The Checklist Assessment
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Understanding the NHS CHC Checklist
The Checklist is the initial step in determining eligibility for NHS Continuing Healthcare (CHC) funding. It’s a preliminary screening tool designed to assess whether an individual may qualify for a full assessment of their care needs. Importantly, the Checklist is not a final decision about eligibility—it simply identifies whether someone should move forward to the next stage: a full assessment conducted by a Multidisciplinary Team (MDT). When Should the Checklist Be Completed? The Checklist should ideally be completed as soon as the patient requires full-time care or if their health and care needs suggest they may qualify for CHC funding. Delaying this process increases the risk of being means-tested and having to pay for care unnecessarily before it’s even determined whether the NHS has a duty to cover these costs. What exactly is the Checklist?
The Checklist is a universal tool used by the NHS to screen an individual's health and associated care needs across 11 specific domains, with each domain focusing on a particular area of care. The outcome of the Checklist will be either positive or negative, deciding whether the individual progresses to the next stage of the CHC process. Keep in mind that the threshold for passing the Checklist is deliberately low, so most people with significant needs should progress to the full assessment stage. The 11 care domains assessed by the Checklist are as follows: 1. Breathing* This domain assesses breathing difficulties, such as: • The need for oxygen therapy or a ventilator. • Severe shortness of breath or other respiratory conditions. 2. Nutrition This domain focuses on the ability to eat and drink, including: • Issues with swallowing or choking. • The need for artificial feeding, such as via a feeding tube. 3. Continence This domain evaluates bladder and bowel management, such as: • Continence problems requiring support or aids. • Catheter or stoma care needs. 4. Skin Integrity This domain examines conditions affecting the skin, such as: • Pressure sores, ulcers, or open wounds. • The need for frequent dressings or specialist intervention. 5. Mobility This domain reviews the individual’s ability to move, such as: • Walking independently or with aids. • Risks of falls or requiring assistance to transfer or reposition. 6. Communication This domain considers the ability to communicate needs, including: • Verbal or non-verbal communication challenges. • Speech difficulties or the need for assistive devices. 7. Psychological and Emotional Needs This domain focuses on mental well-being, including: • Anxiety, depression, or other mental health conditions. • Behaviour related to emotional distress. 8. Cognition This domain examines memory and understanding, such as: • Difficulty processing information or making decisions. • Cognitive impairments like dementia. 9. Behaviour* This domain assesses challenging or unpredictable behaviours, including: • Aggression, self-harm, or other behaviours requiring intervention. 10. Drug Therapies and Medication* This domain reviews medication needs, such as: • Complex pain relief regimens. • Regular medication reviews or side-effect management. 11. Other Significant Care Needs This domain captures any additional needs not covered elsewhere, including: • Use of specialised equipment. • Support for unique or rare conditions. You can download a copy of the Checklist Tool here
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Who Carries Out the Checklist Assessment? The local Integrated Care Board (ICB) appoints a trained assessor to carry out the Checklist. This could be a health or social care professional, such as: • A registered nurse employed by the NHS, • A GP or another clinician, • A local authority social worker, care manager, or social care assistant. The assessor must have training in the National Framework for CHC and experience assessing or reviewing care needs. Their role is to apply the CHC eligibility criteria using the Checklist scoring system. How is the Checklist scored? To be considered for a full assessment for Continuing Healthcare eligibility, the ICB requires that the individual achieves a minimum aggregate score on the Checklist. The scoring criteria are as follows: 2 or more ‘A’s 5 or more ‘B’s or 1 A and 4 ‘B’s Or at least 1 A in a domain with an asterisk* ‘A’ scores are rated as High need ‘B’ scores are rated as Moderate need ‘C’ scores are rated as Low need However, the bar for the Checklist is set deliberately low, to catch all those who may potentially be eligible for Continuing Healthcare. As such it acts as a filter for the full assessment. Checklist Outcomes: • Positive Outcome: The individual progresses to a full assessment for CHC funding. • Negative Outcome: Their needs are not considered high enough to move forward, but this decision can be reviewed or challenged. You have 12 months to lodge a complaint and request reconsideration. When Should You Request a Checklist Assessment? A Checklist assessment should be requested when:
How to Request a Checklist Assessment If you or your loved one needs a Checklist, the first step is to contact your local Social Services team. Request a meeting with a social worker or care manager to complete the Checklist. If they are not trained or deny responsibility, approach the District Nurse, GP, or CHC team at the ICB instead. If you’re already working with a social worker, having the patient’s contact information can make the process smoother. However, if you encounter resistance or delays, remain persistent and escalate your request until the Checklist is completed. ARROW can also request a Checklist assessment from the ICB on your behalf, once we have received the relevant authority to do so. What about hospital discharge? CHC assessments are rarely conducted in acute hospital settings. According to the National Framework for NHS Continuing Healthcare, assessments for longer-term or end-of-life care needs should be carried out once the individual has reached a point of recovery, enabling an accurate evaluation of their long-term care needs. This process is outlined in the hospital discharge guidance. Already had a Checklist? If you or your loved one has already had a Checklist but you believe the process was flawed—such as not being involved in the assessment—you can request that the Checklist be repeated. If the Checklist was negative it can serve as a useful benchmark for future reassessments if the patient's needs change over time. Remember, the Checklist is not the final decision—it’s simply a screening tool to determine if a full assessment is required. If you need help with the Checklist process, ARROW is here to guide you every step of the way. Please contact us for further details: |
Challenges Accessing the Checklist
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Despite its importance, many families encounter significant difficulties accessing the Checklist. Responsibility for starting the process varies across regions and can fall to Social Services, District Nurses, GPs, or CHC teams. Unfortunately, these professionals often pass the responsibility between them, leaving families stuck in a frustrating loop. In theory, any trained professional can complete the Checklist, but in practice, a lack of training and unclear guidance often cause delays. This inconsistency can leave families exasperated and paying for care unnecessarily while trying to get the process started. Remember, ARROW can also initiate a Checklist assessment with the ICB on your behalf, once we have received the relevant authority to do so. |
Click the button below to discover how ARROW can support you through the Checklist assessment process:
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