How Does an NHS Continuing Healthcare Assessment Work?
The ordinary NHS Continuing Healthcare process has two distinct stages.
The ordinary NHS Continuing Healthcare process has two distinct stages.
First, a Checklist screens for people who may need a full assessment. If that is positive, a multidisciplinary team carries out the full assessment and uses the Decision Support Tool, usually called the DST, to make a recommendation about eligibility.
A positive Checklist is a doorway to assessment, not an award of funding.
Stage one: the Checklist
The Checklist looks across care domains and records needs at A, B or C levels.
Its threshold is intentionally low. Government guidance says this is to ensure people who may require a full assessment get the opportunity to have one.
A full assessment is triggered by specified combinations, including two or more A selections; five or more B selections; one A plus four Bs; or an A in certain priority-capable domains, as well as direct referral in appropriate circumstances.
Stage two: multidisciplinary assessment
After a positive Checklist, the ICB coordinates a full assessment.
The multidisciplinary team should include at least two professionals from different healthcare professions, or at least one healthcare professional and one social-care professional who are knowledgeable about the person’s needs.
The person and their representative should be enabled to participate and contribute their views.
What does the DST examine?
The DST considers 12 care domains:
behaviour; cognition; psychological and emotional needs; communication; mobility; nutrition; continence; skin; breathing; drug therapies and medication; altered states of consciousness; and other significant care needs.
Each domain has defined levels. Some can reach priority, some severe, some high, and others have lower maximum levels.
The tool structures professional judgement; it is not simply an arithmetic points test.
How does the DST lead to a recommendation?
A priority level in one domain, or severe levels in two or more domains, would normally indicate a primary health need.
Other combinations can also demonstrate eligibility. The multidisciplinary team must consider the totality of needs through nature, intensity, complexity and unpredictability.
That is why counting domain labels alone can be misleading.
How long should it take?
The National Framework says the overall process from the ICB being notified that a full assessment is required to the eligibility decision should, in most cases, not exceed 28 calendar days.
There can be valid reasons for delay, but families should ask what stage has been reached and what is outstanding if the process extends significantly beyond that expectation.
What happens after the MDT recommendation?
The multidisciplinary team makes a recommendation to the ICB.
The Framework says the ICB should accept the recommendation except in exceptional circumstances and should not refer a case back simply because it disagrees with the professional judgement.
The person should receive a written decision with reasons and information about review rights if they are not eligible.
Last reviewed
5 September 2026
Important informationThis guide provides general information about NHS Continuing Healthcare in England and is not intended to provide legal, financial, medical or other professional advice. Rules and processes differ elsewhere in the UK and individual circumstances can be different. You may wish to check current official information and seek advice from an appropriately qualified professional before making important decisions.