirmation that these will be circulated to all MDT members before the meeting
Challenging a CHC decision
When: When the assessment outcome is negative and you believe it was incorrect
Your letter should include:
- +The date of the decision and reference number
- +Specific domains where you believe the scoring was wrong, with evidence
- +Reference to the NHS National Framework (2022) and the relevant scoring descriptors
- +A request for a local review or referral to the Independent Review Panel
Common questions
What evidence is needed for a CHC assessment?
The Multi-Disciplinary Team (MDT) panel considers clinical records (GP notes, hospital discharge summaries, consultant letters), care home daily records, your own care diary, and any professional assessments (physiotherapy, speech therapy, mental health). The strongest cases include specific, dated examples of care needs across the 12 DST domains.
Can family members submit evidence to the CHC assessment?
Yes. The NHS National Framework (2022) states that the individual and their family should be invited to contribute to the assessment and that their views must be recorded. You can submit a written statement, a care diary, and supporting documents. The MDT must consider this evidence alongside clinical records.
How far in advance should I start gathering evidence?
Start as soon as you know a CHC assessment is being arranged — ideally 2-4 weeks before the MDT meeting. However, even if the meeting is imminent, any evidence you can provide is valuable. If you are requesting a retrospective review, you may need to gather historical records going back months or years.
What if the care home won't share daily records with us?
You have the right to request these records under UK GDPR. If the individual lacks capacity, the person with Lasting Power of Attorney (Health and Welfare) or a court-appointed deputy can request them. If the care home refuses, put your request in writing citing the Data Protection Act 2018 and escalate to the ICO if necessary.
Take the next step
Let AI analyse your medical records
Our Case Strength Report reviews your clinical records and identifies the strongest evidence across all 12 DST domains — showing you exactly where your case is strongest and where to focus your preparation.