The CHC Checklist
The screening tool that stands between your loved one and a full assessment
Before the NHS carries out a full Continuing Healthcare assessment, a clinician completes a Checklist — an 11-theme screening tool that determines whether the case goes forward. Many families never know it happened. Fewer know how to challenge it.
Last reviewed June 2026 · Based on the National Framework for NHS Continuing Healthcare (revised 2022).
What is the CHC Checklist?
The CHC Checklist is the first formal stage of the NHS Continuing Healthcare assessment process. It is completed by a clinician — typically a nurse, social worker, or care coordinator — and its purpose is to screen out cases that are unlikely to meet the eligibility threshold before a full multidisciplinary assessment is arranged.
The Checklist is not a diagnosis. It is not a care plan review. It is a structured screening document across 11 care themes, each scored at one of three levels: A (most severe), B (moderate), or C (low or no need).
A person generally proceeds to a full Decision Support Tool (DST) assessment if:
- They score A on two or more Checklist themes, or
- They score B on five or more Checklist themes, or
- There is any A score in specific high-priority themes
If the Checklist concludes that a full assessment is not warranted, the process stops there — unless the family challenges the decision.
The 11 Checklist themes
1. Behaviour
Behaviours that challenge carers or put the person or others at risk, including agitation, aggression, wandering, or self-harm.
2. Cognition
The person’s ability to understand information, make decisions, retain memory, and communicate their needs.
3. Psychological and emotional needs
Anxiety, depression, grief, or other psychological conditions that require specialist intervention.
4. Communication
The ability to express and receive information. Includes verbal, non-verbal, and augmentative communication needs.
5. Mobility
The level of physical assistance required to move safely, including transfers, pressure area management, and falls risk.
6. Nutrition, food and drink
The ability to swallow safely, maintain a healthy weight, or manage enteral feeding or parenteral nutrition.
7. Continence
Management of bladder and bowel function, including catheter care, stoma management, and the frequency of intervention required.
8. Skin and tissue viability
Pressure ulcer risk, wound care complexity, and the clinical skill required to manage skin integrity.
9. Breathing
Respiratory support needs including oxygen therapy, suctioning, ventilation, or management of distressing breathlessness.
10. Drug therapies and medication: symptom control
The complexity of medication regimes, the clinical skill required to administer them, and the management of pain or symptom control.
11. Altered states of consciousness
Episodes of unconsciousness, seizures, or other altered states that require immediate clinical response.
Why families should always ask to see the Checklist
The Checklist is a document you are entitled to see. Many families do not know it exists until after the process has concluded. By the time they become aware that a Checklist was completed, a negative screening decision may already have been accepted — and the window for timely challenge may have passed.
Asking to see the completed Checklist allows you to:
- Confirm that all 11 themes were assessed, not just the ones the clinician considered most relevant
- Check whether scores reflect the person’s worst presentations, not just their typical day
- Identify themes where the score appears to understate the level of need
- Build the basis for a challenge if the screening decision appears wrong
The National Framework requires that any Checklist decision be notified in writing to the person or their representative. If you have not received written notification of a Checklist outcome, request it immediately.
How to challenge a negative Checklist decision
A negative Checklist outcome — one that stops the process before a full DST assessment — can and should be challenged if you believe it is wrong. The challenge process differs from the full appeal route (which applies after a DST).
Steps to challenge:
- Request the completed Checklist document in writing
- Review all 11 themes and note where you disagree with the scoring
- Gather evidence: care home records, GP notes, hospital discharge letters, specialist reports
- Write to the ICB requesting a review, citing the specific themes where you believe the score was too low and providing supporting evidence
- If the ICB refuses to reconsider, escalate to the NHS Independent Review process
- Consider instructing a CHC solicitor if the person’s needs are significant — the earlier specialist advice is taken, the better
The key principle: the Checklist should reflect the person’s actual presentation, including their worst episodes, not a snapshot of a single clinical visit.
Frequently asked questions
What is the difference between the CHC Checklist and the Decision Support Tool (DST)?
The Checklist is a screening tool — it determines whether a full assessment is warranted. The DST is the full assessment itself, completed by a multidisciplinary team across 12 care domains with detailed scoring. The Checklist has 11 themes; the DST has 12 domains. If the Checklist concludes that a full DST is not needed, the process stops unless challenged. The DST is where the formal eligibility decision is made.
Can you request a CHC Checklist if no one has mentioned it?
Yes. If your loved one is in hospital, a care home, or receiving significant community health care and no one has raised CHC eligibility, you can — and should — request that a Checklist be completed. The legal duty to consider CHC eligibility rests with the NHS, but it is frequently not proactively applied. You can write to the responsible ICB or speak to the care coordinator to formally request an assessment.
How long does it take to move from Checklist to full DST assessment?
There is no legally mandated timeframe for Checklist to DST, but NHS guidance suggests the process should be completed without unnecessary delay. In practice, delays of weeks or months are common. If a DST is warranted but not being arranged promptly, write to the ICB requesting confirmation of the timeline and escalate to the Patient Advice and Liaison Service (PALS) if no response is received.