How Do I Prepare for an NHS CHC Assessment and What Evidence Should I Keep?
The best evidence for NHS Continuing Healthcare is not the thickest file.
The best evidence for NHS Continuing Healthcare is not the thickest file.
It is evidence that shows what care the person actually needs: what happens, how often it happens, what intervention is required, what skill or supervision is involved and what the consequences would be without that care.
A diagnosis list is useful background. The day-to-day evidence explains the need.
Start with records already being created
Ask what records exist because care is already happening.
These may include care plans, daily notes, medication administration records, falls records, behaviour charts, repositioning charts, wound or skin records, nutrition and fluid charts, seizure records, hospital letters, therapy assessments and specialist nursing information.
You do not need every page ever written. Focus on records that show the current pattern and significant incidents.
Show frequency, not just existence
“Dad falls” is less useful than a record showing four falls in six weeks, two requiring assistance from the floor and one resulting in hospital assessment.
“Night needs” becomes clearer when records show repeated waking, toileting, wandering, distress or repositioning.
Frequency helps assessors understand intensity and the actual workload required.
Show what carers do to prevent the bad outcome
Some of the strongest evidence is hidden because care works.
If skin remains intact because somebody repositions the person through the night, record the repositioning. If weight is stable because every meal is prompted and supervised, show that support.
The DST guidance recognises that well-managed needs remain needs. Do not wait for care to fail before describing what prevents failure.
Capture interaction between needs
CHC is not twelve separate people living in one body.
Cognition may prevent safe mobility. Behaviour may make medication difficult. Swallowing problems may interact with nutrition and respiratory risk. Pain may increase distress that the person cannot communicate.
Evidence that connects these needs can help demonstrate complexity.
Include the difficult day without pretending every day is the worst day
Fluctuating conditions need an honest range.
Describe good days, typical days and significant deteriorations. If something happens twice a week, say twice a week rather than “constantly”.
Credibility matters. Precise evidence is more useful than dramatic language.
Prepare a short family summary
A concise chronology can help professionals see the pattern.
Include major diagnoses, recent admissions, significant changes, current care setting, nighttime needs, major risks and the interventions the family believes are most important.
Use it as a map to the underlying records, not as a replacement for clinical evidence.
What should I take to the DST meeting?
Take the current care plan, your short summary and the key evidence you want the team to consider.
Mark specific records rather than arriving with an unindexed box.
For each disputed domain, be ready to explain the need, frequency, intervention, risk and why you think the proposed level does not reflect the evidence.
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.