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NHS Continuing Healthcare assessment
What happens during an NHS Continuing Healthcare assessment?
A full NHS Continuing Healthcare assessment usually follows a positive Checklist. A multidisciplinary team should assess the person’s health and social-care needs, complete the Decision Support Tool across 12 care domains and make a recommendation on whether the person has a primary health need. The Integrated Care Board then makes the eligibility decision.
Reviewed 17 September 2026. Based on the current National Framework and GOV.UK CHC tools for England.
The process
From screening to the ICB decision
Checklist screening
The Checklist is a screening tool. Its threshold is intentionally low. A positive result means a full CHC assessment is required; it does not mean funding has already been awarded.
Read the CHC Checklist guide →Comprehensive assessment
The person’s needs should be assessed comprehensively. Relevant records and professional evidence should be gathered so the MDT is considering the actual needs, not simply the diagnosis or care-home label.
Multidisciplinary team
The full assessment is undertaken by an MDT. NHS England describes this as at least two people from different healthcare professions, or one healthcare professional and one person responsible for adult social-care assessments.
Decision Support Tool
The DST brings the assessment evidence together in 12 care domains. The MDT considers the levels of need and the four key characteristics — nature, intensity, complexity and unpredictability — before making its recommendation.
See the 12 DST domains →Primary health need recommendation
The MDT should explain whether the needs, taken together, amount to a primary health need. The DST supports the decision; it is not a simple points-based calculator.
Understand the primary health need test →ICB decision
The MDT recommendation is sent to the Integrated Care Board. The public guidance says the ICB should usually accept the MDT recommendation except in exceptional circumstances, with clearly articulated reasons where it does not.
Timing
How long should the CHC assessment take?
The eligibility decision should normally be made within 28 calendar days from the date the ICB receives notification that a full assessment is needed, usually after a positive Checklist. The National Framework recognises that some cases will take longer, but the 28-day expectation remains the normal benchmark.
If the assessment is materially delayed, ask the ICB for a clear timetable and whether interim support is required. Delay does not itself decide eligibility.
Evidence
What evidence should be available to the MDT?
Care-home records
Care plans, daily notes, risk assessments, behaviour charts, falls records, repositioning records, nutrition or fluid monitoring and medication records where relevant.
Medical and nursing records
Hospital records, GP information, district-nursing notes, specialist letters and other clinical evidence that explains the needs and interventions.
Professional assessments
Assessments from clinicians, therapists, social-care professionals and others involved in treatment, support or risk management.
Family evidence
A relative or representative can often explain changes, triggers, night-time needs, behavioural patterns, failed interventions and the practical consequences of the care plan.
Questions families should ask
Before the DST meeting
Have we been given the date, format and purpose of the MDT meeting?
Which records and professional assessments will the MDT have?
Are recent changes in needs reflected in the evidence?
Have well-managed needs been described by reference to the care needed to control them?
Are interactions between different needs being considered, rather than each domain in isolation?
Will we receive the completed DST and written eligibility decision with reasons?
A family member does not decide the scores, but the person and their representative should be enabled to participate in the process and provide relevant information.
Common problems
What can go wrong in a CHC assessment?
Diagnosis replaces needs analysis
CHC eligibility is based on needs, not diagnosis. Dementia, Parkinson’s, stroke or another condition can be relevant, but none automatically proves or defeats eligibility.
Successful care hides the underlying need
A need can remain relevant even where medication, supervision, skilled care or equipment is successfully managing it.
Read about well-managed needs →Domains are treated as isolated boxes
The MDT should consider the overall picture and the four key characteristics, including how needs interact and increase complexity or unpredictability.
Reasons are too vague
A defensible decision should explain how the evidence led to the recommendation and final decision. If CHC is refused, the written reasoning matters for any challenge.
If CHC is refused
What happens after an unfavourable decision?
If the ICB decides that the person is not eligible, the decision should be given in writing with reasons and information about the review or appeal route. A challenge should focus on the evidence, disputed domain descriptions, the primary-health-need analysis and any material procedural problem.
Primary sources
Official guidance used for this page
Reviewed by Paris Theodorou, Solicitor & Principal, Christodoulos Ltd. Updated 17 September 2026.
Have a Checklist, DST or decision letter?
Start with the document you already have
If you want us to identify the stage you are at and the next practical step, send the decision or assessment information with a short summary of the care needs.