NHS Continuing Healthcare checklist tool
Work through the twelve care domains used in the NHS Continuing Healthcare Decision Support Tool and get an honest indication of whether a full assessment is worth pursuing. It takes about five minutes, nothing is stored, and you do not need to give us an email address.
Rate each of the twelve care domains
For each domain, choose the level that best describes a typical two-week period. If you are between two levels, choose the higher one and note why — that note is the beginning of your evidence.
Getting the levels right is the whole job
Families consistently under-score. Not because they exaggerate in the other direction, but because they have absorbed so much of the care themselves that it has stopped registering as care. The prompt that helps most is this: describe what would happen if nobody was there.
Score the typical fortnight, not the good hour
Assessments are supposed to consider needs over time. A person who is calm and orientated during a two-hour visit may be neither of those things at four in the morning, four times a week. Write down dates and times. “Sometimes agitated” carries no weight. “Agitated and attempting to leave the building on nine occasions in fourteen days, three of them after 11pm” carries a great deal.
Describe the response, not just the problem
Domain levels are driven by what the need requires, not only by what the need is. Who has to respond, how quickly, with what skill, and what happens if they get it wrong. Two carers rather than one. A registered nurse rather than a care assistant. A same-day response rather than a scheduled visit.
Look for interaction between domains
Complexity is one of the four characteristics that decide a primary health need, and it usually shows up where domains collide — cognition plus nutrition plus medication, or behaviour plus mobility plus skin integrity. Assessments that treat each domain in isolation routinely miss it, and it is worth saying so out loud in the meeting.
Unpredictability is a level, not an excuse
Where needs fluctuate, the framework expects that to be reflected — not averaged away. If a week can go smoothly and the next can involve three emergency responses, the assessment should reflect the risk, not the mean.
- Daily care records covering several weeks
- Falls, incident and behaviour logs with dates and times
- Medication charts, including as-required doses actually given
- Wound and pressure area records, and how often they are reviewed
- Weight charts, food and fluid charts, speech and language reports
- Ambulance call-outs, out-of-hours contacts and hospital attendances
- Your own dated diary of a representative fortnight
From checklist to decision
Request the checklist
Ask in writing. Anyone in health or social care can complete it, and the threshold to progress is deliberately low.
Prepare the evidence
Gather records before the full assessment, not after. The Decision Support Tool is only as good as what is put in front of it.
Attend the MDT
You are entitled to be there and to have your account recorded. Bring your fortnight diary and your dates.
Read the decision
Ask for the completed tool and the decision letter. If domain levels do not match the care being delivered, say so, in writing, promptly.
Questions about the checklist
Is this the official NHS checklist?
No. The official Checklist and the Decision Support Tool are NHS documents completed by health and social care professionals. This tool uses the same twelve care domains so you can think in the right language and arrive at the meeting prepared. It has no official status and it does not decide anything.
What is the difference between the Checklist and the Decision Support Tool?
The Checklist is a short screening document that decides only whether a full assessment happens. The Decision Support Tool is the full assessment, scored across the twelve domains by a multidisciplinary team with evidence attached. Passing the Checklist is not the same as being eligible — and being told you “failed the checklist” is worth challenging, because the bar is set low on purpose.
Who can ask for a Continuing Healthcare checklist?
You can ask, and so can a GP, a district nurse, a social worker, a hospital discharge team or a care home manager. Ask in writing, keep a copy, and ask for the completed checklist to be sent to you dated and signed.
What if the care home says the person will not qualify?
Care homes do not decide eligibility and generally have no authority to screen people out. Some are genuinely trying to be helpful and some are simply repeating what they have always heard. Either way, ask for the checklist to be completed and let the process decide.
Does a dementia diagnosis score anything by itself?
No. No diagnosis scores anything. What scores is the care that the condition requires — cognition, behaviour, nutrition, medication and so on. This is the single most misunderstood part of the whole system, and it cuts both ways: people with serious diagnoses are refused, and people with modest ones qualify.
My relative is at the end of life. Is there a faster route?
Yes. Where someone has a rapidly deteriorating condition that may be entering a terminal phase, an appropriate clinician can complete a Fast Track Pathway Tool, which bypasses the full assessment and should put funding in place immediately. If you are being told to wait for a normal assessment in those circumstances, say the words “Fast Track” explicitly.
Can I use this for someone living at home?
Yes. CHC is not restricted to care homes and can fund a package of care in someone's own home. Score the domains the same way, based on what the care actually requires rather than on where it is delivered.
What if we were refused before?
Refusals can be reviewed, and many are overturned when the evidence is properly assembled. Time limits apply, they are not generous and they are not always explained. Find out where you stand on timing first — that is the first thing we check in a CHC Review.
Do you guarantee we will get funding?
No, and nobody honest will. What we can do is tell you whether there is a case, what the evidence gaps are and how the domains should be argued. If there is no case we will say so on the first call rather than sell you a process.
Take it further
CHC explained in full
Eligibility, the process, timescales and what to do if you are refused.
CHC Funding Review
An expert-led, independent review of your case and your evidence.
Hospital discharge
Where CHC is most often lost, and what to ask before you agree to anything.
The 2-minute Care Check
Not sure CHC is your issue? Start here instead.
You don’t need to know which service you need.
Just tell us what’s happening.
No pressure. No care-provider commissions. Just a conversation about what may help.