NHS CHC Checklist: What Triggers a Full Assessment
NHS Continuing Healthcare Checklist: What Triggers a Full Assessment
The NHS Continuing Healthcare (CHC) checklist is the first gate‑keeping tool used by Clinical Commissioning Groups (CCGs) to decide whether a person’s needs are sufficiently complex to warrant a full CHC assessment.
Understanding exactly what triggers that full assessment – and why the checklist matters – can save families thousands of pounds in social‑care fees and ensure that people with a genuine primary health need receive the fully funded care they are entitled to.
This guide walks you through the legal thresholds, the scoring system, the time‑scales, the cost implications and the practical mistakes that most often trip applicants up.
What the CHC checklist actually does
The checklist is a screening document, not a final funding decision.
It is completed by a trained health or social‑care professional (often a district nurse, social worker or CCG case manager) and records the presence and severity of needs across 11 defined care domains.
The result is a simple “yes” or “no” as to whether a full assessment should be arranged.
A “yes” means the CCG must proceed to the next stage – the Decision Support Tool (DST) – and ultimately to a full CHC eligibility decision.
Who can request a checklist and when it is triggered
Any individual, their carer, a GP, a hospital discharge team or a social‑care worker can ask the CCG to carry out a checklist.
The CCG is obliged to consider the request if the person appears to have a need for care that goes beyond what social services would normally provide.
In practice, the checklist is often triggered after a hospital admission, a rapid deterioration in a long‑term condition, or when a care‑home placement is being considered.
The 11 care domains and how they are scored
Each domain is scored 0 (no need), 1 (low need), 2 (moderate need) or 3 (high/complex need).
The domains are:
| Domain | Score range |
|---|---|
| Behaviour | 0‑3 |
| Cognition | 0‑3 |
| Psychological / Emotional | 0‑3 |
| Communication | 0‑3 |
| Mobility | 0‑3 |
| Nutrition | 0‑3 |
| Continence | 0‑3 |
| Skin Integrity | 0‑3 |
| Breathing | 0‑3 |
| Drug Therapies & Symptom Control | 0‑3 |
| Mood | 0‑3 |
The scoring thresholds that trigger a full assessment
According to the national framework, a full assessment is required if either of the following applies:
- Any single domain scores 2 or above (i.e., moderate, high or complex need).
- The total aggregated score across all 11 domains is 6 or more (some CCGs apply this as an alternative trigger).
If neither condition is met, the checklist returns a “no” and the person is not eligible for a full CHC assessment at that time.
However, a negative checklist does not preclude a future referral if the person’s condition deteriorates.
Tip: Ask the professional completing the checklist to give you a copy and to record the exact score for each domain.
This written evidence is vital if you later wish to challenge the outcome.
The end‑to‑end process and the statutory time‑limits
Once a checklist is requested, the CCG should complete it within 28 calendar days.
If the result is “yes”, a full assessment using the Decision Support Tool (DST) must be arranged within a further 28 days.
The DST is a more detailed document that expands the 11 domains to 12 and introduces five levels of need (A‑E).
The multidisciplinary team (MDT) – which must include at least two health or social‑care professionals – completes the DST and makes a recommendation to the CCG, which then issues a final eligibility decision.
What a positive CHC decision means for your wallet
If a person is found eligible for NHS CHC, the NHS pays for the entire package of care – including care‑home fees, home‑care visits, specialist equipment and any related health‑care costs.
This funding is not means‑tested and does not count as a social‑care contribution.
In contrast, if the checklist is negative and the DST also returns a non‑eligible result, the individual becomes responsible for their own care costs, which are then subject to social‑care means‑testing.
Typical care‑cost benchmarks (2024/25)
| Setting | Approx. weekly cost (England) | Annual cost (approx.) |
|---|---|---|
| Residential care home (standard) | £700 – £1,100 | £36,400 – £57,200 |
| Nursing care home | £900 – £1,400 | £46,800 – £72,800 |
| Live‑in home care (24‑hr) | £1,200 – £2,000 | £62,400 – £104,000 |
| Dom care (15 hrs/week) | £300 – £500 | £15,600 – £26,000 |
These figures illustrate why a successful CHC claim can be worth tens of thousands of pounds each year.
Even a modest delay of a few months can result in a substantial financial burden for families who are unaware of the funding route.
Warning: If you miss the 28‑day deadline for the checklist, the CCG is still required to consider your request, but delays can push the full assessment beyond the statutory window and may complicate the gathering of up‑to‑date clinical evidence.
Why the “primary health need” test matters
The DST does not simply add up scores; it applies the “primary health need” test.
This means the panel must be satisfied that the majority of the person’s needs are health‑related (as opposed to social‑care needs) and that those health needs are of a nature or intensity that exceeds what a local authority could be expected to provide.
A domain scored “D” (high need) in at least one area, combined with at least one other domain scored “C” (moderate) or above, is a common pattern that meets the primary health need threshold.
Common mistakes that cause a checklist to return “no”
Many families are surprised to learn that a negative checklist is often the result of procedural or evidential gaps rather than an absence of need.
Below is a checklist of the most frequent errors, expressed in the ✅/❌ format so you can use it as a quick audit tool.
- ✅ Gather recent hospital discharge letters, GP summaries and district‑nurse notes before the assessment.
- ❌ Relying solely on verbal accounts without supporting documentation.
- ✅ Ensure the professional scoring the checklist has been trained on the 2022 National Framework.
- ❌ Allowing a social