The NHS Continuing Healthcare Checklist

The NHS Continuing Healthcare Checklist, usually called the CHC Checklist, is a short screening form that decides whether the NHS should carry out a full assessment of someone's eligibility for NHS Continuing Healthcare (CHC) in England. A trained health or care professional completes it, not the family. The threshold is deliberately low: a positive Checklist means a full assessment rather than funding, and a negative one means no full assessment, although you can ask the integrated care board (ICB) to reconsider. This guide covers who completes it, the exact thresholds and what to do after a negative result.

It often arrives at a stressful moment: a hospital discharge, a care home move or a sharp decline. It is only the first gate, you have rights around it and there is a route after a “no” that is often left out of other guides.

What the CHC Checklist is for

If an ICB uses an initial screening process, the Standing Rules Regulations 2012 require it to use the Checklist, to tell the person or their representative in writing whether a full assessment will be carried out and to record that decision. The aim is proportionate assessment: full multidisciplinary assessments go to the people most likely to be eligible, and every decision has a recorded rationale.

The Checklist has 11 domains, each with three columns: A, B and C. Column A describes the highest level of need and column C no or low need. On the printed form they run C, B, A from left to right. A positive result leads to the Decision Support Tool and its 12 domains.

Who completes the Checklist, and how to ask for one

Trained practitioners complete it: registered nurses employed by the NHS, GPs, other clinicians and local authority staff such as social workers and care managers. Each ICB agrees locally who does it.

You or a family member cannot complete and submit a Checklist, and the person cannot self-refer. You can ask:

• a practitioner who already knows the person, such as the GP, a district nurse, a social worker or the hospital ward team, to complete one;
• the ICB's CHC team to arrange for someone to visit;
• the care home manager or support provider to contact the ICB for you.

Practice guidance says the ICB should respond in a timely way, and in most circumstances complete a Checklist within 14 calendar days of a request. The person should get reasonable notice and normally the chance to attend with a representative. Ask who will do it and which evidence they will use.

When a Checklist is not needed

The national guidance lists six situations:

1. It is clear to practitioners there is no need for CHC at this time. If they are in doubt, they should complete the Checklist.
2. The person has short-term needs or is recovering from a temporary condition and has not yet reached their optimum potential.
3. The ICB has agreed a direct referral for a full assessment.
4. The person has a rapidly deteriorating condition and may be entering a terminal phase. The Fast Track Pathway Tool is used instead.
5. Services under section 117 of the Mental Health Act 1983 are meeting all of the person's assessed needs.
6. The person was previously found not eligible and nothing has changed.

If no Checklist is done, the decision and reasons should be recorded in the person's notes.

The Checklist and hospital discharge

In the vast majority of cases screening should happen in a community setting after discharge and a period of recovery, because an assessment in an acute hospital is unlikely to reflect longer-term needs. CHC assessment should not delay a safe discharge. Instead the NHS should consider interim NHS-funded support, such as therapy, rehabilitation or an interim care package, which continues until it is decided whether CHC is needed, with no gap in support. If a hospital Checklist is positive, interim services can run until the full assessment is completed.

The 11 Checklist domains and what column A describes

The Checklist has the same domains as the Decision Support Tool except the twelfth, other significant care needs. The four marked with an asterisk on the form can trigger a full assessment on a single entry in column A. The table paraphrases the themes of column A, not the exact wording.

The asterisked domains are the four that can reach priority level in the DST. The assessor picks, for each domain, the description that most closely matches the person's needs, and selects column A if the needs equal or exceed it.

CHC Checklist thresholds: when a full assessment is required

A full assessment for CHC is required if any one of these applies:

• two or more domains are in column A;
• five or more domains are in column B;
• one domain is in column A and four are in column B;
• one domain is in column A in an asterisked domain (breathing, behaviour, drug therapies or altered states of consciousness), whatever is selected elsewhere.

Exceptionally, a full assessment may be appropriate below these thresholds if there is a clear rationale and local protocols are followed. If practitioners disagree about whether a Checklist is needed at all, they should complete one. The arithmetic in practice:

This is illustrative arithmetic, not a way to score a real person. Which column fits depends on the assessor's judgement of the evidence.

Well-managed needs apply here too

The principle that well-managed needs are still needs applies to the Checklist as it does to the DST. The assessor should record the need as it exists with good care in place, neither ignoring it because it is controlled nor imagining the care away.

The outcome must be in writing, with reasons

Whatever the outcome, it must be communicated clearly and in writing to the person or their representative as soon as reasonably practicable, with the reasons, normally by giving a copy of the Checklist. Keep that copy: it records the assessor's description of each domain and their source of evidence. For someone screened out, the ICB is responsible for making sure they are given a copy, told how to seek a review and offered a referral to the council for social care support.

What a positive Checklist means

A positive Checklist means a full assessment is required. It does not mean the person is eligible. The ICB appoints a case coordinator and a multidisciplinary team completes the Decision Support Tool; see how to prepare for the MDT meeting.

• Timing: in most cases the process should not exceed 28 calendar days from the ICB receiving the positive Checklist to the decision, and the ICB normally responds to the MDT's recommendation within 48 hours.
• Support meanwhile: the person should not be left without appropriate support, and existing care arrangements continue until the ICB decides.
• Delay: if the ICB takes more than 28 days without good reason and then finds the person eligible, it should refund costs paid for services from day 29.

The figures show why a positive Checklist is permission to be assessed, not a prediction. In 2025/26 NHS England recorded 66,068 completed standard referrals and 8,776 people found eligible, about 13% (our arithmetic). Of the 50,402 standard assessments completed, 17.4% ended in eligibility.

A negative Checklist: what to do next

A negative Checklist means the NHS has decided the person does not need a full assessment and is not eligible for CHC at this point. It is not the end of the matter, and the route that follows is often left out of other guides.

1. Get the outcome in writing, with a copy of the Checklist. You are entitled to the reasons.
2. Compare it with reality. Check each domain against the bad days and the nights and against the care you or the home provide. Note any entry that does not match.
3. Ask the ICB to reconsider. Write to the ICB with the extra information. It should give the request due consideration, taking account of all the information available, but it is not obliged to do a further Checklist.
4. Flag expected changes. If needs are likely to increase in the next three months, the assessor should record that and decide whether to review the Checklist within a set period. If needs later change, a new Checklist or a direct full assessment may be considered.
5. Use the NHS complaints procedure if you remain dissatisfied. The ICB's written response should explain your rights under it.
6. Independent review is not available here. NHS England's own guide says the independent review process cannot look at an ICB's refusal to consider a request for a full assessment following a negative Checklist. That route belongs to decisions made after a full assessment: see local resolution and independent review.
7. Ask about other help. The person should be asked whether they would like a Care Act assessment of their social care needs; council-arranged care can be means-tested. In a care home with nursing, a negative Checklist does not prevent NHS-funded nursing care, paid directly to the home at a standard flat rate of £267.68 a week from 1 April 2026.

One point is easy to miss. When the review of someone who receives NHS-funded nursing care takes place, potential eligibility for CHC must always be considered by completing a Checklist, unless one was done before and needs have not changed. That review is a natural moment to ask again.

Consent: what family can see and share

Sharing information between the health and social care professionals involved does not need the person's consent. Sharing it with family, friends or advocates does need explicit consent. Guidance published by the Department of Health and Social Care on 8 May 2026 says consent is normally sought at the Checklist stage and recorded on the NHS CHC consent form. The person decides how much to share and with whom, and can change or withdraw consent at any time.

If the person lacks capacity, a lasting power of attorney for health and welfare or a health and welfare deputy can decide for them, and otherwise the decision is made in their best interests. A property and financial affairs attorney cannot consent to health and welfare matters, although a third party acting in the person's best interests can legitimately request information to challenge an eligibility decision. If information cannot be shared with family, the quality of the assessment evidence may suffer, so it is worth settling consent early.

What to tell the assessor

NHS England's own guide for families, written for the review stage, asks for habits that help here too: be specific, so that “usually two or three times a day” helps far more than “a lot”, and give equal weight to mental and emotional needs and to care that relatives provide.

• Describe a typical day and a bad day, and include the nights. A 7-day care diary kept at the time makes this easier.
• Give numbers: how often, for how long and how many people are needed.
• Say what happens if care is late or missed.
• Bring recent letters, care plans and the home's daily notes.

Describe what really happens and no more. The same information is carried forward into the full assessment, and exaggeration does not help the person.

Common questions