The CHC Assessment, Explained in Plain English

By Len Burgess, Senior Care Advisor · Published 12 May 2026

This is part of our Jargon Buster series goes inside the room where CHC decisions get made, the meetings, the paperwork, the scoring, and exactly what to do (and say) to give yourself the best possible chance.

This is part of our Jargon Buster series goes inside the room where CHC decisions get made, the meetings, the paperwork, the scoring, and exactly what to do (and say) to give yourself the best possible chance.


If you've read our previous post on CHC, you already know what NHS Continuing Healthcare is and why it matters. This post is the operator's manual, a step-by-step walkthrough of the assessment process itself, from the moment someone first asks "could you be eligible?" to the moment the decision letter lands on your doormat.


Why does it matter?

Because the difference between a successful CHC claim and a rejected one is almost never how ill the person is. It's how well the assessment is run, and how prepared the family is when it happens. Most families turn up to a CHC assessment having never heard the words "Checklist," "DST," "MDT," or "primary health need" before. That's the gap this post closes.


So keep reading and get all the details


What is a CHC assessment?

A CHC assessment is the formal process the NHS uses to decide whether someone is eligible for NHS Continuing Healthcare, a package of care fully funded by the NHS for adults whose primary need for care is a health need rather than a social need.


Crucially, "a CHC assessment" isn't one event. It's a sequence of stages, each with its own paperwork and decision point:


  1. The CHC Checklist — a quick screening tool that decides whether you proceed to a full assessment
  2. The Decision Support Tool (DST) — the full assessment, completed by a multi-disciplinary team
  3. The eligibility decision — signed off by your local Integrated Care Board (ICB)
  4. (If needed) The appeal — a two-stage challenge process you have the right to use


Knowing which stage you're in is the single most important orientation point. People who confuse the Checklist with the full assessment, or who don't realise an appeal is available, routinely miss out on funding they should have had.


A few foundational points: anyone can request a Checklist (you don't need a referral); the assessment isn't a diagnosis, it evaluates needs, not conditions, so two people with identical diagnoses can have very different outcomes; you have the right to be involved at every stage; and the whole thing is supposed to take 28 days from referral to decision, though in practice it routinely takes longer.


How does a CHC assessment actually work?

Here's the full journey, stage by stage, with the things most guides leave out.


Stage 1: The Checklist

The CHC Checklist is a screening tool, not an assessment proper. Its job is to filter people in or out of the full process, with the bar deliberately set low so anyone who might qualify gets through.


The Checklist looks at 11 care domains, Breathing, Nutrition, Continence, Skin, Mobility, Communication, Psychological and Emotional Needs, Cognition, Behaviour, Drug Therapies and Medications, and Altered States of Consciousness. For each, you're scored A (high need), B (moderate need), or C (low or no need).


To pass and trigger a full assessment, you typically need one of the following:



The Checklist can be completed by any trained health or social care professional. Since the 2022 framework revisions, it's preferable for it to be completed after hospital discharge, when ongoing needs are clearer.


A few things to watch out for: if you're told someone doesn't need a Checklist because they "obviously won't qualify," that's not the staff member's call, ask for it to be completed and for any refusal to be recorded in writing. Don't accept a Checklist completed without your input. And a negative Checklist can be challenged, you have 12 months from the date of the letter to dispute it through the NHS complaints process.


Stage 2: The Decision Support Tool (DST)

If you pass the Checklist, the next stage is the full assessment using the Decision Support Tool. This is the real thing, and it's where almost all CHC decisions are won or lost.


The DST is completed by a Multi-Disciplinary Team (MDT) of at least two professionals from different disciplines, typically a nurse assessor and a social worker, sometimes joined by a GP or specialist nurse.


The DST assesses needs across 12 care domains (the Checklist's 11 plus "Other Significant Needs"). For each, needs are scored on a sliding scale: No needs → Low → Moderate → High → Severe → Priority (only Behaviour, Breathing, Drug Therapies, and Altered States of Consciousness reach Priority).


Critically, scoring isn't just a points exercise. The MDT must also evaluate your needs against the four key indicators: Nature (what kind of needs and what interventions they require), Intensity (how severe and continuous the care is), Complexity (how needs interact and how skilled the response must be), and Unpredictability (how likely the situation is to change suddenly).


The overall question is whether you have a primary health need, meaning your care, taken as a whole, is predominantly about meeting health needs rather than social ones.


DST meetings usually take 2–4 hours. You, your relative, a family member, or an advocate has the right to attend and contribute, challenging scores in real time, providing additional evidence, and asking for things to be recorded. You'll receive a copy of the completed DST along with the decision.


Stage 3: The decision

After the DST meeting, the MDT makes a recommendation to your local Integrated Care Board (ICB), the NHS body responsible for CHC commissioning. The ICB formally accepts (or, very occasionally, overturns) the recommendation and issues a written decision.


The whole process is supposed to be completed within 28 days of referral. In practice, delays are common. Importantly: if the process overruns and the person is found eligible, the NHS must backdate funding to cover the delay.


Stage 4: The appeal (if needed)

If you're turned down, you have the right to appeal. The process has three stages: Local Resolution with your ICB (within 6 months of the decision letter), Independent Review Panel (IRP) convened by NHS England, and the Parliamentary and Health Service Ombudsman as a final route. More on this in question 4 below.


What are your chances of getting through each stage?

Here's what the NHS's own data shows.


At Checklist stage, the threshold is deliberately low, so most people who genuinely need a full assessment do trigger one. Most "no's" come at the DST stage.


At DST stage, around 21% of standard CHC assessments result in eligibility, roughly one in five. There's enormous regional variation, from 7% in some areas to over 42% in others.


At Local Resolution (first appeal stage), around 13–25% of appeals succeed, meaning roughly one in five negative decisions is reversed at the first formal challenge.


At Independent Review Panel (second appeal stage), success rates aren't systematically published, but families who go in well-prepared report substantially higher success rates.


The honest summary: the system rejects a lot of valid claims, but the appeal routes work, especially for people who know how to use them.


Who tends to be approved?

A clear pattern emerges from published case studies and the practitioners who handle these assessments daily.


Multiple severe needs across several domains. CHC rewards combinations, severe cognitive impairment and high physical needs and unpredictable behaviour scores better than one very intense single need.


Unpredictable conditions. Stable, well-managed conditions, even serious ones, often fail because the system is built to identify needs requiring rapid, skilled NHS intervention. If your relative's condition can deteriorate suddenly, document it relentlessly.


End-of-life patients. The Fast Track Pathway Tool bypasses the Checklist and DST entirely. Decisions are made within 48 hours and funding starts immediately.


Strong written evidence. Detailed care notes, GP letters, specialist reports, behaviour logs, and medication charts make an enormous difference. Verbal assertions don't carry the same weight.


Representatives who know the framework. Applicants whose families understand the four key indicators and use that language do markedly better than those who simply describe symptoms.


Free help from Beacon CHC, Age UK, and Citizens Advice can dramatically tilt the odds.


Where people get turned down: when needs are framed primarily as personal care (washing, dressing, eating, mobility) without enough emphasis on the underlying clinical management, risk, and unpredictability driving those needs. The system is built to identify health needs, so language matters.


How does this apply to me?

The five questions below come from what families like yours are actually searching for online.


1. How long does a CHC assessment take?

The NHS target is 28 days from initial referral to final eligibility decision. In practice, this is widely missed, 6–12 weeks is common, and 3–6 months not unusual when there are delays gathering evidence, scheduling MDT meetings, or waiting for ICB sign-off.


Fast Track assessments are different: decisions should be made within 48 hours of the Fast Track form being submitted, with funding starting almost immediately.


The most important thing to know: if your assessment overruns 28 days and you're ultimately found eligible, the NHS must backdate funding to cover the period since referral. Keep records of every date. If the timeline slips, you may be entitled to backdated funding even when the eventual decision is a "yes."


2. What scores are needed for CHC?

This is the question everyone wants a clean answer to, but it doesn't have one, and that's important to understand from the start.


At Checklist stage, there are specific thresholds: 2+ A's, 5+ B's, 1A + 4Bs, or a single A in one of the four priority domains.


At DST stage, the rough rule of thumb is that you'll typically be found eligible with one Priority-level need or two or more Severe-level needs. A combination of Severe and High needs across several domains may also qualify, depending on how they interact.


But, and this is critical, CHC is not decided on scores alone. The MDT is required to step back from the scoring and ask whether, taken as a whole, your needs amount to a primary health need judged against the four key indicators. Some people qualify with modest scores because their overall picture is complex and unpredictable. Others fail despite scoring well because their needs, while serious, are stable and routinely managed.


Scores get you in the conversation, but the four key indicators win the case.


3. What is a "primary health need"?

This phrase sits at the heart of CHC, and it's deliberately not defined in legislation. The closest thing to a definition is the test the NHS uses: your need for care must be predominantly about health rather than social needs, and the care required must go beyond what a local authority is legally able to provide as social care.


In plain English: would the care you need look more like something a hospital would provide, or more like something a typical care home or home-care service would provide? If the answer is "more like a hospital, but delivered in the community," you probably have a primary health need.


This is why diagnosis alone doesn't determine eligibility. Someone with mild dementia who needs help with washing and dressing has social needs. Someone with advanced dementia who has severe behavioural issues, unpredictable falls, swallowing difficulties, and complex medication regimes has a primary health need, even though the diagnosis is the same word.


4. What is the success rate of a CHC appeal?

It varies by stage, by region, and, significantly, by how well-prepared the appeal is.


At Local Resolution (the first appeal stage with your ICB), NHS data shows success rates of 13–25%, meaning roughly one in five to one in four contested decisions is overturned even at this first stage.


At Independent Review Panel (the next stage, run by NHS England), outcomes aren't systematically published, but specialist organisations representing families consistently report substantially higher success rates, Beacon CHC, for example, reports around 70–75% for cases they represent.


The lesson: the headline appeal success rate is influenced by how many appeals are submitted without proper preparation. Well-evidenced appeals, backed by a clear understanding of where the original decision went wrong, succeed far more often.


If you're appealing, focus on identifying specific errors: domains under-scored against the evidence, the four key indicators not properly applied, care records ignored, or the primary health need test misapplied. Generic "we disagree" appeals rarely succeed. Specific, evidence-based ones frequently do.


5. What is classed as "complex health needs"?

This phrase comes up constantly in CHC decisions. Complex health needs typically involve several conditions interacting at once, where managing one affects another and care can't be delivered as a series of separate, routine tasks, for example, advanced dementia combined with diabetes and challenging behaviour; Parkinson's with swallowing difficulties and unpredictable medication response; stroke with cognitive impairment and pressure sore risk; or mental health needs combined with physical conditions like heart failure or COPD.


What makes needs "complex" isn't the seriousness of any single condition, it's how the conditions interact and how skilled the response has to be. A single very serious condition that's well-managed by routine care may not be classed as complex. A combination of moderate conditions requiring constant adjustment, monitoring, and skilled clinical judgement often is.


When evidencing complexity, focus on interactions: how does Condition A affect the management of Condition B? What happens when one medication has to be changed? How often does the care plan need adjusting? Specific examples carry far more weight than general descriptions.


The takeaway

A CHC assessment is not a one-off event you turn up to and hope for the best. It's a structured, multi-stage process with very specific rules, paperwork, and language, and families who understand those rules get markedly better outcomes than those who don't.


Five things tilt the odds in your favour: knowing which stage you're in, bringing detailed evidence to every meeting, using the language of the four key indicators, attending the DST in person, and appealing robustly when the decision goes against you.


None of that requires paying anyone. Free expert help is available from Beacon CHC, Age UK, Citizens Advice, and Healthwatch.


Use our funding calculator to see how a successful CHC outcome fits into your overall care funding picture. And look out for the next post in this series, where we'll tackle the £86,000 care cost cap.


This article is for general guidance only and reflects CHC assessment rules in England as of 2026. Wales uses a similar framework; Scotland phased out CHC in 2015; Northern Ireland uses a different system. For tailored advice, contact your local ICB, Age UK, Beacon CHC, or Citizens Advice. You should never need to pay for help with a CHC assessment.

Sources

Frequently asked questions

Who can request a CHC Checklist?

Anyone. You do not need a GP referral, a social worker's permission, or a hospital's involvement to start the process. If you think you (or a relative) might be eligible, contact your local Integrated Care Board (ICB) and ask for a Checklist to be completed. The ICB covering your area is usually findable on the NHS website by postcode, or your GP or care home will know. Family members can request a Checklist on behalf of a relative, though formal involvement in the assessment itself usually requires Power of Attorney or the person's consent.

Can I have a CHC assessment if I live at home?

Yes. CHC isn't tied to a particular care setting. You can be assessed, and, if eligible, receive CHC funding, whether you live in your own home, with family, in supported living, in a residential care home, or in a nursing home. The assessment process is identical regardless of setting, and the four key indicators are applied the same way. If you receive CHC at home, the NHS will fund whatever care package is needed to meet your assessed needs, sometimes through a Personal Health Budget that lets you arrange your own care.

What evidence should I bring to a DST meeting?

The more detailed and specific, the better. Useful evidence includes: recent GP records and consultant letters, the current care plan, daily care notes from the last 3–6 months, medication charts, incident logs (falls, behavioural incidents, hospital admissions), specialist therapy reports (physio, OT, speech and language), nurse handover notes, and any risk assessments. If you're a family member, bring your own log of how needs present day-to-day, including frequency and unpredictability. The DST is heavily weighted towards written evidence, verbal descriptions, however accurate, carry less weight than documented examples.

What if the MDT and I disagree about a domain score during the DST?

Speak up at the time. The DST is supposed to be a collaborative process, and you have the right to challenge scores in real time, provide additional evidence, and ask for your disagreement to be recorded in the notes. If a score is being assigned that doesn't reflect the evidence, ask the assessor to explain their reasoning against the National Framework descriptions for that domain. If they can't justify it, push back. Even if the final score isn't changed during the meeting, having your disagreement formally recorded strengthens any later appeal significantly.

What is retrospective CHC and can I claim it?

Retrospective CHC is funding backdated for a past period when someone should have been receiving CHC but wasn't assessed (or was wrongly turned down). For families who've already spent significant sums on care that the NHS should have funded, it can result in substantial refunds, case studies regularly report recoveries of £50,000–£170,000+. The process is more complex than a current assessment, with tighter time limits and a need for historical evidence (care records, GP notes, incident logs from the relevant period). Claims can be made on behalf of someone who has died, as long as you have legal authority. If you think a relative was wrongly denied CHC, or never assessed when they should have been, contact Beacon CHC or a specialist for a free initial review of whether a retrospective claim is viable.