The Assessment Process
The CHC Assessment \u2014 A Step-by-Step Guide
A CHC assessment involves a multidisciplinary team, a structured scoring tool, and a formal decision by your Integrated Care Board. Most families go into this process without knowing what to expect. This guide explains every stage \u2014 from the referral to the decision letter.
How a CHC assessment is triggered
A CHC assessment can be initiated in several ways:
Referral by a healthcare professional \u2014 a GP, hospital consultant, district nurse, or social worker can refer someone for a CHC assessment if they believe needs may meet the threshold. This is the most common route.
Hospital discharge \u2014 when someone with complex health needs is being discharged from hospital, the discharge team should screen for CHC eligibility. If the screening suggests possible eligibility, a full assessment must follow.
Family request\u2014 you can request a CHC assessment directly from the person's ICB or social worker. The NHS cannot lawfully refuse if there is a reasonable belief the person may be eligible.
Retrospective trigger \u2014 if someone has been paying privately and may have been eligible in the past, a PUPoC review is a separate retrospective process.
Once a referral is accepted, the ICB appoints a multidisciplinary team to carry out the assessment.
Stage 1 \u2014 The Checklist
Before a full assessment, a Checklist must be completed. This is a shorter screening tool \u2014 11 care themes, each marked as Present, Not Present, or Not Known.
If two or more themes are marked Present, or one theme is marked Present and the assessor has concerns, the person proceeds to a full DST assessment. If the Checklist does not indicate eligibility, the assessment process ends here \u2014 though families can challenge this conclusion.
The Checklist is often completed by a single professional (nurse or social worker) rather than a full MDT. It is less detailed than the DST and can be completed quickly. Families should ask to see the completed Checklist and challenge it if themes relevant to the person have been marked Not Present incorrectly.
Stage 2 \u2014 The Decision Support Tool (DST)
The DST is the full assessment. It maps needs across the 12 care domains and produces a recommendation for the ICB.
The MDT completing the DST typically includes:
- A registered nurse (usually from the ICB or community health team)
- A social worker (usually from the local authority)
They should also consult the care home staff, GP, and any relevant specialists \u2014 and must involve the person being assessed (if they have capacity) and their family.
The DST meeting lasts 1\u20133 hours. The assessors work through each domain, discussing the evidence and agreeing a score. You have the right to be present, to hear the scoring discussion, and to challenge scores during the meeting.
After the meeting, the completed DST \u2014 including all domain scores and the overall recommendation \u2014 is submitted to the ICB.
Stage 3 \u2014 The ICB decision
The ICB's decision-maker reviews the DST recommendation. They can:
- Accept the recommendation (eligible or ineligible)
- Refer it back to the MDT for further evidence
- In rare cases, override the recommendation
The ICB must notify the person and family of the decision in writing. If eligible, a care plan is developed and funding begins. If ineligible, the letter must explain which domains were scored and why, and must set out the right to request local resolution.
The ICB has no fixed statutory deadline for making a decision, but NHS England guidance indicates decisions should be made promptly \u2014 within weeks, not months. If there is delay, write to the ICB formally requesting a decision date.
What happens after an eligibility finding
If found eligible, the ICB takes responsibility for arranging care. This means:
- The ICB agrees a care plan with the person and family
- Care is arranged in the most appropriate setting \u2014 care home, nursing home, or at home
- The ICB pays all care costs directly to the provider
- The person's income (State Pension, benefits) is not taken \u2014 but a nominal contribution may be agreed in some cases for personal expenses
Eligibility is not permanent. The ICB must review CHC eligibility at least annually and following any significant change in needs. If needs reduce, funding can be withdrawn. If needs increase, a higher level of care should be arranged.
Frequently asked questions
Can the assessment happen without the family being present?
Legally, no — the ICB must take reasonable steps to involve the person and those who know them well. In practice, assessments are sometimes scheduled with very short notice or at inconvenient times. If you cannot attend, request a postponement in writing. If the assessment proceeds without you and you were not given adequate notice, this is a procedural ground for challenging the outcome.
What if we disagree with domain scores during the meeting?
Say so at the time, specifically and with evidence. Explain which domain you believe is scored incorrectly, give a concrete example from your care diary or the clinical records, and reference the National Framework if you can. The assessor must record your disagreement. If the score is not changed, request that your objection is noted in the DST.
How long does a CHC assessment take from referral to decision?
There is no fixed statutory timeline. In practice, the full process — from referral to ICB decision — typically takes 4–12 weeks. Hospital discharge situations are supposed to be assessed faster. If your case is being delayed, write formally to the ICB requesting a timetable and referencing NHS England’s guidance on prompt decision-making.