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Nation-specific guidance

By Does Your Duck Quack

NHS Continuing Healthcare: checklist, assessment and appeals

Understand NHS Continuing Healthcare eligibility, the checklist, full assessment, decision support tool, appeals and how Scotland’s approach differs.

Checked: 2 October 2026 · Next review: 2 April 2027 · Applies to: UK, with nation notes
How this guide was prepared

Purpose: how to guidance · Level: detailed

Checked by: Does Your Duck Quack. Sources are linked below; seek professional advice for individual circumstances.

The short answer

What to do first

Understand NHS Continuing Healthcare eligibility, the checklist, full assessment, decision support tool, appeals and how Scotland’s approach differs.

Start here: A clinician, social-care worker, the person or a representative can raise CHC with the integrated care board in England or the relevant health body elsewhere. Screening often starts with the checklist, but exceptional cases can move directly to a full assessment. Ask who is coordinating, what records are needed and whether the person’s current setting is distorting the picture. A hospital discharge date should not replace a safe decision about needs and funding responsibility.

Visual guides

See the decision at a glance

Continuing Healthcare pathway
  1. ChecklistAsk for consideration and a copy of the completed screening checklist with reasons.
  2. Full assessmentIf screened in, a multidisciplinary team considers the nature, intensity, complexity and unpredictability of needs.
  3. Decision and care planRequest the written recommendation, ICB decision, funding arrangement and review date.
  4. Review or appealUse the stated local-resolution and independent-review routes within the deadlines.
Continuing Healthcare evidence
  1. Needs over timeCare records, incidents, symptoms, interventions, night needs and variation across ordinary and difficult days.
  2. Interactions and riskShow how needs combine, how quickly support is required and what happens when care is delayed or missed.
  3. Clinical and care recordsAssessments, plans, medicine records, professional letters and the person’s own account, organised by date.

Scope of this guide

This guide helps you understand the options and questions to ask. It is not personal medical, legal or financial advice. Check the official sources for your nation and seek qualified help for high-stakes decisions.

Who this guide is for

For adults with significant ongoing health needs, families and advocates preparing for a Continuing Healthcare screening, full assessment or review of a decision.

NHS Continuing Healthcare (CHC) is a package of care arranged and funded by the NHS for adults whose primary need is health-related. Eligibility depends on the nature, intensity, complexity and unpredictability of needs, not a diagnosis, savings or a simple list of tasks. A positive checklist is only a screen that leads to a full assessment; it is not an award. Ask for the process to reflect the person’s usual needs and involve them, with consent and communication support.

Practical steps

1. Ask for screening when needs suggest it may be relevant

A clinician, social-care worker, the person or a representative can raise CHC with the integrated care board in England or the relevant health body elsewhere. Screening often starts with the checklist, but exceptional cases can move directly to a full assessment. Ask who is coordinating, what records are needed and whether the person’s current setting is distorting the picture. A hospital discharge date should not replace a safe decision about needs and funding responsibility.

2. Prepare for the checklist

The checklist looks across broad areas of need and uses evidence from care records and people who know the person. Provide examples of what happens on an ordinary day and during a difficult episode, how often help is needed, what can go wrong and how quickly support must respond. Include medication, mobility, cognition, behaviour, breathing, nutrition, skin, continence and communication where relevant. Ask that risks and variability are recorded, not only the best day or a brief appointment.

3. Understand what a positive checklist means

A positive result means the person should receive a full multidisciplinary assessment; it does not mean they have qualified for CHC. Ask for a copy of the checklist, its scores and the reason for any negative outcome. If important evidence is missing or the result does not match lived experience, ask the coordinator how to correct the record and whether a review or full assessment is appropriate. Keep the name of the decision-maker and the date of the next step.

4. Take part in the full assessment and decision tool

A multidisciplinary team gathers evidence and uses the national Decision Support Tool in England to recommend whether the person has a primary health need. The tool considers domains and the overall picture; a particular diagnosis or one high domain does not automatically decide the outcome. Ask for the evidence behind each rating and explain any disagreement clearly. A family member or advocate can contribute with consent, but the person’s own views and communication needs should remain central.

5. Read the written decision and care plan

The relevant NHS body should explain the decision, evidence and review arrangements in writing. If eligible, discuss the package: care at home or in a care setting, provider, personal preferences, contingency cover and how changing needs trigger review. If not eligible, ask for a separate social-care needs and financial assessment where appropriate. Do not assume that an NHS decision settles every question about immediate discharge, safeguarding or clinical treatment.

6. Challenge a decision through the local process

Write promptly to the decision-maker and identify the disputed parts of the checklist or tool. Give dated examples, point to records and explain what evidence was omitted or misinterpreted. Ask for local resolution and an independent review route, and keep to the timescale in the decision letter. In England, unresolved eligibility disputes may go to an NHS England independent review panel after local resolution. Obtain advocacy or specialist advice if the process is complex or the person’s care is at risk.

Questions and checks

Common questions

Does a positive CHC checklist mean NHS funding is approved?

No. A positive checklist means the person should move to a full multidisciplinary assessment. The assessment uses evidence about all relevant needs and, in England, the Decision Support Tool. Ask for a copy of the checklist and keep contributing evidence; eligibility is decided after the full process. The screening form is not a funding decision.

Is NHS Continuing Healthcare based on diagnosis or savings?

Eligibility is based on the person’s overall health needs and whether the primary need is for healthcare. A particular diagnosis does not guarantee qualification, and savings are not the eligibility test. If the person is not eligible, social-care support may involve a separate financial assessment. Keep the decision letter for that next step.

Can I challenge a CHC decision?

Yes. The decision letter should explain the local resolution and review process. Set out the disputed evidence, use dated examples from care records and explain why a rating or conclusion does not reflect the person’s needs. The escalation route differs across nations; in England, independent review may follow local resolution.

Does Scotland have NHS Continuing Healthcare?

Scotland uses a different arrangement from the English CHC framework. Hospital-based complex clinical care is an NHS route for people with complex needs in hospital, while ongoing support at home or in a care home follows Scottish social-care and free personal or nursing care arrangements. Ask the local health and social care partnership which route applies.

Before you act

Write down the outcome you want, the names and dates involved, and the evidence or documents you already have. Ask for important decisions, costs and next steps in writing. If information is unclear, ask which nation’s rules are being used and when the decision will be reviewed.

If there is a delay or disagreement

Keep a short factual record of calls, letters and missed actions. Ask for the responsible person, the written reasons, the complaints or review route and any deadline. Immediate health or safety risks should be escalated separately rather than waiting for a routine complaint.

Differences across the UK

The English CHC framework and Decision Support Tool do not apply identically across the UK. Wales has its own national framework and local health-board process; Northern Ireland uses HSC arrangements and policy routes. Scotland does not operate the same English-style CHC system for ongoing care at home: hospital-based complex clinical care is a distinct NHS arrangement, while local social care and free personal or nursing care follow Scottish rules. Ask the local NHS body which framework applies before using another nation’s form.

Primary sources

The publisher checked this guide against the 9 official sources below. This is an editorial source check, not approval by a clinician, lawyer or benefits adviser.

Editorial note: By Does Your Duck Quack.