Key Facts
- You have the legal right to a CHC checklist before discharge to a care home (National Framework, 2022)
- The hospital cannot force discharge while a CHC checklist request is outstanding
- A positive checklist means the NHS pays 100% of care costs — no means test
- Do not sign care home contracts or self-funding agreements before the checklist is done
- Bed-blocking threats directed at families have no legal basis when a CHC assessment is pending
- Put your checklist request in writing to the ward manager for a timestamped record
- If the hospital refuses, escalate to the Integrated Care Board in writing within 24-48 hours
If your relative is being discharged from hospital to a care home, they have the legal right to a CHC checklist assessment before they leave the ward. If that checklist is positive, NHS Continuing Healthcare may fund 100% of their care costs with no means test. Most families sign care home paperwork before anyone tells them this right exists.
TL;DR: Under the NHS National Framework (2022, para 44), a CHC checklist must be completed before hospital discharge to a care home. A positive outcome triggers full NHS funding — 100% of care costs, no means test. Most hospitals skip this step. Put your request in writing to the ward manager today. Do not sign any care home contract or self-funding agreement until you have the outcome in writing.
What happens when a hospital discharges a patient to a care home?
Discharge planning begins as soon as the clinical team decides your relative's acute medical needs are managed and the hospital bed is no longer clinically necessary. Under NICE guideline NG27, the transition from hospital must meet both clinical and social care needs before the patient leaves. At that point, a hospital social worker or discharge coordinator gets involved and starts arranging the next placement.
Two funding routes exist for care after discharge. The first is local authority social care funding, which carries a means test — the council assesses your relative's savings, income, and property, and they may have to pay some or all of the costs themselves. The second is NHS Continuing Healthcare, which carries no means test at all. In our experience supporting families during hospital discharge, most are never told about this second route until they are already paying privately. If your relative has a "primary health need," the NHS pays 100% of care costs. No savings threshold. No property assessment.
However, the problem is structural. Many hospitals skip the CHC assessment entirely and route patients straight into the social care track. The discharge coordinator hands the family a list of care homes, a funding agreement, and a pen. The CHC checklist — the screening tool that determines whether the NHS should be paying — is never mentioned.
Under the NHS National Framework (2022), paragraph 44, the hospital must offer a CHC checklist before discharging a patient to a care home. This is not optional guidance. If your family has not been told about the CHC checklist, you must ask for it — and you must ask in writing.
What is the CHC checklist and why must it happen before discharge?
The CHC checklist is a 12-domain screening tool that assesses whether your relative's care needs are primarily health-related. It covers behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other significant care needs.
Any registered nurse or social worker can complete it. Notably, it does not require a specialist referral. The ward nurse looking after your relative today is qualified to do it.
The legal basis is the National Framework for NHS Continuing Healthcare (2022), paragraph 44: the hospital must complete the checklist before discharging the patient to a care home. The Framework has statutory weight. When the ward team tells you it cannot be arranged before Friday, that is an operational claim, not a legal one.
As a result, a positive checklist outcome triggers a full assessment by a multidisciplinary team using the Decision Support Tool (DST). The Integrated Care Board (ICB) must arrange this within a target of 28 days. If that full assessment confirms a primary health need, the NHS funds 100% of care — care home fees, personal care, nursing care. Your family pays nothing.
In contrast, a negative checklist outcome does not end the process. You can challenge the scoring through the ICB's complaints and appeals procedure. Request a copy of the completed checklist, review how each domain was scored, and provide evidence where scores do not reflect your relative's actual condition.
The critical rule: do not sign any care home admission paperwork or self-funding agreement until the checklist is complete and you have the outcome in writing.
Is your relative facing hospital discharge to a care home this week? Don't sign anything before you know whether the NHS must fund their care. Check CHC eligibility in 3 minutes
Check eligibility nowUnsafe discharge: definition and legal grounds
An unsafe discharge from hospital is one where the NHS fails to meet its legal obligations before transferring a patient. The following all constitute an unsafe discharge:
- The CHC checklist has not been completed when it has been requested or should have been offered.
- No written care plan has been provided before the transfer takes place.
- The patient lacks mental capacity and no formal decision-maker — a person holding a Lasting Power of Attorney for health and welfare, a Court of Protection deputy, or an Independent Mental Capacity Advocate — has taken part in the placement decision. This breaches the Mental Capacity Act 2005.
- The family has been verbally pressured to accept a placement on the same day, with no documentation and no opportunity to review options.
You cannot be forced to sign. Verbal pressure from the ward team, however urgent it sounds, has no legal force. If no one has put the discharge proposal in writing with a care plan attached, the process is incomplete.
The hospital discharge care plan and what it must contain
The hospital discharge care plan is a written document that sets out your relative's care needs, the support required, who provides that support, and where the care will be delivered. Under NICE guideline NG27, it must be in place before discharge happens.
The plan should specify the funding route: whether your relative is self-funding, funded by the local authority, or funded through NHS Continuing Healthcare. If the plan does not state the funding route clearly, ask why — and ask in writing.
Do not accept verbal assurances. "We'll sort the funding out once they're settled in the home" is not a care plan. It is an invitation to start paying fees the NHS may owe. Insist on seeing the written plan before any transfer takes place. If no written plan exists, the discharge process is not complete.
Can the hospital charge for "bed-blocking" if you delay discharge?
This is the threat families fear most — and it is not legally founded in the way ward staff sometimes imply.
The delayed discharge charging mechanism under the Care Act 2014 and the Community Care (Delayed Discharges etc.) Act 2003 allows the NHS to charge local authorities for delays in arranging social care placements. It is a mechanism between NHS bodies and councils. It does not create a right to charge patients or their families directly.
If your relative's discharge is delayed because you have requested a CHC checklist and the hospital has not completed it, you are exercising a right recognised by the National Framework (2022). That is not "bed-blocking." That is the assessment process running as it should.
Verbal warnings about bed-blocking charges directed at families — "if you don't move them, you'll be charged for the bed" — have no legal basis when a CHC assessment is outstanding. If a member of staff makes this claim, ask them to put it in writing with the legal authority they are relying on. In practice, the claim will not be repeated.
Stay firm. The CHC checklist right does not expire because the hospital wants the bed back.
Rights at discharge: quick reference
| Situation | Your right | What to do |
|---|---|---|
| Hospital wants discharge this week | CHC checklist before any transfer (National Framework 2022, para 44) | Request in writing to ward manager today |
| No written care plan provided | Written plan required before discharge (NICE NG27) | Refuse to sign anything until written plan provided |
| Pressure to sign self-funding agreement | Right to CHC outcome before any financial commitment | State in writing: no contracts until checklist complete |
| Checklist request ignored within 48 hours | ICB must act on your request | Write to ICB CHC team directly |
| Patient lacks mental capacity | Decision-maker must be formally involved (MCA 2005) | Invoke LPA or request IMCA |
| Ward threatens bed-blocking charges | Charges target local authorities, not families | Ask for the legal basis in writing — the threat rarely survives |
What to do when the hospital is pushing for discharge this week
If you are reading this because the ward team has told you your relative must leave by the end of the week, take these steps in order.
Step 1: Put the CHC checklist request in writing today.
Address it to the ward manager. Copy the hospital social worker. Use this language:
"I am requesting that a CHC checklist assessment be completed for [name] before any discharge decision is made. This is our right under the National Framework for NHS Continuing Healthcare (2022), paragraph 44."
Send it by email so you have a timestamp. Use a specific subject line: "Written request for CHC checklist assessment — [patient name] — [ward name] — [date]."
Step 2: Do not sign any care home contracts or funding agreements.
No admission paperwork. No self-funding agreements. No "interim" placement contracts. Nothing goes in front of a pen until you have the checklist outcome in writing. Specifically, once you sign, the ICB treats your relative as self-funding. Reversing that takes months.
Step 3: If refused or ignored within 24-48 hours, escalate to the ICB.
Therefore, contact the Integrated Care Board's CHC team directly. You can find your local ICB through the NHS England website. Tell them you have made a written request for a CHC checklist, the hospital has not acted on it, and discharge is being pushed without the legally required assessment. Put this escalation in writing as well.
Step 4: If the ICB is unresponsive, complain to NHS England.
NHS England oversees compliance with the National Framework. A formal complaint to NHS England, referencing the specific paragraph of the Framework being breached, creates a record that is difficult to ignore. Keep copies of every email, every letter, and every form you have been given throughout the process.
The paper trail you build in these four steps is what turns a verbal dispute into a resolved claim. Start today.
The CHC checklist is your relative's legal right before discharge. Find out if they qualify for full NHS funding before any paperwork is signed. See if the NHS must fund your relative's care
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