We receive a lot of enquiries about the CHC Checklist and what the process entails. Most of the questions on this topic come from people whose elderly relatives are currently in hospital, awaiting discharge to a care home environment, or are already in care but have never even been assessed for Continuing Healthcare Funding.

In both the above cases, the Checklist is the first step in the CHC assessment process. The Checklist is a screening tool, used to identify whether a full assessment of eligibility for NHS Continuing Healthcare Funding is required. The Checklist has a low threshold for success and is designed to filter out only those who clearly do not meet the criteria for CHC Funding. Those who score highly enough on the Checklist will automatically proceed to the next stage, the full assessment or “MDT”.

The Checklist Criteria

The Checklist has 11 care domains: Breathing, Nutrition, Continence, Skin, Mobility, Communication, Psychological & Emotional Needs, Cognition, Behaviour, Drug Therapies & Medications, Altered States of Consciousness.

Each domain is broken down into 3 levels, A, B or C, where A represents the highest level of care need, and C the lowest. The outcome of the Checklist depends on the number of As, Bs and Cs identified. A “positive” Checklist only confirms the need for full assessment and is not an indicator of eligibility for CHC Funding.

A positive Checklist is indicated by the following scores:

2 or more As
5 or more Bs
1 A and 4 or more Bs
1 or more As in an asterisked* domain (Breathing, Behaviour, Drug Therapies & Medications, Altered States of Consciousness)

According to the National Framework, completion of the Checklist is intended to be relatively quick and straightforward, and it is not necessary to provide detailed evidence at this stage.

What are the possible outcomes of the Checklist?

A positive Checklist confirms the need for full assessment, meaning the person will automatically be referred to the next stage of the process: completion of the Decision Support Tool by a multidisciplinary team (“MDT).

A negative Checklist confirms there is no need for any further assessment and marks the end of the process. However, the person may still qualify for Funded Nursing Care – this is a weekly payment made by the NHS to the nursing home, to cover the cost of some basic nursing needs.

The threshold at this initial stage has been set intentionally low to ensure that everyone who might qualify for CHC Funding is considered. Therefore, if your relative does not trigger for a full assessment, and the Checklist has been completed fairly and robustly, you can be confident they do not meet the criteria for CHC Funding.

When should the Checklist be completed?

The Checklist can be completed in any non-acute setting, once the person’s ongoing care needs are clear. A Checklist should be undertaken whenever there is a possibility that there may be a need for CHC Funding.

After a period of treatment in hospital, the NHS may need to provide an interim package of further support, which often includes rehabilitation. The National Framework recommends that in these circumstances, assessment for Continuing Healthcare Funding should be deferred until the package of support measures has taken effect. This will ensure the long-term care needs are stable and clear.

Practically speaking, this usually means the Checklist should not be completed until your relative has been discharged from hospital, all rehabilitation is complete and they have settled into their home environment (either in their previous place of residence or a new care facility).

Who completes the Checklist?

The Checklist can be carried out by a variety of health and social care professionals – e.g. a GP, District Nurse, physiotherapist or other NHS clinician; a Social Worker, Care Home Manager or Social Care Assistant. The person completing the Checklist must be trained and qualified to do so. It is also expected, so far as possible, that the person completing the Checklist will be involved in the care and/or treatment of the person being assessed.

We increasingly hear of families struggling to get a Checklist completed: GPs will say they do not know about Continuing Healthcare and care home staff will refuse. In these circumstances, we recommend contacting your local Integrated Care Board for advice.

Preparing for the Checklist

You (and your relative) should be given reasonable notice of the Checklist taking place and you should be invited to participate.

Often, we hear that Checklists are completed without the family’s knowledge or input. In some cases, the family are not even notified of the outcome until it comes to light months – or even years – later that a Checklist was completed, with the outcome that no further assessment was required.

Before the Checklist, make sure you download a copy of the tool and familiarise yourself with the care domains. In each case, read the descriptors for A, B and C, and think about which describes your relative’s needs most accurately.

What happens afterwards?

Once the Checklist has been completed, you will usually be notified of the outcome straight away.

If the Checklist is positive, your relative will be referred for a full assessment by a multidisciplinary team.

If the Checklist is negative, you should receive a letter enclosing copy of the Checklist with information about how to challenge the outcome if you disagree. You have 12 months from the date of the letter to dispute the outcome of a negative Checklist, via the NHS complaints process.

Remember: a negative Checklist does not mean your relative will never qualify for CHC Funding. Needs can and do change, and you should use the Checklist as a baseline as things progress. If your relative’s needs increase, their eligibility for CHC Funding can be reassessed.

Download our free guide.

The NHS Continuing Healthcare Funding Checklist explained