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Evidence for NHS Continuing Healthcare
What evidence should you gather for NHS Continuing Healthcare?
Gather records that show what care the person actually needs, how often it is required, the risks being managed and what happens when care is delayed or absent. Useful evidence can include care plans, daily notes, medical and nursing records, medication charts, risk assessments, incident logs, hospital records and specialist reports. The strongest evidence usually connects the written record to the person’s needs across the CHC care domains.
Reviewed 17 September 2026 by Paris Theodorou, Solicitor & Principal. England guidance only.
The purpose of evidence
Evidence should explain the need, the care and the consequence
The Decision Support Tool brings together information from the assessment of needs so the multidisciplinary team can make an evidence-based recommendation. Good CHC evidence therefore does more than prove a diagnosis. It shows the underlying need, the intervention required to manage it, the frequency or intensity of that intervention, the risks involved and the interaction between different needs.
Core records
Which records are most useful in a CHC case?
Care plans
Current and historic care plans can show the assistance, supervision, equipment and interventions that staff are expected to provide. Earlier plans may also show deterioration or increased dependency.
Daily care notes
Daily notes can demonstrate the frequency and reality of care: night-time support, refusals, agitation, repeated repositioning, continence care, nutrition support, falls, seizures or other recurring needs.
Medication records
Medication administration records can help show timing, complexity, rescue medication, monitoring and the consequences of missed or delayed medication. The prescription list alone may not show the care burden.
Risk assessments
Falls, pressure damage, choking, malnutrition, dehydration, behaviour, moving and handling, seizures and other risk assessments can help explain why supervision or skilled intervention is required.
Incident and event logs
Falls, near misses, choking episodes, behaviour incidents, infections, ambulance call-outs, hospital admissions and safeguarding events can make frequency and consequences easier to evidence.
Clinical and therapy records
GP, consultant, nursing, physiotherapy, occupational therapy, speech and language therapy, dietetic, tissue-viability and mental-health records may explain needs that are not fully captured in care-home documentation.
Make the record usable
How do you turn records into useful CHC evidence?
Identify the relevant date or period, especially if needs changed over time.
Link the record to the care domain it helps explain, rather than presenting an undifferentiated bundle.
Record frequency: once a month, several times a week, every shift or repeatedly overnight can describe very different care burdens.
Record duration and staffing where relevant, including whether one or two carers are required and whether a nurse or other skilled professional must intervene.
Record consequences and risk: what happens, or may happen, without the care?
Record fluctuation and unpredictability, including good and bad days rather than selecting only the easiest period.
Record interaction: explain how one need affects another and makes care harder to plan or deliver.
A short chronology or evidence table can be useful if it helps the reader find the underlying record quickly. It should summarise the evidence, not replace it.
See how to prepare for the CHC assessment →Well-managed needs
Evidence the care that is preventing deterioration
A stable presentation may reflect successful care rather than a low level of need. Where medication, equipment, supervision, skilled nursing, behavioural strategies, pressure care, dietary measures or other interventions are controlling a need, record both the underlying problem and the care required to manage it.
What is being done?
Describe the intervention precisely: supervision, repositioning, medication, modified diet, prompting, monitoring, specialist equipment or skilled response.
How often?
Show whether care is occasional, daily, every shift, repeated overnight or continuously required.
What would happen without it?
Identify the likely consequence, such as falls, aspiration, pressure damage, distress, missed medication, deterioration or hospital admission.
Who provides it?
Record whether the need requires routine care, trained carers, registered nursing input, specialist oversight or rapid clinical judgement.
Evidence gaps
What if the records are incomplete or inconsistent?
Do not assume that missing paperwork means the need did not exist. Identify what is absent, whether another source can corroborate the point and whether the records conflict. A care plan may say one thing while daily notes, medication charts, incident logs or hospital records show a more demanding picture.
Compare care plans with daily notes to see whether the planned level of care matches what staff actually provided.
Check whether significant incidents appear in risk assessments and were carried through into the DST.
Check whether professional recommendations were implemented and whether the resulting care is visible in the records.
Where family evidence differs from formal records, identify the precise disagreement and look for objective corroboration.
For retrospective periods, separate what is known, what can be evidenced and what remains uncertain rather than filling gaps with assumptions.
Assessment and appeal
How should evidence be used after a CHC refusal?
Start with the written DST and decision. Compare the description and level recorded in each relevant domain against the underlying evidence. Then ask whether the recommendation properly addresses the totality of needs, their interaction and the four key characteristics. An appeal is usually stronger when it identifies specific evidential or reasoning errors rather than simply asserting that the scores should have been higher.
Have records, a DST or a refusal?
Start with the documents that actually show the care
If you want a solicitor-led review, send the decision documents and the most relevant records you already have. We can start by identifying the issues that warrant closer examination.