CHC Assessment and the Decision Support Tool Explained

In short: A CHC assessment in England usually starts with a short checklist and, if that is positive, moves to a full assessment by a multidisciplinary team using the decision support tool. The integrated care board (ICB) then decides eligibility, usually within 28 days. This guide explains each stage, as described on NHS.uk and GOV.UK in November 2026.

What a CHC assessment is

A CHC assessment is the process the NHS uses to decide whether someone qualifies for NHS continuing healthcare (CHC). CHC is an ongoing package of health and social care arranged and funded solely by the NHS for adults with a primary health need arising from disability, accident or illness. It can be provided at home or in a care home.

Eligibility is based on assessed needs, not on a diagnosis. Two people with the same condition can reach different outcomes, and eligibility can change if needs change. The question the team asks is whether your main need is for health care rather than social care, taking into account how much care you need, how complex and unpredictable it is, and how much skilled input it takes. This is called having a primary health need.

You do not need to be in hospital to be assessed. People living at home, in a care home or in other settings can all be assessed. Anyone aged 18 or over can be considered, and children and young people have a separate continuing care process.

The rules come from the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, published on GOV.UK and last updated on 14 July 2023. Since 1 July 2022, integrated care boards (ICBs) have been responsible for it in England. Our guide to NHS continuing healthcare at home covers what the funding can pay for.

Stage one: the checklist

The first stage of a CHC assessment is the checklist, a screening tool that decides whether you go forward to a full assessment. A nurse, doctor, other healthcare professional or social worker usually completes it.

A positive checklist does not mean you are eligible. It means a full assessment is needed. A negative checklist means you will not go forward, though you can ask for it to be looked at again. The reasons are recorded in writing, signed and dated, and you should receive a copy.

If nobody has offered a checklist, you can ask a GP, hospital discharge team or social worker to complete one. Ask what the outcome was and keep your copy safely, as you may need it later if you decide to challenge a decision.

The checklist is published on GOV.UK by the Department of Health and Social Care, along with a referral form for the clinician. Our CHC checklist explained page walks through it in more detail.

The full CHC assessment and the decision support tool

If the checklist is positive, a multidisciplinary team (MDT) carries out a full CHC assessment. The team must include at least two professionals from different professions, usually from health and social care. The team gathers evidence about your needs and records it in the decision support tool, often called the DST.

The DST is published on GOV.UK. It supports practitioners to reach consistent, evidence-based recommendations about eligibility. It is the main document the ICB looks at, so it matters that it reflects your needs on a typical bad day as well as a good one, not just on the day of the visit.

The NHS continuing healthcare assessment should also take into account your views and those of your family or representative. You can ask who is on the team and ask to see the DST before a decision is made. If you disagree with how a need has been described, say so at the time and ask for your view to be recorded.

Consent matters too. The team needs your agreement, or that of someone with legal authority to decide for you, to share information. If you lack capacity, a person acting under a lasting power of attorney for health and welfare may be involved, so ask the team how they will involve them.

A separate fast track route exists for people whose health is deteriorating quickly and who are nearing the end of life. NHS.uk says a package is usually put in place within 48 hours. See our fast track CHC guide.

The 12 care domains and the levels

The decision support tool looks at your needs across 12 care domains. NHS.uk lists them as:

1. Breathing
2. Nutrition
3. Continence
4. Skin (including wounds and ulcers)
5. Mobility
6. Communication
7. Psychological and emotional needs
8. Cognition
9. Behaviour
10. Drug therapies and medication
11. Altered states of consciousness
12. Other significant care needs

In each domain, the team records a level of need. NHS.uk gives these levels as priority, severe, high, moderate, low or no needs. Not every domain has every level. Priority is the highest and is used only where the need is most intense, complex or unpredictable.

The team should record the evidence behind each level, not just the level itself. Needs in different domains can affect each other, and the team is expected to consider the overall picture.

Families often find the behaviour, cognition and psychological domains hardest to describe. Specific examples help, such as how often an episode happens, what triggers it and how many staff it takes to manage safely.

How the tool recommends eligibility

The decision support tool does not add up scores. NHS.uk says that, usually, at least one priority need, or severe needs in at least two domains, leads to a recommendation of eligibility. Other combinations can also qualify, for example one severe need plus a number of high or moderate needs.

The team looks at the nature, intensity, complexity and unpredictability of your needs, and how they interact. It then makes a recommendation to the ICB. A recommendation is not the final decision, and the ICB should not rely only on a budget or on the setting you live in when deciding.

The ICB role is to decide eligibility and to coordinate the process. It must assess you if it seems you may need CHC. It usually follows the MDT recommendation, and if it does not, it should explain why. If you are found eligible, it works with you on the care package, which can include a personal health budget.

If you are not eligible, you can be referred to your local council for support. You may be offered a joint package if you still have some health needs. If you live in a care home that provides nursing, you may qualify for NHS-funded nursing care, covered in our NHS-funded nursing care guide.

CHC assessment timescales and what to prepare

NHS.uk says a decision on a full CHC assessment is usually made within 28 days of the initial assessment or request. If an ICB takes longer than 28 days without good reason and you are then found eligible, it should refund care costs from day 29 until its decision.

A little preparation helps the team see the full picture of your needs, and a family member or friend can help gather it:

• Write down the help needed over a full 24 hours, including nights, and how often it is needed
• Note falls, incidents, hospital stays and changes in behaviour or memory
• Gather recent care plans, care home or agency notes, and medication lists
• Ask the GP, district nurse or specialist nurse for any relevant reports
• Decide who will attend with you, and ask the team for the date and who will be there
• Keep a copy of the checklist and, once available, the DST and the decision

You are entitled to ask the ICB for the reasons behind a decision and the decision documents.

Reviews, appeals and differences across the UK

If you are found eligible, NHS.uk says your care is reviewed within 3 months and then at least once a year, or sooner if your needs change. Eligibility can end if your needs change, so keep notes of any change.

If you disagree with a decision, ask the ICB for its reasons and the DST first. NHS.uk points to Beacon, a free independent service, on 0345 548 0300, for help with challenging decisions. Our appeal guide sets out the stages.

This page covers England. Scotland, Wales and Northern Ireland have their own NHS arrangements and do not use the English National Framework in the same way, so check with your local health board or trust.

This is general information, not medical or legal advice. For advice on your situation, speak to your GP, a social worker or a solicitor.

Frequently asked questions

What is a CHC assessment?

It is the process the NHS uses to decide whether you qualify for NHS continuing healthcare, which is care arranged and funded solely by the NHS. It begins with a checklist and, if that is positive, continues to a full assessment by a team of professionals.

What is the decision support tool?

The decision support tool, or DST, is a national form published on GOV.UK. The multidisciplinary team uses it to record your needs across 12 domains and to reach a consistent, evidence-based recommendation to the integrated care board about whether you are eligible.

What are the 12 care domains?

They are breathing, nutrition, continence, skin, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies, altered states of consciousness, and other significant care needs. Each is given a level, from priority down to no needs, based on the evidence.

How long does a CHC assessment take?

NHS.uk says a decision on a full assessment is usually made within 28 days of the initial assessment or request. If the ICB takes longer without good reason and you are found eligible, it should refund care costs from day 29 until its decision.

Does a positive checklist mean I get CHC?

No. A positive checklist only means you go forward to a full assessment. The multidisciplinary team then completes the decision support tool, and the ICB decides eligibility. Being referred does not guarantee funding, and the reasons for the outcome should be given to you in writing.

How often is CHC reviewed?

NHS.uk says care is reviewed within 3 months of becoming eligible, then at least once a year, or sooner if your needs change. Funding can change or stop if a review finds your needs are different.

Can I challenge a CHC decision?

Yes. Ask the ICB for its reasons and the decision documents, which you are entitled to receive. NHS.uk lists Beacon, a free independent service, on 0345 548 0300 for help with challenging decisions. See our appeal guide for the stages.

Official sources

• NHS.uk: NHS continuing healthcare
• GOV.UK: National framework for NHS continuing healthcare and NHS-funded nursing care
• GOV.UK: NHS continuing healthcare decision support tool
• GOV.UK: NHS continuing healthcare checklist
• GOV.UK: NHS continuing healthcare and NHS-funded nursing care collection

This page is general information, not legal, medical or financial advice. The Care Panel is an independent guide and is not part of any government body or care provider. Last checked 9 November 2026.

Related: CHC checklist explained · Fast track CHC · Appeal a continuing healthcare decision

Reviewed by The Care Panel team on 9 November 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.