Free NHS Continuing Healthcare Guide
Your Free NHS Continuing Healthcare Guide
CHC Checklist - What You Need to Know
The CHC Assessment & DST Explained
Fast Track CHC Funding Explained
This NHS Continuing Healthcare Guide explains the CHC Checklist, how it works, what the scores mean and what should happen if the threshold for a full assessment is met.
A straightforward explanation of the full CHC assessment, the Decision Support Tool (DST), the care domains and how eligibility for NHS Continuing Healthcare should be considered.
What Fast Track funding is, who it is for, how the process should work and what families need to know when a person’s condition is rapidly deteriorating and may be entering a terminal phase.
FREE CHC GUIDE
CHC Checklist - What You Need to Know
The NHS Continuing Healthcare (CHC) Checklist is a screening tool used to decide whether someone should be referred for a full CHC assessment. It is not the assessment itself and it does not determine whether a person is eligible for CHC funding.
A Checklist should consider the person’s needs across 11 care domains. The purpose is to identify people who may need a full assessment, so the threshold is deliberately set relatively low. A positive Checklist does not mean CHC will automatically be awarded — it means a full assessment should normally follow.
View the Official NHS CHC Checklist
You can view the complete NHS Continuing Healthcare Checklist, including the A, B and C descriptors used for each care domain, on the official GOV.UK website.
What do the A, B and C scores mean?
Each care domain is given an A, B or C rating. An A indicates a higher level of need, B indicates a moderate level of need, and C indicates a lower level or no identified need in that domain. The scores are used to decide whether the threshold for a full CHC assessment has been met — they do not determine CHC eligibility.
When does a Checklist trigger a full CHC assessment?
A full CHC assessment should normally be arranged if the Checklist shows:
• 2 or more A scores
• 5 or more B scores
• 1 A and 4 B scores
• 1 A in a domain marked with an asterisk (*), with any number of scores in the other domains
Meeting the Checklist threshold does not mean that CHC funding has been awarded. It means the person should normally be referred for a full assessment using the Decision Support Tool (DST).
In exceptional circumstances, a full assessment may still be appropriate even if the usual Checklist threshold is not met. If a Checklist is negative and you believe the person’s needs have not been properly reflected, you can ask the Integrated Care Board (ICB) to reconsider the decision.
What happens after a positive Checklist?
A positive Checklist should normally lead to a full NHS Continuing Healthcare assessment. This is usually carried out by a multidisciplinary team using the Decision Support Tool (DST), which looks in more detail at the person’s needs across the CHC care domains.
A positive Checklist is only the start of the assessment process. The full DST should consider the nature, intensity, complexity and unpredictability of the person’s needs before a decision about CHC eligibility is made.
Common CHC Checklist Problems to Watch For
The Checklist should reflect the person’s actual needs, not simply how well those needs appear to be managed. When completing or reviewing a Checklist, make sure the evidence describes what support, supervision or intervention is required and what could happen without it.
Look out for needs being understated because they are “managed”, scores being based on a good day rather than the overall picture, relevant evidence being overlooked, or family members and carers not being given a proper opportunity to explain the person’s needs.
If the Checklist is completed without you being present, ask for a copy. Check that the needs and scores recorded accurately reflect the evidence and, if you disagree with the outcome, ask for the reasons in writing.
Need Help Understanding a CHC Checklist?
If you are unsure whether a Checklist accurately reflects your relative’s needs, or you would like help understanding what should happen next, CHC Advocates Ltd offers a free initial discussion. I will give you a straightforward view of the situation and explain your options before you decide whether you need any further help.
The CHC Assessment & Decision Support Tool (DST) Explained
If the CHC Checklist threshold is met, the person should normally be referred for a full assessment for NHS Continuing Healthcare. This assessment usually involves a multidisciplinary team (MDT) using the Decision Support Tool (DST) to bring together evidence about the person’s needs and make a recommendation about CHC eligibility.
What is the Decision Support Tool (DST)?
The DST is the national tool used to support decision-making about eligibility for NHS Continuing Healthcare. It considers the person’s needs across 12 care domains and brings together the available evidence to help the multidisciplinary team consider whether the person has a primary health need.
View the Official NHS CHC Decision Support Tool
You can view the complete NHS Continuing Healthcare Decision Support Tool (DST), including the care domains and levels of need used during a full CHC assessment, on the official GOV.UK website.
How is the DST scored?
Each of the 12 care domains contains descriptions of different levels of need. Depending on the domain, these range from No Needs or Low through to Moderate, High, Severe or Priority. Not every level is available in every domain.
The domain scores are important, but CHC eligibility is not decided simply by adding them up. The multidisciplinary team must consider the totality of the person’s needs and whether, taken together, they demonstrate a primary health need.
The Four Key Characteristics
When considering whether someone has a primary health need, the multidisciplinary team should look at the nature, intensity, complexity and unpredictability of their needs. These characteristics help describe how the person’s needs interact, how difficult they are to manage and what level of skill, monitoring or intervention is required.
Nature
Nature describes the particular characteristics of the person’s needs and the type of interventions required to manage them. It considers what those needs are, how they affect the person overall and the quality and type of care needed to meet them.
Intensity
Intensity describes the quantity, severity and continuity of the person’s needs and the support required to manage them. It considers how often care or intervention is needed, how much care is required at a time and whether needs are sustained throughout the day or night.
Complexity
Complexity describes how the person’s needs interact with each other and how this affects the care required to manage them. It considers whether different needs combine in a way that makes care more difficult to plan, deliver or monitor, and the level of skill needed to manage them effectively.
Unpredicability
Unpredictability describes how much the person’s needs fluctuate, whether changes can be anticipated and the risks if appropriate care is not provided at the right time. It considers the degree of monitoring required and whether skilled intervention may be needed quickly when needs change.
How is CHC eligibility decided?
There is no simple points system for deciding CHC eligibility. The multidisciplinary team should consider the evidence across all of the care domains, how the needs interact, and the four key characteristics before making a recommendation about whether the person has a primary health need.
The DST includes guidance about combinations of domain levels that may indicate a primary health need, but these are not a substitute for professional judgement. The final recommendation should be based on the overall picture of the person’s needs and supported by clear evidence and reasons.
Common DST Problems to Watch For
The DST should be based on clear, relevant evidence and an accurate picture of the person’s needs. Make sure important records are considered, family and carers are given a proper opportunity to contribute, and disagreements about the domain levels or evidence are recorded.
Look out for needs being understated because they are well managed, important incidents being treated in isolation, or the assessment focusing only on what happens routinely without considering the skill, monitoring and intervention required to prevent deterioration or manage risks.
Before the DST is finalised, check that the written descriptions accurately reflect the person’s needs and that any disagreement you have with the MDT’s assessment is clearly recorded. You should normally be provided with a copy of the completed DST and the written decision.
Need Help With a CHC Assessment or DST?
If you are preparing for a CHC assessment, have received a completed DST, or are concerned that the assessment does not accurately reflect your relative’s needs, CHC Advocates Ltd offers a free initial discussion. I will give you a straightforward view of the situation and explain your options before you decide whether you need any further help.
Who can use the Fast Track pathway?
The recommendation must be completed by an appropriate clinician who has knowledge of the person’s diagnosis, treatment and needs. The decision is based on whether the person has a rapidly deteriorating condition and may be entering a terminal phase — it is not restricted to a particular diagnosis or a fixed life expectancy.
What happens when a Fast Track recommendation is made?
Once an appropriate clinician has completed the Fast Track Pathway Tool and recommended immediate NHS Continuing Healthcare, the ICB should normally accept and action the recommendation without delay. The purpose of Fast Track is to put an appropriate package of care and support in place as quickly as possible.
There is no fixed life-expectancy rule
Fast Track eligibility should not be based on a fixed prognosis such as “six weeks”, “twelve weeks” or any other set period. The guidance makes clear that “rapidly deteriorating” should not be interpreted narrowly and that a person does not need to be in the final days of life
How quickly should Fast Track funding be arranged?
Fast Track is intended to provide urgent access to NHS Continuing Healthcare with minimum delay. NHS guidance says the ICB should arrange the care package promptly and the public information guidance states that this should normally be within 48 hours of receiving the completed Fast Track Pathway Tool.
Can Fast Track funding be reviewed?
Yes. Fast Track funding can be reviewed, but it should not be withdrawn simply because a person has survived longer than expected or because their condition appears temporarily more stable. Any review should consider the person’s current needs and whether they remain eligible for NHS Continuing Healthcare.
View the Official NHS CHC Fast Track Pathway Tool
You can view the complete NHS Continuing Healthcare Fast Track Pathway Tool and guidance on the official GOV.UK website, including the criteria clinicians should consider when making a Fast Track recommendation.
Fast Track NHS Continuing Healthcare Funding Explained
The Fast Track pathway is used when a person has a rapidly deteriorating condition and may be entering a terminal phase. It allows an appropriate clinician to recommend that NHS Continuing Healthcare funding is put in place quickly, without completing the usual Checklist or Decision Support Tool (DST) process.
Common Fast Track Problems to Watch For
Fast Track should not be refused because someone does not have a particular diagnosis, is not thought to be in the final days or weeks of life, or because their care needs are currently being well managed. The key question is whether they have a rapidly deteriorating condition and may be entering a terminal phase.
If an appropriate clinician considers the Fast Track criteria are met, the recommendation should be acted on promptly. Families should ask for a copy of the completed Fast Track Pathway Tool and, if there is delay or disagreement, ask the ICB to explain the position in writing.
Need Help With Fast Track CHC Funding?
If you are unsure whether Fast Track should have been considered, are dealing with delay after a Fast Track recommendation, or have concerns about a refusal or review, CHC Advocates Ltd offers a free initial discussion. I will give you a straightforward view of the situation and explain your options before you decide whether you need any further help.