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NHS Continuing Healthcare assessment preparation
How do you prepare for an NHS Continuing Healthcare assessment?
Prepare by gathering the records that show the person’s actual needs, identifying the help needed day and night, recording risks and incidents, and noting what would happen without the care that currently keeps them stable. The full assessment should consider the person’s health and social care needs as a whole, use evidence from people who know those needs directly, and involve the individual or their representative where appropriate.
Reviewed 17 September 2026 by Paris Theodorou, Solicitor & Principal. England guidance only.
Before the meeting
Start with the needs, not the diagnosis
A CHC assessment is not a test of whether a diagnosis such as dementia, Parkinson’s disease or stroke is “serious enough”. The MDT should assess the person’s actual needs, bring the evidence together in the Decision Support Tool and consider the nature, intensity, complexity and unpredictability of those needs when deciding whether there is a primary health need.
Preparation checklist
What should you do before the CHC assessment?
1. Ask for the meeting details
Confirm the date, time and format, who is coordinating the assessment and who is expected to attend. NHS England says the individual should be invited to participate in the MDT meeting, and a relative, friend or advocate can also be involved where appropriate.
2. Get the records together
Collect current care plans, daily notes, risk assessments, medication records, incident and falls logs, hospital or ambulance records, therapy reports and specialist correspondence. Do not rely on a diagnosis list alone.
3. Map the evidence to the 12 domains
Look at breathing, nutrition, continence, skin, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, altered states of consciousness and any other significant care needs.
4. Record frequency and consequences
For each need, ask how often help is required, how long it takes, what skill or supervision is needed, what risks arise, what happens when care is delayed and whether needs fluctuate or interact.
5. Include well-managed needs
Do not describe a need as absent merely because good care is controlling it. Explain what medication, supervision, equipment, skilled intervention or staffing is required to keep the person stable.
6. Write down disputed points
If previous records, assessments or care plans understate a need, identify the disagreement in advance and have the underlying evidence ready. This is usually more useful than arguing over a score without evidence.
Evidence
What should you take to the meeting?
The latest care plan and, where useful, earlier care plans showing changes over time.
Medication administration records and details of monitoring, side effects, rescue medication or time-critical medication.
Falls logs, incident reports, safeguarding records, ambulance call-outs and hospital admissions.
Risk assessments covering mobility, pressure damage, nutrition, choking, behaviour, seizures or other relevant risks.
GP, consultant, nursing, physiotherapy, occupational therapy, speech and language therapy, dietetic and mental-health records where relevant.
Daily care notes showing what staff actually do, including night-time interventions, supervision and repeated care tasks.
A short chronology of significant deterioration, incidents, infections, admissions, weight loss, medication changes or changes in supervision.
A concise family or representative note identifying points that may not be obvious from formal records.
The aim is not to overwhelm the MDT with paper. The aim is to make sure the evidence accurately reflects the needs, risks, interventions and consequences that matter to the assessment.
See our detailed guide to CHC evidence and records →During the meeting
How should you describe the person’s needs?
Use concrete examples. “Needs help with mobility” is less useful than explaining the number of staff required for transfers, how often assistance is needed, whether there have been falls or near misses, what equipment is used and what happens if support is delayed. The same principle applies across every domain.
Describe the underlying need
Explain the condition or impairment, but focus on how it affects care in practice.
Describe the intervention
State what carers or clinicians do, how often they do it and whether skilled judgement is required.
Describe the risk
Explain what may happen without the intervention, including deterioration, injury, distress, aspiration, pressure damage, missed medication or other relevant consequences.
Describe interaction between needs
Show how one problem makes another harder to manage, such as cognition affecting nutrition, behaviour affecting medication or mobility affecting continence and skin care.
Common mistakes
What should families avoid?
Do not treat the DST as a points system. Domain levels inform the recommendation, but the primary health need analysis remains central.
Do not assume a calm day means the needs are always low. Fluctuation, unpredictability and the care required to prevent deterioration may matter.
Do not understate needs because carers have become used to providing intensive support.
Do not rely only on verbal recollection if records can corroborate the point.
Do not wait until after the meeting to identify obvious missing records if they can be obtained beforehand.
Primary and NHS sources
Sources used for this guide
DHSC: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care →GOV.UK: NHS Continuing Healthcare Decision Support Tool guidance →NHS England: NHS Continuing Healthcare explainer transcript →NHS: Continuing Healthcare assessment guidance →Have a CHC assessment coming up?
Make sure the evidence tells the real story of the care
If you want a solicitor-led review of the records, a Checklist or an upcoming full assessment, send us the documents you already have and a short summary of the care needs.