The NHS Continuing Healthcare Checklist is the first formal step in deciding whether an adult may be eligible for NHS Continuing Healthcare (CHC) funding. It is a screening tool, not the final decision, and its purpose is to identify people who should go forward for a full assessment.
Because many families misunderstand the checklist, this guide explains the NHS Continuing Healthcare Checklist in detail—what it is, who completes it, how it is scored, what a positive or negative result means, and what your rights are.
What Is the NHS Continuing Healthcare Checklist?
The NHS Continuing Healthcare Checklist is a short screening assessment used to decide whether someone should have a full NHS CHC assessment.
Key points:
It does not decide eligibility on its own
It is used to filter who should move to the next stage
It focuses on the level of need, not diagnosis or finances
The process and checklist are part of the national framework set by NHS England.
Who Is the Checklist For?
The checklist is for adults aged 18 or over who may have:
Ongoing health needs
Complex care requirements
Deteriorating or unpredictable conditions
It can be used in:
Hospitals
Care homes (with or without nursing)
The person’s own home
It applies regardless of income, savings, or property ownership.
Who Completes the Checklist?
The checklist is usually completed by a:
Nurse
Social worker
Other trained health or social care professional
Important:
The individual being assessed should be informed
A family member or representative should be involved where possible
Consent must be obtained (unless the person lacks capacity)
What Does the NHS CHC Checklist Assess?
The checklist looks at 11 care domains and scores the level of need in each one.
The domains are:
Behaviour
Cognition
Psychological and emotional needs
Communication
Mobility
Nutrition
Continence
Skin integrity
Breathing
Drug therapies and medication
Altered states of consciousness
Each domain is scored as:
A = High need
B = Moderate need
C = Low or no need
How the Checklist Is Scored
The checklist triggers a positive result (meaning a full assessment is required) if any one of the following applies:
Two or more A scores
One A score and four or more B scores
Five or more B scores
If these thresholds are not met, the checklist result is negative.
What a Positive Checklist Means
A positive checklist does not mean funding is approved.
It means:
The person must have a full NHS CHC assessment
A multidisciplinary team (MDT) will be involved
The Decision Support Tool (DST) will be completed
This is where eligibility is actually decided.
What a Negative Checklist Means
A negative checklist does not mean CHC is impossible forever.
It means:
A full assessment will not happen at this time
The decision must be recorded and explained
The person may still receive local authority support or NHS-funded nursing care
A new checklist should be completed if:
Needs increase
The condition deteriorates
Circumstances change
Common Mistakes with the CHC Checklist
Many incorrect decisions happen at the checklist stage due to:
Rushing the assessment
Understating needs
Focusing on diagnosis instead of daily impact
Ignoring risks and unpredictability
Completing the checklist without family input
The checklist must reflect actual needs, not ideal or best-day scenarios.
Your Rights During the Checklist Process
You have the right to:
Be informed that a checklist is being completed
Be present (or represented) during completion
Receive a copy of the completed checklist
Ask questions and challenge inaccuracies
If consent is refused or capacity is lacking, decisions must follow best-interest principles.
Checklist vs Full CHC Assessment (Important Difference)
| Checklist | Full CHC Assessment |
|---|---|
| Screening tool | Eligibility decision |
| Short and initial | Detailed and evidence-based |
| Single assessor | Multidisciplinary team |
| 11 domains | 12 domains |
| No final decision | Determines funding |
The checklist only decides whether the next stage happens.
When the Checklist Should NOT Be Used
The checklist should not be used:
To delay discharge from hospital
To justify withdrawing existing CHC funding
As a cost-saving tool
As a replacement for a full assessment when clearly needed
Misuse of the checklist is a common reason for successful appeals.
Fast Track and the Checklist
If someone has a:
Rapidly deteriorating condition
Likely end-of-life needs
They should be considered for Fast Track NHS Continuing Healthcare, which:
Bypasses the checklist
Provides immediate funding
In these cases, the checklist is not appropriate.
What to Do After a Checklist Decision
If Positive
Ask when the full assessment will take place
Ensure evidence is gathered
Prepare for the Decision Support Tool meeting
If Negative
Request a copy of the checklist
Check whether needs were accurately recorded
Ask when the checklist will be reviewed
Request reassessment if needs worsen
Common Myths About the Checklist
It does not decide funding
It is not based on diagnosis
It is not means-tested
A negative result is not permanent
Understanding this prevents unnecessary stress and confusion.
Practical Tips for Families
Keep care notes and incident records
Describe needs on a bad day, not a good day
Highlight risks, supervision needs, and unpredictability
Ask professionals to justify scores clearly
Being informed helps ensure a fair outcome.
Final Summary
The NHS Continuing Healthcare Checklist is the gateway assessment that decides whether someone should receive a full NHS CHC eligibility assessment. It is a screening tool, not a funding decision, and must be completed fairly, accurately, and with appropriate involvement from the individual or their representative.
A positive checklist leads to a full assessment using the Decision Support Tool, while a negative checklist should always be reviewed if needs change. Understanding how the checklist works is essential for ensuring that people with complex health needs are not wrongly excluded from NHS Continuing Healthcare funding.
