The hospital says your relative is ready for discharge. They need ongoing care — possibly in a care home — and someone is asking who will pay. This is the most critical moment in the entire CHC process, and most families miss it completely.
This guide gives you a clear, step-by-step action plan for the next 72 hours. It covers what to say, who to contact, your legal rights, and how to make sure NHS Continuing Healthcare is properly considered before your relative leaves hospital. Based on the NHS National Framework for CHC and FNC (2022).
Why is hospital discharge the most critical moment for CHC?
Hospital discharge is when families are at their most vulnerable. Your relative is unwell, the hospital is under pressure to free beds, and decisions are being made quickly. In this environment, CHC is routinely overlooked. Discharge teams focus on arranging a care placement, not on checking whether the NHS should be funding it.
The consequences of missing CHC at this stage are significant. If your relative is discharged to a self-funded care home placement without a CHC screening, you could end up paying £1,000–£1,500 per week for care that the NHS should be funding. Over a year, that is £50,000–£78,000. Some families pay for years before discovering they were eligible all along.
The NHS National Framework (2022) is clear: anyone who may have a primary health need should be screened for CHC. But the screening does not happen automatically. You must ask for it.
What are your legal rights at hospital discharge?
Families are often unaware of the protections that exist. Here are the key rights you should know:
Right to a CHC Checklist screening
You can request a CHC Checklist at any time. The NHS has a duty to screen anyone who may have a primary health need. You do not need permission — simply ask the ward sister, social worker, or discharge coordinator.
Right to a written discharge plan
The hospital must provide a clear discharge plan covering where the person is going, what care will be in place, and who is responsible. You are entitled to see this before discharge happens.
Right to challenge an unsafe discharge
If you believe the discharge plan does not provide adequate care, you can raise this with the ward manager, PALS, or the hospital's Chief Nurse. The hospital has a duty of care and should not discharge into an unsafe situation.
Right not to be pressured into self-funding
The hospital cannot require you to sign a contract with a care home or agree to self-fund while a CHC assessment is pending. If asked to pay, make clear in writing that any payment is "without prejudice" to the CHC outcome.
Your 5-step action plan
Follow these steps as soon as hospital discharge is mentioned. The earlier you act, the stronger your position.
Request a CHC Checklist screening before discharge
As soon as discharge is mentioned, ask the ward sister, discharge coordinator, or hospital social worker to complete a CHC Checklist screening. You do not need to wait for anyone to offer this — you have the right to request it. Say: "I would like a CHC Checklist screening to be completed before any discharge arrangements are made." Put this request in writing (email is fine) and keep a copy. Under the National Framework (2022), the NHS has a duty to assess anyone who may have a primary health need.
Ask for the discharge plan in writing
Request a written discharge plan that includes where your relative will be discharged to, what care package will be in place, who will provide the care, and what medications or equipment are needed. The hospital must provide this. If the plan involves a care home placement, ask who is funding it and for how long. Do not sign anything or agree to self-fund until you understand the CHC position.
Gather evidence of care needs while in hospital
Hospital is the best time to collect evidence because your relative is under clinical observation. Request copies of nursing assessments, medical notes, therapy reports (physiotherapy, occupational therapy, speech and language), and medication charts. Ask the ward staff to document specific incidents — falls, confusion, agitation, challenging behaviour, incontinence episodes — in the clinical notes. This evidence will be critical if a CHC assessment is triggered.
Know your rights if the hospital pressures you
Hospitals cannot discharge a patient to a care home and expect the family to pay without first checking whether the person might be eligible for CHC. If the hospital is pressuring you to agree to a self-funded placement, say: "We are not agreeing to self-fund until a CHC Checklist screening has been completed. Please arrange this before discharge." If you are told there is no time, ask for the Patient Advice and Liaison Service (PALS) and escalate in writing. You can also contact the hospital's Chief Nurse or the local Integrated Care Board (ICB) directly.
Follow up within 48 hours if no screening has been arranged
If you have requested a CHC Checklist screening and nothing has happened within 48 hours, escalate immediately. Write to the ward manager and copy in the hospital PALS team, stating the date of your original request and that no screening has been arranged. If your relative is discharged without a CHC screening, you can still request one after discharge — either from the ICB or via your GP. You can also apply for a retrospective review if you believe CHC should have been considered at the time of discharge.
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Get the free checklistWhat should you say to hospital staff about CHC?
Knowing what to say can be the difference between being heard and being dismissed. Here are word-for-word phrases you can use in conversations with hospital staff:
To request a CHC screening
"I would like a CHC Checklist screening to be completed for my [mother/father/relative] before any discharge arrangements are finalised. Please can you arrange this and confirm in writing."
If told there is no time
"I understand the hospital needs the bed, but the NHS National Framework requires that anyone who may have a primary health need is screened for CHC. I am asking for this screening to be arranged. If it cannot be done before discharge, please confirm in writing who will arrange it after discharge."
If pressured to agree to self-funding
"We are not in a position to agree to self-fund care until a CHC Checklist screening has been completed. Any interim payments made are without prejudice to the CHC assessment outcome."
If you need to escalate
"I have requested a CHC Checklist screening on [date] and this has not been arranged. I would like to speak to the ward manager and the Patient Advice and Liaison Service (PALS). I am also writing to the Integrated Care Board."
Who should you contact if the hospital won't screen for CHC?
If your request for a CHC screening is being ignored or delayed, escalate through these channels in order:
- Ward sister or discharge coordinator— your first point of contact for the CHC Checklist request.
- Ward manager— if the discharge coordinator does not act within 24 hours.
- Patient Advice and Liaison Service (PALS)— every NHS hospital has a PALS team. They can intervene on your behalf and are required to respond promptly.
- Chief Nurse or Director of Nursing— for serious failures, such as an unsafe discharge or repeated refusal to arrange a CHC screening.
- Integrated Care Board (ICB)— the ICB is responsible for CHC in your area. You can contact them directly to request a screening, even if the hospital has not cooperated. Find your local ICB on the NHS England website.
Always put your requests and escalations in writing. An email to the relevant person creates a paper trail that protects you if the process goes wrong. Keep copies of everything.
What can you do if your relative has already been discharged?
If you are reading this after your relative has already left hospital, it is not too late. You can request a CHC Checklist screening at any time — not just during a hospital stay. Contact your local ICB or ask the GP to arrange one.
If your relative was discharged without any mention of CHC and you have been paying for care since, you may be eligible for a retrospective CHC claim. If the review finds your relative should have been eligible at the time of discharge, the NHS may be required to refund care fees you have paid.
Not sure if your relative might qualify? Our free CHC eligibility screener takes under five minutes and gives you an initial indication of whether CHC is worth pursuing.
Frequently asked questions
Can the hospital discharge my relative without completing a CHC screening?
Technically, yes — the hospital can discharge a patient once they are medically fit. However, if there are reasonable grounds to believe the person may have a primary health need, the NHS has a duty to arrange a CHC Checklist screening. If the hospital discharges your relative without a screening, you can request one after discharge from the ICB or GP. You may also be able to claim a retrospective review for the period when CHC should have been considered.
What is the 28-day rule for hospital discharge and CHC?
The NHS National Framework sets a target of 28 days from the CHC Checklist screening to a Decision Support Tool (DST) assessment. This means the full CHC assessment process should ideally be completed within four weeks. In practice, many ICBs take longer. If the 28-day target is exceeded, write to the ICB citing the Framework target and requesting an update on timescales.
Who pays for care while the CHC assessment is ongoing?
If the CHC assessment has been triggered (i.e. the Checklist indicates a full assessment is needed), the NHS should not expect you to commit to self-funding until the assessment is complete. In some cases, the NHS will arrange interim funding, particularly if the person is being discharged from hospital to a care home. Ask the discharge team or ICB what funding arrangements are in place during the assessment period. If you are asked to self-fund, make clear in writing that this is "without prejudice" to the CHC assessment outcome.
What if my relative has already been discharged and is now in a care home?
You can request a CHC Checklist screening at any time — there is no rule that says it must happen during a hospital stay. Contact your local ICB or ask your GP to arrange a screening. If you believe CHC should have been considered at the point of hospital discharge but was not, you may also be entitled to a retrospective review covering the period from discharge onwards.
What is an unsafe discharge and what can I do about it?
An unsafe discharge is when a patient is sent home or to a care setting without adequate care arrangements in place. If you believe a discharge is unsafe — for example, the person needs 24-hour nursing care but is being sent home with minimal support — you should raise this immediately with the ward manager and PALS. Put your concerns in writing, stating why you believe the discharge is unsafe. The hospital has a duty of care and should not discharge a patient into a situation where they are at risk of harm.
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Sources: NHS National Framework (2022) | NHS PALS Service | NHS.uk: Continuing Healthcare
CareAdvocate provides advocacy and guidance, not legal advice. Every case is different and outcomes cannot be guaranteed. If you need legal advice, please consult a solicitor specialising in healthcare law.