The CHC Checklist, explained

What is the CHC Checklist?

The Checklist is the first formal step towards NHS Continuing Healthcare, the NHS funding for adults whose main need for care is a health need. If CHC itself is new to you, start with our guide to what NHS Continuing Healthcare is and then come back here. This page covers the screening stage that opens the door to a full assessment.

The Checklist does one job. It decides whether the person should have a full assessment of eligibility, carried out by a multidisciplinary team using the Decision Support Tool. It has two possible outcomes, and the official guidance defines both:

"A positive Checklist means that the individual requires a full assessment of eligibility for NHS Continuing Healthcare. It does not necessarily mean that the individual will be found eligible for NHS Continuing Healthcare."

Checklist guidance, paragraph 26

A negative Checklist means the individual does not require a full assessment and is not eligible for NHS Continuing Healthcare (Checklist guidance, paragraph 23). Whichever way it goes, the outcome should be given to the person in writing "as soon as is reasonably practicable" (Checklist guidance, paragraph 22).

One situation skips the Checklist altogether. Where a person has a rapidly deteriorating condition that may be entering a terminal phase, the Fast Track Pathway Tool should be completed instead. It replaces both the Checklist and the Decision Support Tool. The ICB must accept and immediately action a properly completed Fast Track Tool, and the care package should not usually take more than 48 hours to agree and commission from receipt (National Framework, pages 77 to 79).

What are the 11 Checklist domains?

The Checklist looks at 11 areas of daily life, called domains. Each one is scored separately. Four of the domains are marked with an asterisk on the official form because they carry a priority level in the Decision Support Tool, and a high score in any of those four matters more than a high score elsewhere.

Each domain has a full written descriptor for levels A, B and C in the official Checklist referral form, the NHS Continuing Healthcare Needs Checklist (July 2022). The practitioner should read the person's needs against those descriptors, word by word. The Decision Support Tool used at the full assessment covers the same 11 domains and adds a twelfth, "other significant care needs".

How is the Checklist scored?

Already have a completed Checklist in hand? Our free Checklist scorer reads the A, B and C levels back and explains which referral rule they meet.

Every domain gets one of three levels. A is the highest level of need and C is the lowest. The guidance tells practitioners how to choose:

"Practitioners should compare the domain descriptors to the needs of the individual and select level A, B or C, as appropriate, choosing whichever most closely matches the individual. If the needs of the individual are the same or greater than anything in the A column, then 'A' should be selected."

Checklist guidance, paragraph 18

One scoring principle matters more than any other for families. Needs that are being managed well can look small on the day of the screening, because good care hides them. The National Framework closes that gap directly:

"The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS Continuing Healthcare eligibility."

National Framework, page 51, paragraphs 162 to 166

The Checklist guidance confirms that this principle applies at the screening stage just as it does at the full assessment (Checklist guidance, paragraph 21). So if your mother has not fallen for three months because a carer walks beside her everywhere, the need for that carer still counts. Score the need, then note how it is managed.

What score triggers a full assessment?

The Checklist guidance, paragraph 19, sets out the threshold. A full assessment for NHS Continuing Healthcare is required if there are:

• two or more domains selected in column A;
• five or more domains selected in column B, or one selected in A and four in B; or
• one domain selected in column A in one of the boxes marked with an asterisk, meaning the domains that carry a priority level in the Decision Support Tool, with any number of selections in the other two columns.

That third route matters. A single A in Breathing, Behaviour, Drug therapies and medication, or Altered states of consciousness triggers a full assessment on its own, whatever the other ten domains score. The bar is also set low on purpose. The National Framework says the Checklist threshold "has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity" (National Framework, page 40).

The threshold is not the only route either. The guidance says there may very occasionally be circumstances where a full assessment is appropriate even though the person does not apparently meet the threshold, provided a clear rationale is given and local protocols are followed (Checklist guidance, paragraph 20).

If you want a picture of where a case stands before the formal screening, our free screener asks 18 plain-English questions about the same areas of daily care and shows whether a full assessment looks due. It takes about three minutes.

What happens after a positive Checklist?

The completed Checklist should be sent to the ICB "without delay" (Checklist referral form, Section 3). A multidisciplinary team then carries out the full assessment using the Decision Support Tool, and the ICB makes the eligibility decision.

There is a clear expectation on timing. The National Framework says the time from the ICB receiving a positive Checklist to its eligibility decision "should not exceed 28 calendar days in most cases" (National Framework, page 55). If the ICB takes longer without justification, the person is then found eligible, and the person or the council paid for care in the meantime, the ICB should refund the care costs from day 29 to the date of the decision (National Framework, Annex E, paragraphs 8 to 9).

Care must carry on while you wait. The guidance says an individual "should not be left without appropriate support while they await the outcome of the assessment and decision-making process" (Checklist guidance, paragraph 27).

What if the Checklist is negative?

A negative Checklist means the person does not require a full assessment and is not eligible for NHS Continuing Healthcare (Checklist guidance, paragraph 23). You can ask the ICB to reconsider. The guidance says the ICB "should give this request due consideration, taking account all of the information available, and/or including additional information from the individual or carer, though there is no obligation for the ICB to undertake a further Checklist" (Checklist guidance, paragraph 25).

A reconsideration request works best when it points at evidence the screening missed: a need that was scored low because it is well managed, a domain where the descriptor for a higher level matches the person word for word, or records the practitioner never saw. Set that out in writing, domain by domain, and send it with the supporting documents. For a refusal later in the process, after a full assessment, see what to do after a CHC refusal.

How should families prepare?

Preparation for the Checklist is mostly evidence work, and the Framework itself names the tool families need. Where needs are hidden by good care, it says:

"It may be necessary to ask the provider to complete a detailed diary over a suitable period of time to demonstrate the nature and frequency of the needs and interventions, and their effectiveness."

National Framework, page 51

You can keep that diary yourself too. Short, dated, factual entries carry far more weight than general statements like "she needs a lot of help". For example:

• 12 June, 3.40am. Found at the front door trying to leave the house. Needed 45 minutes of reassurance before returning to bed.
• 14 June, lunch. Coughed repeatedly on thickened fluids. The meal took 40 minutes with one-to-one prompting throughout.
• 17 June, 8am. Refused morning medication twice. The carer returned at 11.20 and it was taken then.

Alongside the diary, gather the paper trail before the screening: care plans, falls records, medication charts, district nurse notes, hospital discharge letters and anything from the GP. For each of the 11 domains, note what the need is, how often it appears and what would happen if the current care stopped. That last question is the practical test of the well-managed needs principle.

If you would rather not build all of that alone, see our Case Report for a domain-by-domain preparation pack built from your screener answers. However you prepare, take your notes to the screening and ask for the reasons behind each score in writing.