Free NHS Continuing Healthcare Checklist Tool

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.

Written by Francis, co-founder · registered mental health nurseReviewed by Samantha, co-founderLast reviewed 8 August 2026Sources: GOV.UK, NHS, our editorial standards

Uses the real domainsThe same twelve areas an assessing team scores, in the same order.

Answer for a typical fortnightNot the best day, not the worst. Assessments turn on what is usual.

Indication, not a decisionOnly an assessment by an NHS multidisciplinary team can decide eligibility.

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.

Domain 1 of 12

Behaviour

Challenging behaviour, resistance to care, risk to self or others, and how predictable it is.

Domain 2 of 12

Cognition

Memory, understanding, orientation, and whether the person can recognise risk to themselves.

Domain 3 of 12

Psychological and emotional needs

Mood, distress, anxiety or withdrawal, and the level of support needed to manage it.

Domain 4 of 12

Communication

Ability to make needs understood, including by staff who do not know them.

Domain 5 of 12

Mobility

Transfers, falls risk, positioning, equipment and how many people are needed.

Domain 6 of 12

Nutrition — food and drink

Eating, drinking, swallowing difficulties, weight loss, tube feeding.

Domain 7 of 12

Continence

Continence management, catheter or stoma care, and any related skin risk.

Domain 8 of 12

Skin integrity

Pressure damage, wounds, dressings, and how often specialist input is required.

Domain 9 of 12

Breathing

Breathlessness, oxygen, suction, tracheostomy or ventilation.

Domain 10 of 12

Drug therapies and medication

Complexity of the regime, symptom control, and the risk if it is not managed correctly.

Domain 11 of 12

Altered states of consciousness

Seizures, blackouts or episodes needing intervention.

Domain 12 of 12

Other significant care needs

Anything significant that the other eleven domains do not capture.

Nothing is submitted or stored. This is not an NHS assessment.

HOW TO USE IT PROPERLY

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.

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.