CHC assessment in England: what happens and how we can help
We help you get ready for the NHS Continuing Healthcare (CHC) assessment in England. We read the care records, match the evidence to the 12 areas of need and support you at the meeting.
- Fixed price for one full assessment
- A written evidence report before the meeting
- Help before, at and after the meeting
What is a CHC assessment?
A CHC assessment decides whether the NHS will pay for someone's care in full. In England it has two stages: a short Checklist, then a full assessment using the Decision Support Tool (DST) across 12 areas of need. The decision comes from the integrated care board (ICB), the NHS body that decides CHC funding in your area. It should normally decide within 28 days of receiving a positive Checklist.
CHC is a package of care "arranged and funded solely by the NHS" (National Framework, glossary, page 167). It's for adults with the highest levels of complex, intense or unpredictable needs. It can be provided in any setting, including the person's own home, a care home or a hospice (page 24). Our guide to CHC funding explains what it covers and who it's for.
The CHC assessment asks one question: does the person have a "primary health need"? That means the main part of the care they need is focused on health needs (page 22). It's judged on their actual day-to-day needs rather than on their diagnosis. Money plays no part. The National Framework, the written rules for CHC in England, says "financial issues should not be considered" in the decision (page 24). Our guide to the CHC eligibility criteria goes through the test in detail.
CHC Funding Support helps families in England through this process. We are not part of the NHS.
How does the continuing healthcare assessment process work?
The continuing healthcare assessment process has four steps, and the National Framework sets the rules for each one.
The Checklist
A trained practitioner, such as a nurse, GP or social worker, scores 11 areas of need at level A, B or C. The bar is set low on purpose, so that everyone who needs a full assessment has the chance of one. A positive Checklist means a full assessment follows. It doesn't necessarily mean the person will be found eligible.
Checklist supportThe full assessment and the DST
A multidisciplinary team (MDT) of professionals completes the Decision Support Tool (DST). It records the evidence and a level of need for each of 12 care domains, or areas of need. Then it recommends to the ICB whether the person has a primary health need.
Assessment supportThe ICB decision
The ICB makes the decision. You should get it in writing, with a copy of the DST and details of how to ask for a review.
Assessment supportThe care package and reviews
If the person is eligible, the NHS arranges and pays for the care package. The first review should take place within three months of the decision, and after that at least once a year.
Review meeting support
Our CHC Checklist guide explains the 11 areas and the scores. If you already have a completed Checklist, the Checklist score checker shows whether its scores should lead to a full assessment.
Sources: National Framework, pages 22, 40, 42, 54 and 61, glossary page 167, and Practice Guidance 28, page 141. Checklist guidance, "What happens following a positive checklist". Decision Support Tool guidance, "How to use the DST".
Who carries out the assessment?
The multidisciplinary team (MDT) carries out the full assessment. The Framework's glossary defines it as "a team of at least two professionals, usually from both the health and the social care disciplines" (page 167). Before the meeting, a coordinator gathers information from the professionals involved (Practice Guidance 28, page 139).
You have a part to play as well. At each stage, the Framework says, practitioners "should make all reasonable efforts to seek the participation of the individual (or their representative)" (page 28). A representative includes a family member who is supporting them (page 27). The Framework also says the contribution of family members "is usually key" to a good assessment (page 30). You know what the worst days look like, and a single meeting can easily miss them.
What happens at the CHC meeting?
Before the CHC meeting, the coordinator should explain the team's role and the ways you can take part. If you ask for copies of the papers the team will use, the Framework says they "should be supplied" (Practice Guidance 28, page 140). The meeting should be held as near to your relative as possible, so that they can be involved (Practice Guidance 27, page 139).
At the meeting, the team works through the 12 care domains one at a time. The table under "How to prepare" below lists them all. For each one, the team should write down the evidence and where it came from, then choose a level of need (DST guidance, "How the care domains are divided into levels of need").
Then the team looks at the whole picture, using four characteristics of the person's needs. These are nature, intensity, complexity and unpredictability (National Framework, pages 23 to 24). It agrees a recommendation and writes down why. Some teams make the recommendation after the family has left. If they do, the guidance says it's best practice to let you state your views before you go (Practice Guidance 28, page 140).
The recommendation then goes to the ICB. The Framework says that "only in exceptional circumstances, and for clearly articulated reasons" should the team's recommendation not be followed (page 54). If you disagree with the decision, you can challenge it. Our page on CHC appeals explains each stage.
Can a CHC assessment happen in hospital?
It can, although the National Framework expects it to be rare. It says that "in the vast majority of cases, CHC assessments should take place in community settings" (page 37). That's because an assessment on an acute ward "is unlikely to accurately reflect an individual's longer-term needs" (page 36). Most people should leave hospital first and have the CHC assessment once their ongoing needs are clearer. In the meantime, they should have interim NHS-funded support where it's appropriate. The Framework also says the CHC process "should not be allowed to delay hospital discharge" (pages 36 to 37).
If the person is otherwise ready for discharge, the Framework expects an acute hospital assessment to take "far fewer than 28 calendar days" (page 56). NHS England publishes the number of DSTs each ICB completes in an acute hospital, so you can see how often it happens in your area.
How long does a CHC assessment take?
The National Framework says the whole CHC assessment should take no more than 28 calendar days in most cases. That runs from the ICB receiving a positive Checklist to its decision. Once the team has made its recommendation, the ICB should normally respond within 48 hours (page 55).
The national figures fall short of that. In July to September 2026, ICBs in England decided 67.5% of standard referrals within 28 days. Source: NHS England CHC and FNC data, Q2 2026/27, published 12 November 2026 (our sums).
Delay can matter for money. Sometimes the ICB takes longer than 28 days without good reason, and the person is then found eligible. If the family or the council paid for care while waiting, the ICB should refund the cost. The refund runs from day 29 to the date of the decision (Annex E, paragraphs 8 and 9).
| Stage | Who does it | Time limit | What you receive | Source |
|---|---|---|---|---|
| Checklist | A trained practitioner, such as a nurse, GP or social worker | Sent to the ICB "without delay", with no fixed period | The outcome in writing "as soon as is reasonably practicable" | Checklist form, section 3. Checklist guidance, "What happens next" |
| Full assessment | A team of at least two professionals | Inside the 28 days below | Copies of the papers the team will use, if you ask | National Framework, glossary page 167. Practice Guidance 28 |
| ICB decision | The integrated care board | 28 days from a positive Checklist in most cases, and normally 48 hours after the recommendation | The decision in writing, a copy of the DST and how to ask for a review | National Framework, page 55. Practice Guidance 28, page 141 |
| First review | The integrated care board | Within three months of a decision that the person is eligible, then at least once a year | A check of the care package and of eligibility | National Framework, pages 61 to 62 |
| Refund for delay | The integrated care board | Costs from day 29, if the decision took longer without good reason and the person is found eligible | A refund of the care costs paid while waiting | National Framework, Annex E, paragraphs 8 and 9 |
How to prepare for a CHC assessment
An assessment happens on one day, and a good day can make serious needs look small. Preparing well means the team sees the whole picture.
- Ask for copies. Ask the coordinator for the papers the team will use. Ask the care home or care agency for its own records too, such as care plans, daily notes, medication charts, falls logs and behaviour charts.
- Keep a diary of the worst days. Short, dated entries carry more weight than general statements. For example: "3 July, 2.15am. Woke breathless and distressed. Sat upright with oxygen for 50 minutes before settling."
- Count the needs that good care hides. The Framework says "well-managed needs are still needs" (National Framework, page 51). If carers stop falls, sores or distress from happening, that care is evidence of the need. Write down what they do and what would happen without it.
- Gather evidence for each of the 12 areas. Use the table below, so that no care domain is left out.
- Be there and speak up. Where the description of a higher level matches your relative's real day, say so and ask the team to record it.
Ask the care provider to keep a diary too
The Framework says it may be necessary to ask the provider to keep a detailed diary (National Framework, page 51). The aim is "to demonstrate the nature and frequency of the needs and interventions, and their effectiveness". Ask for one as soon as you know the date of the assessment.
| Care domain | Records worth gathering |
|---|---|
| Breathing | Oxygen or nebuliser use, records of breathless episodes and what carers did |
| Nutrition: food and drink | Weight charts, swallowing or choking notes, how long meals take, any feeding plan |
| Continence | Catheter care, infection records, bowel care and how often help is needed |
| Skin (including tissue viability) | Wound or pressure ulcer records, turning charts, dressing plans |
| Mobility | Falls log, falls risk assessment, hoist use or the number of carers needed to move them |
| Communication | How they make their needs known, and notes of times they could not |
| Psychological and emotional needs | Notes of distress, anxiety or withdrawal, and what helps or does not |
| Cognition | Memory and orientation, decisions they cannot make, notes on risk |
| Behaviour | Behaviour charts, incident reports and the support plan that keeps everyone safe |
| Drug therapies and medication: symptom control | Medication records, pain charts, and any medicine that needs a nurse to give or monitor it |
| Altered states of consciousness | Records of seizures, blackouts or episodes, with dates and what happened |
| Other significant care needs | Anything the other 11 areas miss, with the records that show it |
The 12 care domains are the ones in the Decision Support Tool (DST guidance, October 2026, "How to use the DST").
How we help with your CHC assessment
Assessment support covers one full CHC assessment, from the first request for records to the decision letter.
Before the meeting
We'll start with a call, then ask for the care records with your written permission. We'll check the process so far and speak to the coordinator. If something has gone wrong, we'll write to the ICB. Then we'll match the records to the 12 care domains. You'll get a written evidence report at least a week before the meeting, then a 90-minute call to get you ready.
At the meeting
We'll attend the meeting by video or phone. We'll check that what the team writes on the DST matches the evidence. We'll also ask for your views to be recorded.
After the meeting
We'll have a debrief call with you, and we'll send the ICB written comments on the draft DST. When the decision arrives, we'll explain it to you.
What it doesn't include
- The Checklist stage, which is our Checklist support service
- An appeal against the decision
- A clinical opinion
- A second full assessment
- Travel to meetings in person, which we'll quote for first
Best started 2 weeks or more before the meeting
Care records can take time to arrive, and we need time to write the evidence report. If your meeting is sooner, get in touch anyway and we'll tell you what can be done in the time.
What it costs
Assessment support costs £2,495 for one full assessment.
Assessment support
£2,495for one full assessment
Pay half when we start and half after the assessment meeting.
- Your care records read and matched to the 12 care domains
- A written evidence report at least a week before the meeting
- A 90-minute call to get you ready
- We attend the meeting by video or phone
- Written comments on the draft DST, and a view on the decision
We also help at the stages either side of the assessment. Checklist support costs £995. Review meeting support, for someone who already has CHC funding, costs £1,495. If you're not sure the case is worth taking further, a case review costs £495, and we take the fee off the next stage. Our CHC case review page explains what it includes. Every price is on our prices page.
How our price compares
Here's our price next to Beacon's published prices for similar work, and what some Compass reviewers say they paid.
| Service | CHC Funding Support | Beacon CHC | Compass CHC |
|---|---|---|---|
| Checklist support | £995 | £2,880 | No prices published |
| Assessment support | £2,495 | £4,800, or £7,200 with its Evidence Review | Some reviewers report about £7,000 to £8,000 for its records report |
Beacon: published prices from its fees page at beaconchc.co.uk, read 12 November 2026, with VAT at 20% added because Beacon adds VAT to its fees. Compass publishes no prices. Where we show a Compass figure, it's what some reviewers on Trustpilot say they paid (review 1, review 2, read 12 November 2026). A quote from Compass may be different.
The work included differs. Beacon's lower assessment price includes a read of the care records in the 2 working days before the meeting. Its higher price reads them in the 2 weeks before (Beacon fees and service pages, read 12 November 2026). Compass's figure is for its records report before an assessment. Ours covers the work set out above for one full assessment. We run a competing service, so please check each provider's own website before you choose.
What we'll tell you in writing
Nobody can know the outcome before the assessment. Before any work starts, you'll get a written quote with the full total for each stage. When the decision arrives, we'll give you our written view on whether an appeal is worth making. If the records don't support the case, we'll tell you in writing before you pay for the next stage.
We'll also point you to other help that might suit. That could be council funding or NHS-funded Nursing Care (FNC), a fixed weekly NHS payment towards nursing costs in a care home with nursing.
Our limits
We're a small team, so we keep each case with the same people from start to finish. We work in England only, because the National Framework doesn't apply in Scotland, Wales or Northern Ireland. There's no clinician on our staff. If a case needs a clinical opinion, we'll buy one in and agree the cost with you first. We're not solicitors either, and if a case needs legal advice, we'll tell you.
CHC assessment questions
Can a family member be at the CHC assessment?
Yes. The National Framework says practitioners should make all reasonable efforts to involve the person or their representative at each stage. A representative includes a family member who is supporting them. The person should normally have the chance to be present at the Checklist with their representative.
Who is qualified to complete the CHC Checklist?
A range of health and social care practitioners can complete it, as long as they've been trained in its use. The National Framework gives examples. They include registered nurses employed by the NHS, GPs and other clinicians. They also include council staff such as social workers, care managers or social care assistants. Each ICB and council agrees locally who can complete it.
How is the CHC full assessment scored?
The team gives each of the 12 care domains a level: no needs, low, moderate, high, severe or priority. Not every domain can reach the top levels. The guidance expects a clear recommendation of eligibility in two cases. One is a priority level in one of the four domains that carry it. The other is two or more severe levels. Other combinations can also show a primary health need. The Framework says these thresholds are not to be viewed prescriptively.
Does Attendance Allowance stop if you get CHC funding?
It usually does when CHC pays for a care home place. GOV.UK says that when NHS Continuing Healthcare pays for a care home, most benefits usually stop within 28 days of the person going in. It lists Attendance Allowance as a benefit you may keep only if you pay for the care home yourself. Whatever the setting, tell the Attendance Allowance helpline when CHC funding starts, so they can check the award.
What is a CHC review?
A review checks whether the care package still meets the person's needs and whether they're still eligible. The first should take place within three months of the decision, then at least once a year. The Framework warns reviewers not to mistake well-managed needs for reduced needs. It also says funding shouldn't be withdrawn without a joint reassessment and other funding in place first.
How do I ask for a CHC assessment?
Ask for a CHC Checklist. You can't refer your relative by filling one in yourself. But you can ask the ICB for one, or ask a trained professional who knows them. That could be the GP, the hospital team, the social worker or the care home nurse. Put the request in writing, keep a note of the date, and ask for the outcome in writing too.
This is information, not legal advice. It explains the rules for England, which are set out in the National Framework for NHS Continuing Healthcare.
Sources
- National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, Department of Health and Social Care, July 2022 revision, corrected July 2023.
- NHS Continuing Healthcare Checklist and its guidance, Department of Health and Social Care, 20 October 2026.
- NHS Continuing Healthcare Decision Support Tool and its guidance, Department of Health and Social Care, 20 October 2026, guidance updated 22 October 2026.
- NHS Continuing Healthcare and NHS-funded Nursing Care data, Q2 2026/27, NHS England, published 12 November 2026.
- Going into a care home: benefits, GOV.UK, read 13 November 2026.
Get help with your case
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