CHC Checklist in England: what it is, how it works and how to prepare
The CHC Checklist is the screening form that decides whether someone in England gets a full NHS Continuing Healthcare assessment. A trained professional scores 11 areas of need as A, B or C. Two or more A scores, or five or more B scores, mean a full assessment should follow. So does one A with four B scores, or one A in a priority area.
What is the CHC Checklist?
The CHC Checklist is the first formal step towards NHS Continuing Healthcare (CHC) in England. Its full name is the NHS continuing healthcare checklist. You'll also hear it called the continuing healthcare checklist, the NHS CHC checklist or just the CHC form. CHC itself is the funding for adults whose care needs are mainly health needs. If that's new to you, our guide towhat NHS Continuing Healthcare is covers the basics. Our CHC funding guide walks through the whole process from start to finish.
The Checklist is a screening tool. It decides whether someone should have a full assessment of eligibility. That's the longer process where a team of professionals completes the Decision Support Tool (DST), the form that records the person's needs in detail. The integrated care board (ICB), the NHS body that decides CHC funding in your area, then makes the decision. The National Framework says the threshold "has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity" (page 40).
There are two possible outcomes. A positive Checklist means the person now needs a full assessment. The guidance is clear that this "does not necessarily mean the individual is eligible". A negative Checklist means they don't need a full assessment and they aren't eligible for CHC (Checklist guidance, October 2026).
When should a Checklist be done, and when isn't it needed?
Wherever there may be a need for CHC, a Checklist should normally be completed. The National Framework says one would be expected whenever someone needs a long-term place in a care home with nursing. The same goes for someone with significant support needs (page 41). The October 2026 guidance lists the situations where a Checklist isn't necessary:
- it's clear to the professionals that there's no need for CHC at this point (if they disagree among themselves, the Checklist should be done)
- the person has short-term needs, or is still recovering and hasn't yet reached their best level
- the ICB has agreed to go straight to a full assessment
- the person has a rapidly deteriorating condition and may be entering a terminal phase, where the Fast Track Pathway Tool is used instead
- the person gets aftercare under section 117 of the Mental Health Act 1983 that meets all their assessed needs
- they were found not eligible before and their needs clearly haven't changed
If a professional decides not to do a Checklist, the decision and the reasons should be written in the person's notes. If you think one should have been done, ask for those reasons in writing.
Where do I find the CHC Checklist form?
The Department of Health and Social Care publishes the form free on theNHS continuing healthcare checklist page on gov.uk. The current version came out on 20 October 2026. It comes as a standard and an accessible form, in Word and ODT, with the guidance on a web page beside them. Gov.uk says the update was made "for ease of use and to improve clarity". It keeps the same 11 areas of need and the same thresholds for a full assessment as the July 2022 version it replaced.
If you search for a CHC Checklist PDF or an NHS continuing healthcare checklist PDF, you may still find older copies. Check the date on any form you're given.
What's on the CHC Checklist form?
The form has five sections, and knowing what each one records makes a completed Checklist much easier to read.
| Section | What it records | What to look for |
|---|---|---|
| 1. Individual's information | Personal and GP details, where the Checklist was done, whether the person took part, whether they were offered a representative such as a family member, and who attended | Whether you were offered the chance to be there |
| 2. The Checklist | When not to screen, then the 11 domains. For each one, a brief description of need, the source of evidence and the level chosen | A reason and a named source for every level |
| 3. Outcome | The thresholds, whether the Checklist is positive or negative, and the rationale for the decision | The rationale, in words you can follow |
| 4. Assessors' information | Who completed it: name, job title, professional type and organisation | Who to contact about the scores |
| 5. Equality monitoring | Optional questions about the person, for NHS data | Nothing that affects the outcome |
Source: NHS continuing healthcare checklist, accessible version, DHSC, October 2026.
The top of the form also has a box for the date the ICB received it. That date matters, because the ICB's 28 days to reach a decision after a positive Checklist start from it.
Who completes the CHC Checklist?
A health or social care practitioner who has been trained to use it. The National Framework gives examples: registered nurses employed by the NHS, GPs and other clinicians (page 42). Council staff such as social workers, care managers or social care assistants are on the list too. Each ICB and council agree locally who can complete it. As far as possible, this is expected to include staff who assess or review people's needs in their day-to-day work.
You can't fill in the Checklist yourself. But the Framework says a person can ask their ICB for one (page 42). You can also ask the professionals already involved, such as the GP, the hospital discharge team, the social worker or the care home nurse. Put the request in writing, copy in the ICB's CHC team and keep a copy.
The person should get reasonable notice and should normally have the chance to be there, with a representative such as a family member (page 42). If you want to take part, say so when you ask for the Checklist. Ask for the date and the name of the person who'll complete it.
Does the person need to consent?
Not for the Checklist itself. The October 2026 guidance says health and social care professionals don't need consent to carry out the Checklist or the assessment. They also don't need it to share information with each other and with care providers for the person's direct care. Consent is needed for any physical examination of someone who has capacity to give it. Explicit consent is also needed before personal information is shared with a family member, friend or advocate.
That second point is what the CHC consent form is for. The Department of Health and Social Care published the NHS continuing healthcare consent form for sharing information on 8 May 2026. Its guidance says it's best practice for the professional completing the Checklist to complete it at the same time. If the person can't make the decision, an attorney or deputy with the right authority can decide. Otherwise, a best interests decision is made under the Mental Capacity Act 2005. The consent form shouldn't hold anything up. Day 1 of the 28-day timescale is the date the ICB receives the Checklist, whether or not the consent form arrives with it.
What are the 11 Checklist domains?
The Checklist looks at 11 areas of care, called domains. If you're looking for a list of CHC Checklist questions, the form works a little differently. Each domain has written descriptions for levels C, B and A. The practitioner picks the one that most closely matches the person. Four domains are marked with an asterisk, because they carry a priority level in the DST used at the full assessment. A single A in any one of them is enough for a full assessment on its own.
| Domain on the form | What it covers | Priority domain |
|---|---|---|
| 1. Breathing | Shortness of breath, inhalers and nebulisers, oxygen, CPAP masks, and breathing through a tracheostomy or with a machine | Yes |
| 2. Nutrition: food and drink | How the person eats and drinks, how long feeding takes, tube feeding, choking risk and unplanned weight loss | No |
| 3. Continence | Bladder and bowel care, from routine toileting and pads to catheters, repeated infections and skilled nursing care | No |
| 4. Skin (including tissue viability) | Pressure sores, wounds and skin conditions, and how often turning or skin care is needed to prevent damage | No |
| 5. Mobility | Weight bearing, help with transfers and repositioning, falls risk, and spasms or contractures | No |
| 6. Communication | Whether the person can make their needs known, in words or in any other way | No |
| 7. Psychological and emotional needs | Low mood, anxiety, distress or hallucinations, and whether prompts and reassurance still help | No |
| 8. Cognition | Memory, confusion, awareness of everyday risks and the ability to make decisions | No |
| 9. Behaviour | Behaviour that challenges, and the risk it poses to the person, other people or property | Yes |
| 10. Drug therapies and medication: symptom control | How medication is given and monitored, and how well pain and other symptoms are controlled | Yes |
| 11. Altered states of consciousness | Blackouts, seizures and other episodes, and the supervision or skilled help needed to keep the person safe | Yes |
Source: NHS continuing healthcare checklist, DHSC, October 2026, Section 2.
The descriptions on the form run to several lines for each level. If you ever challenge a score, quote the full description from the form rather than a summary like the one above. The full assessment uses the same 11 domains and adds a twelfth, "other significant care needs".
How is the CHC Checklist scored?
Each domain gets one level: C for a low level of care need, B in the middle and A for a high level of need. One rule in the guidance is worth knowing by heart: "If the needs of the individual are the same or greater than anything in the A column, then 'A' should be selected." For every domain, the practitioner should also write a short summary of the needs behind the level and note where the evidence came from.
The Checklist guidance and Section 3 of the form set out four ways to reach a full assessment. Meeting any one of them is enough.
| A full assessment is required if the Checklist shows | An example that meets it |
|---|---|
| 2 or more domains at A | A in Cognition and A in Mobility |
| 5 or more domains at B | B in Nutrition, Continence, Skin, Mobility and Cognition |
| 1 domain at A and 4 at B | A in Cognition, with B in Nutrition, Continence, Skin and Mobility |
| 1 A in a priority domain, whatever the other domains score | A in Behaviour, with every other domain at C |
Source: NHS continuing healthcare checklist guidance and form, Section 3, DHSC, October 2026.
One A on its own in a domain without an asterisk, such as Cognition, needs a second A or four Bs alongside it. Scores below these lines don't always rule out a full assessment. The guidance allows one in "rare circumstances" where the practitioners give a clear rationale.
Our free CHC Checklist score checker lets you enter the level for each of the 11 domains. It shows whether the scores meet one of the rules, and how close they are if they don't. Use it on a completed Checklist, or to see how the rules work before the real one.
What does an example of a completed CHC Checklist look like?
This example is invented
Joan is made up for this guide to show how a completed CHC Checklist reads. She isn't a real person or one of our clients.
Joan is 84 and has dementia. She lives in a care home without nursing. Here's how her Checklist might look, with the kind of evidence note a practitioner should write for each domain.
| Domain | Level | Evidence note |
|---|---|---|
| Breathing | C | Normal breathing. No inhalers or oxygen. |
| Nutrition: food and drink | B | Staff feed her at every meal. Lunch takes about 40 minutes. Food and fluid charts, 1 to 14 March. |
| Continence | B | Incontinent of urine and faeces. Monitored for urine infections, three in the last six months. GP records. |
| Skin | B | Turned every two to three hours, day and night, to stop her skin breaking down. Repositioning charts. |
| Mobility | B | Can't consistently take her own weight. Two falls in February. Falls risk assessment says moderate risk. |
| Communication | C | Can say when she's in pain or hungry if staff give her time and ask short questions. |
| Psychological and emotional needs | C | Anxious most late afternoons. A chat and a cup of tea usually settle her. Daily notes. |
| Cognition | A | Forgets within minutes and often doesn't know where she is. Can't make most decisions, even with help. High risk of harm without supervision. Care plan and mental capacity assessment. |
| Behaviour | C | No behaviour that puts her or anyone else at risk. Accepts her care. |
| Drug therapies and medication | C | Staff give her tablets at set times and she takes them. Medication chart. |
| Altered states of consciousness | C | No blackouts or seizures recorded. |
Joan's totals are one A, four Bs and six Cs. One A with four Bs meets the third line of the thresholds table, so her Checklist is positive and she needs a full assessment. Her A is in Cognition, which isn't a priority domain, so it wouldn't have been enough on its own.
Now look at Skin. Joan has never had a pressure sore, because the staff turn her every two to three hours. Suppose the practitioner had scored Skin as C because her skin is fine. The total would drop to one A and three Bs, and the Checklist would be negative. Yet the B description on the form covers exactly her situation. It describes a risk of skin breakdown that needs preventative care several times each day, "without which skin integrity would break down". This is the well-managed need principle at work. It's why every evidence note should say what the care is preventing.
What are the common Checklist mistakes?
A handful of mistakes come up again and again, and each one can move a Checklist to the wrong side of the line.
Scoring a good day
A Checklist done on a calm morning can miss what happens at night, at weekends or on bad days. Make sure the practitioner sees records that cover the whole week. Check that every level has a named source of evidence, too. A level with no source gives you nothing to point to later.
Marking a need down because it's well managed
The National Framework says a need shouldn't be marginalised "just because it is successfully managed: well-managed needs are still needs" (page 51). The October 2026 guidance confirms that this applies to the Checklist just as it does to the full assessment. The test is simple to ask out loud: what would happen if the current care stopped?
Treating refusal of care as challenging behaviour
In the Behaviour domain, whether the person accepts care only appears as part of descriptions about challenging behaviour and risk. Someone who refuses help with washing or dressing, but shows no challenging behaviour, doesn't score B or A for Behaviour. Refusing medication belongs in Drug therapies, where the form puts it at B: "requires the administration of medication (by a registered nurse, carer or care worker) due to: non-compliance". Getting this wrong matters in both directions, because Behaviour is a priority domain.
Choosing B when the needs match A
The guidance says A should be chosen if the needs are the same as or greater than anything in the A column. A habit of settling on B as the safe middle ignores that sentence. When you read a completed form, put each level next to the full description and check the match line by line.
What happens after a positive Checklist?
The form says the completed Checklist should be sent to the ICB "without delay", whether it's positive or negative. After a positive Checklist, a multidisciplinary team (MDT) of at least two professionals carries out the full assessment using the DST. The ICB then makes the eligibility decision. The assessment tests whether the person has a primary health need, which means their care is mainly about meeting health needs. Our guide to the CHC eligibility criteria explains what the test involves.
The National Framework says the time from the ICB receiving a positive Checklist to its decision should not exceed 28 calendar days in most cases (page 55). Sometimes the ICB takes longer without a good reason, and the person is then found eligible. If the person or the council paid for care in the meantime, the ICB should refund care costs from day 29 to the decision date (Annex E, paragraphs 8 to 9).
The guidance says the person "should not be left without appropriate support" while they wait for the outcome of the assessment and decision. This is the stage where preparation counts most. Our CHC assessment support service is built around it. We read the records, match the evidence to the 12 domains and help you get ready for the meeting.
What if the Checklist is negative?
After a negative Checklist, you can ask the ICB to reconsider. The National Framework says the ICB "should give this request due consideration, taking account of all the information available, and/or including additional information from the individual or carer, though there is no obligation for the ICB to undertake a further Checklist" (page 43). It should then give you a clear written response that explains your rights under the NHS complaints procedure if you're still unhappy.
A request to reconsider works best when it points at something specific, such as:
- a need that was scored low because it's well managed
- a domain where the higher description matches the person word for word
- records the practitioner didn't see
Set it out in writing, domain by domain, and send copies of the records with it. A refusal at this stage can't go to an Independent Review Panel, the appeal stage that NHS England runs. NHS England's guide says the panel doesn't cover an ICB's refusal to consider a request for a full assessment after a negative Checklist. If the ICB won't move, the next route is the NHS complaints procedure.
Needs also change. If they're likely to increase in the next 3 months, the guidance says this should be recorded. A decision should then be made on whether to review the Checklist within a set period. If the person's needs change later, you can ask for a new Checklist. For a second pair of eyes on a negative Checklist, our CHC case review starts with us reading the form and the records.
Is there a funded nursing care checklist?
No, there's no separate funded nursing care checklist or NHS funded nursing care checklist. NHS-funded Nursing Care (FNC) is a weekly NHS payment to a care home with nursing. It goes towards the cost of care from a registered nurse. The National Framework says that "in all cases individuals should be considered for eligibility for NHS Continuing Healthcare before a decision is reached about the need for NHS-funded Nursing Care" (page 9). So the CHC Checklist comes first.
The standard FNC rate is £267.68 a week from 1 April 2026 (Department of Health and Social Care, 9 March 2026). FNC is a contribution towards the nursing part of the care, while CHC pays for the whole care package. If FNC is offered without a CHC Checklist, ask why.
How should families prepare for the Checklist?
Preparing for the NHS continuing healthcare checklist is mostly evidence work, so think of this as your own CHC funding checklist. The National Framework suggests a diary where good care hides the needs. It says "it may be necessary to ask the provider to complete a detailed diary over a suitable period of time to demonstrate the nature and frequency of the needs and interventions, and their effectiveness" (page 51).
Keep a dated diary for two weeks
Write down what happened, when, who helped and how long it took. "14 March, 3.40am: found at the front door trying to leave, 45 minutes to settle" carries far more weight than "she needs a lot of help".
Gather the records
Care plans, falls records, medication charts, repositioning and food charts, district nurse notes, and hospital and GP letters, with their dates.
Go through the 11 domains
For each one, note the need, how often it happens and what would happen if the current care stopped. Add the diary entries and records that show it.
Ask for the details in writing
The date of the Checklist, who will complete it, that you'd like to be there, and that your diary and records will be read first.
Ask for a copy afterwards
The outcome should reach you in writing with the reasons, normally as a copy of the completed Checklist.
Our free CHC check asks about the same areas of care in plain English and takes a few minutes. It shows where things stand before the Checklist. If you'd rather not face the Checklist alone, we can go through the records with you beforehand. We'll tell you which domains need the most evidence.
Questions families ask
Can anyone complete a CHC Checklist?
No. It has to be a trained health or social care practitioner, such as an NHS nurse, a GP, a social worker or a care manager. You can't fill one in yourself to refer a relative. You can ask for one, though. The National Framework says a person can request a Checklist from their integrated care board (ICB).
Can a family member be at the CHC Checklist?
Yes, normally. The National Framework says the person should get reasonable notice of the Checklist. They should normally have the chance to be there with any representative they have, such as a family member. The October 2026 form records whether a representative was offered and who attended. If you want to take part, ask in writing when you request the Checklist and bring your notes.
Is CHC funding backdated?
There's no general backdating rule, but Annex E of the National Framework sets out refunds in some situations. If the ICB takes longer than 28 days to decide without a good reason, it should refund care costs from day 29. This applies when the person is found eligible. If a refusal is later overturned, it should refund the council or make a payment to the person who paid. Care that was never assessed at all is a separate claim.
How is the CHC full assessment scored?
The full assessment uses the Decision Support Tool. A team of professionals records needs in 12 domains. Each domain gets a level from no needs up to high, severe or priority, depending on the domain. Four domains can reach priority. One priority level, or two or more severe levels, would be expected to lead to a recommendation that the person is eligible. Other mixes are weighed on the nature, intensity, complexity and unpredictability of the needs.
What are the four criteria for CHC?
People usually mean the four characteristics of need in the National Framework: nature, intensity, complexity and unpredictability. The assessment team uses them to decide whether someone has a primary health need, which is the real test for CHC. Each one can show a primary health need on its own or together with the others. The Checklist comes before all this and uses simpler A, B and C levels.
Is there a CHC Checklist for dementia?
No, there's one Checklist for everyone. The National Framework says a diagnosis isn't in itself what decides eligibility, so what counts is the care the person needs. For someone with dementia, look closely at five domains: Cognition, Behaviour, Psychological and emotional needs, Communication and Nutrition. Gather dated examples for each one before the Checklist.
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, accessible version (Word), Department of Health and Social Care, published 20 October 2026.
- NHS continuing healthcare checklist: guidance, Department of Health and Social Care, published 20 October 2026.
- NHS continuing healthcare decision support tool: guidance, Department of Health and Social Care, updated 22 October 2026.
- NHS continuing healthcare: consent form for sharing information, and its guidance, Department of Health and Social Care, published 8 May 2026.
- NHS Continuing Healthcare: independent review process, public information guide, NHS England, version 3, 3 July 2023.
- Better community care thanks to nursing funding boost (NHS-funded nursing care rates from 1 April 2026), Department of Health and Social Care, 9 March 2026.