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The NHS Continuing Healthcare Checklist Explained
5th April 2026 |
Conversations about NHS Continuing Healthcare (CHC) rarely begin with a clear understanding of the process. More often than not, they begin at a point where things have already become challenging. A relative’s care needs have increased, there has been a hospital admission, or existing care arrangements are beginning to break down. It is at that point that families start asking questions.
They may have been told that NHS funding might be available, often without any real explanation of what the process involves or how it is triggered. At this stage, it becomes important to understand how the process actually works, and in particular the role of the initial screening stage known as the Checklist. 
What exactly is the Checklist?
The Checklist marks the beginning of the NHS CHC assessment process. Broadly speaking, the assessment process is divided into two stages: the first is an initial filtering stage, and the second is a full assessment of eligibility for an NHS-funded care package. Access to that important second stage is far from automatic, as it depends entirely on the outcome of the first. In most cases, the initial screening takes the form of a Checklist assessment carried out by an NHS CHC nurse assessor, using a standardised document known as the Checklist Tool. Once the need for a Checklist has been identified by the individual’s local Integrated Care Board (ICB), the commissioning arm of NHS services, it should be progressed promptly, ideally within 14 days of the request. Early access to assessment is a core principle of the National Framework, and delays at this stage undermine the integrity of the process. The Checklist is intended to operate as a gateway rather than a barrier. The threshold is deliberately set low so that individuals who may eventually qualify for funding following a full and rigorous assessment are not screened out prematurely. Its purpose is to identify those whose care needs require further evaluation through the full assessment process. In practice, however, it is not uncommon for the Checklist to be applied in a more restrictive way, with the effect that access to the process is curtailed at a very early stage. The starting point for triggering a Checklist is also often unclear, as there is no single route for requesting one. It may be initiated by a GP, a clinician, a social worker, a care home manager, or directly with the ICB. Where no professional takes responsibility, families often find themselves having to make that request, sometimes without realising that they are entitled to do so. Importantly, although routinely described as the first step, the Checklist carries more weight than that phrase suggests. It is the point at which the CHC process is either allowed to proceed or brought to an end. It does not determine eligibility, but it determines whether eligibility will even be considered. 
When should a Checklist be completed?
Timing plays a significant role in how the Checklist operates in practice. It should be completed at a point when an individual’s ongoing needs are reasonably clear, and in a setting that reflects those needs accurately. The underlying principle within the National Framework is that screening and assessment should take place at the right time and in the right place for the individual, so that their longer-term needs can be properly understood. This is why the Checklist is now more commonly undertaken in a community setting, rather than in an acute hospital environment. Needs observed during a period of illness, or immediately following admission, can fluctuate and may not provide a reliable picture of the individual’s sustained level of need. Assessing too early risks capturing a temporary presentation rather than the reality of their ongoing care requirements. At the same time, delays in arranging the Checklist can be equally problematic. Where the process is not initiated promptly, families may find themselves making care arrangements, and in some cases funding those arrangements, without any clarity as to whether responsibility should properly sit with the NHS. The intention is that individuals are supported to access the process at a point that is both clinically appropriate and practically meaningful, so that those who require a full assessment are identified without unnecessary delay. 
How does the Checklist work in practice?
The Checklist operates through consideration of eleven broad areas of care, each reflecting a different aspect of an individual’s health and support needs. It is not dependent on any specific diagnosis, but aims to capture the totality of a person’s needs arising from any health-related conditions across these domains. These domains range from physical needs, such as mobility, nutrition, continence and skin integrity, through to cognitive and psychological factors, behaviour, communication, and the management of medication. Within each domain, needs are described and assigned a level, ranging from low to high. These are recorded as A, B or C. An A reflects a high level of need, a B a moderate level, and a C a lower level of need. A full assessment is required where there are two or more domains scored at level A, or where there is a broader pattern of need reflected in five or more domains scored at level B, or a combination of one A and four Bs. In addition, certain domains are marked to reflect their particular significance. Where one of these domains is scored at level A, this alone is sufficient to trigger progression to a full assessment, regardless of the scoring elsewhere. 
What happens after the Checklist?
Once completed, the outcome of the Checklist is binary. A positive outcome means that the individual will be referred for a full assessment of eligibility using the Decision Support Tool. This is the stage at which the nature, intensity, complexity and unpredictability of needs are considered in detail. A negative outcome brings the process to an end at that point. The decision should be communicated clearly and in writing, and a copy of the Checklist should be provided so that the reasoning can be understood. It is important to recognise that a negative Checklist does not necessarily mean that the individual’s needs are insignificant. It means only that, based on the information recorded at that time, the threshold for progressing to a full assessment has not been met. Where there are concerns about how the Checklist was completed, whether relevant information was omitted, or whether the timing was appropriate, the assessing ICB can be asked to reconsider the outcome. It is important to note, however, that a negative Checklist decision cannot be formally appealed. 
What can go wrong at Checklist stage?
Although the Checklist is intended to function as a straightforward screening tool, it is often at this stage that families encounter their first real difficulties with the CHC process. These difficulties rarely arise from the structure of the tool itself, but from the way in which it is applied in practice. One of the most common issues is simply getting the process started. Responsibility for initiating the Checklist is not always clearly understood, and in practice can fall between health and social care professionals. Requests may be passed between GPs, district nurses, social workers and care providers, with no one taking ownership. In some cases, families find themselves caught in a circular process, trying to establish who should be arranging the assessment, while care needs continue to increase and decisions about funding remain unresolved. Even where the need for a Checklist is recognised, delays are not uncommon. A lack of familiarity with the process, combined with inconsistent local practice, can mean that what should be a relatively straightforward step is postponed or overlooked entirely. Where a Checklist is completed, the quality of the outcome depends heavily on the information that is recorded. The CHC nurse assessor is expected to provide a brief description of the individual’s needs in each domain, together with the evidence that supports the level selected. The tool itself does not create accuracy; it depends entirely on the quality of the input. A superficial or incomplete account of someone’s needs can lead to a very different outcome from one that reflects the full reality of their care. For that reason, the involvement of those who know the individual well is not simply desirable, but essential. The National Framework emphasises that the process should be person-centred, including giving reasonable notice of the assessment and the opportunity for the individual or their representative to be present. In practice, however, this is not always observed. Checklists may be completed quickly, sometimes without the knowledge of family members, or at times when those best placed to contribute are not available. Where that occurs, the resulting document may reflect only a partial and, at times, misleading picture of need. There are also more fundamental concerns about how the Checklist is used. Although designed as a low-threshold safeguard, it can in practice operate as a gatekeeping mechanism. Families are sometimes advised in advance that their relative is “unlikely to qualify”, or encounter informal triage steps which have no clear basis within the National Framework. In these circumstances, the Checklist risks being applied more restrictively than intended, limiting access to a full assessment rather than enabling it. This is particularly significant because, as mentioned above, a negative Checklist outcome cannot be formally appealed. While it can be revisited or reconsidered, an incorrect decision at this stage can effectively bring the process to an end before eligibility has been properly explored. Where the principles of transparency and family involvement are not followed, there is a real risk that individuals are screened out without a full and accurate understanding of their needs. 
Is it always necessary to complete a Checklist?
It is worth noting that the Checklist is not used in every situation. There are circumstances in which it will not be completed at all. This may be because it is clear that there is no need for NHS Continuing Healthcare, or because the individual’s needs are short-term and still evolving. In other cases, the Checklist may be bypassed entirely, for example where it is already evident that a full assessment will be required, or where an individual’s condition is rapidly deteriorating and the Fast Track pathway is more appropriate. There are also specific legal contexts, such as where care is provided under section 117 of the Mental Health Act, in which the Checklist does not apply. In each of these situations, the expectation is that the decision not to complete a Checklist, and the reasons for that decision, are clearly recorded. Where there is any uncertainty, the position should revert to one of inclusion, and the Checklist should be completed. 
How can ARROW help at the Checklist stage?
For families navigating this process for the first time, the difficulty is rarely the concept of the Checklist itself. It is understanding how it should operate in practice, recognising when it is not being applied properly, and knowing what to do in response. Armed with knowledge at this early stage, the process can move forward as intended. Without that, it can stall before it has properly begun. For some, a clearer understanding of how the Checklist works is enough to move things forward with confidence. For others, particularly where there is uncertainty about how to access it, whether it has been carried out appropriately, or how to respond to a negative outcome, a more structured conversation can be helpful. ARROW offers a number of ways to support at this stage, depending on how much involvement is required: Where you are managing the process yourself but would value clear, practical input, ARROW’s one-off consultancy support provides the opportunity to consider your situation in detail. This may involve discussing whether a Checklist is appropriate, how best to approach the relevant professionals, how to progress matters where the process appears to have stagnated, and how best to prepare for it once a date has been confirmed. The focus is on ensuring that the position is properly understood, so that informed next steps can be taken. For those who would prefer a more in-depth and structured view at the outset, the ARROW CHC Eligibility Review provides a detailed, domain-based assessment of needs, aligned with the NHS criteria. This offers a clearer indication of how a case is likely to be viewed and can be particularly helpful where a Checklist is being considered or has already been completed. Where a case requires ongoing involvement, ARROW’s Comprehensive Support Package brings together each stage of the process, including the initiation or facilitation of the Checklist and direct liaison with the relevant organisations, ensuring that the process is progressed and managed from the outset. Each approach is designed to meet a different need, but the aim remains the same: to ensure that this early stage is approached properly, so that the process is allowed to move forward on an informed and considered basis. Ultimately, the Checklist is not simply a preliminary formality: it is the point at which access to the CHC process is either opened or closed. Where it is understood and applied properly, it serves its intended purpose, ensuring that those who may be eligible are able to progress to a full and considered assessment. Where it is not, that opportunity can be lost at the outset. Taking the time to understand this stage, and to recognise when it is not operating as it should, can make a significant difference. Not only in whether the process moves forward, but in ensuring that decisions about care and funding are reached on a proper and informed basis. You do not have to navigate this complex system alone — and your relative should not miss out on funding to which they may be legally entitled.
ARROW Continuing Healthcare Consultants offer independent, expert support to ensure families receive the funding they are legally entitled to. Contact us today for a confidential, no-pressure chat. |
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learn more about how arrow can support you with your claim
At ARROW, we provide expert guidance and hands-on support throughout the NHS Continuing Healthcare (CHC) process. We can: ✔️ Arrange an initial Checklist assessment for you or your loved one. ✔️ Fully prepare you for the Checklist and Decision Support Tool (DST) assessments. ✔️ Gain access to healthcare records (for relatives, a certified Power of Attorney or Court Deputyship Order is required). ✔️ Build strong evidence using medical and care records to support your case. ✔️ Draft evidence-based supporting statements for assessment and appeal panels. ✔️ Represent and advocate for you or your loved one at any stage of the process. ✔️ Manage appeals if you’ve been wrongly assessed as ineligible for CHC funding. 💡 If you believe you or your loved one may qualify for NHS Continuing Healthcare, don’t go through it alone--let ARROW guide you every step of the way! 📞 Contact us today for a FREE consultation! |
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