Guidance

NHS continuing healthcare checklist - guidance

Updated 20 October 2026

What the checklist is and why it is used

The NHS continuing healthcare checklist is a screening tool that can be used in a variety of settings. It helps practitioners identify individuals who may need a referral for a full assessment of eligibility for NHS continuing healthcare.

This revised tool accompanies the:

• national framework for NHS continuing healthcare and NHS-funded nursing care (the ‘national framework’) 
• NHS continuing healthcare decision support tool (DST)

The checklist threshold has intentionally been set low. This is to ensure that all those who require a full assessment of eligibility for NHS continuing healthcare have this opportunity.

One of 2 potential outcomes is possible following completion of the checklist:

• a negative checklist - meaning the individual does not require a full assessment of eligibility and they are not eligible for NHS continuing healthcare
• a positive checklist - meaning an individual now requires a full assessment of eligibility for NHS continuing healthcare. It does not necessarily mean the individual is eligible for NHS continuing healthcare

Practitioners should explain that a positive checklist does not automatically lead to eligibility for NHS continuing healthcare. The checklist only indicates that the individual requires a full assessment for NHS continuing healthcare.

Note: the checklist follows a standard format and should be used nationally. The content should not be changed, added to or abbreviated in any way. However, integrated care boards (ICBs) may attach their logo and additional patient identification details if necessary, for example, adding their NHS number.

When the checklist should be completed

Where there may be need for NHS continuing healthcare, the checklist should normally be completed.

There will be many situations where it is not necessary to complete the checklist - refer to ‘When not to use the checklist’ below.

Screening and assessment of eligibility for NHS continuing healthcare should be:

• at the right time and location for the individual
• when the individual’s ongoing needs are clearly understood

This may be in a variety of settings, although the full assessment of eligibility should normally take place when the individual is in a community setting, preferably their own home. Refer to paragraphs 101 to 108 of the national framework for more information.

The core underlying principle is that individuals should be supported to access and follow the process that is most suitable for their current and ongoing needs. This will help practitioners to correctly identify individuals who require a full assessment of eligibility for NHS continuing healthcare.

To understand how NHS continuing healthcare interacts with hospital discharge, refer to paragraphs 101 to 108 of the national framework.

When not to use the checklist

There will be many situations where it is not necessary to complete the checklist - refer to paragraph 121 of the national framework.

Practitioners should review the statements below before they start the process of completing the checklist to decide if it may not be appropriate to screen for NHS continuing healthcare.

The situations where it is not necessary to complete the checklist include when:

• it is clear to practitioners working in the health and care system that there is no need for NHS continuing healthcare at this point in time. Where appropriate or relevant, this decision and its reasons should be recorded. If there is doubt between practitioners, the checklist should be carried out

• the individual has short-term healthcare needs or is recovering from a temporary condition and has not yet reached their optimum potential (although, if there is doubt between practitioners about the short-term nature of the needs, it may be necessary to complete the checklist). Refer to paragraphs 101 to 108 of the national framework for how NHS continuing healthcare may interact with hospital discharge

• it has been agreed by the ICB that the individual should be referred directly for full assessment of eligibility for NHS continuing healthcare
• the individual has a rapidly deteriorating condition and may be entering a terminal phase - in these situations the fast track pathway tool should be used instead of the checklist
• an individual is receiving services under section 117 of the Mental Health Act 1983 that are meeting all of their assessed needs
• it has previously been decided that the individual is not eligible for NHS continuing healthcare and it is clear that there has been no change in needs

If, after reviewing these statements, it is deemed that it is not necessary to screen for NHS continuing healthcare at this time, the decision not to complete the checklist and its reasons should be clearly recorded in the patient’s notes.

Who can complete the checklist

The checklist can be completed by a variety of health and social care practitioners as long as they have been trained in its use. For examples of practitioners refer to paragraph 122 of the national framework and practice guidance note 13.

The role of the individual in the screening process

Practitioners should give the individual (or their representative) reasonable notice of the intention to carry out the checklist and explain the process to them.

Individuals (together with any representative they may have) should normally be given the opportunity to participate actively in the completion of the checklist so that they can contribute their views about their needs.

Taking a person-centred approach

There are several principles that underpin the NHS continuing healthcare process. The most important principle is that assessments and reviews should always focus on the individual’s needs and follow a person-centred approach.

The individual (or their representative) should be fully informed and empowered to participate actively in the assessment process and any subsequent reviews, and their views should be considered.

In addition, there are several legal requirements when it comes to an individual’s consent for parts of the NHS continuing healthcare process. Refer to ‘Consent, capacity to make a decision and information sharing’ for more information.

In the spirit of the person-centred approach, practitioners should make all reasonable efforts to seek the participation of the individual (or their representative) for the assessment and review process for NHS continuing healthcare during each stage of the process.

For a comprehensive assessment, practitioners should consider the best evidence available at the relevant time. This should involve consideration of the individual’s (or their representative’s) view, and they should be empowered and helped to participate.

Throughout the process, this person-centred approach should be embedded in all decisions that relate to the individual’s needs assessment and their care planning.

Consent, capacity to make a decision and information sharing

Consent is a legal requirement for any physical intervention on or examination of a person with capacity to give consent. To the extent that screening for NHS continuing healthcare involves such an intervention or examination, informed consent must be sought from an individual with relevant capacity.

Refer to paragraph 85 of the national framework, which gives detailed guidance on what is required for consent to be valid.

It is necessary to obtain an individual’s explicit consent before sharing any personal data with a third party such as a family member, friend, advocate and/or other representative. Refer to the consent form for sharing information.

Consent is not required from individuals for actions necessary to meet legal requirements relating to the NHS continuing healthcare process. These actions include:

• the carrying out of the checklist or assessment process by health and social care professionals
• the sharing of relevant information between health and social care professionals and the care providers involved where this is necessary for the purpose of direct patient care

If there is a concern that the individual may not have capacity to give consent to a physical intervention or examination that is part of the assessment process, or to the sharing of personal data with third parties such as a family member, friend, advocate and/or other representative, this should be determined in accordance with the Mental Capacity Act 2005 and the associated code of practice.

It may be necessary to make a ‘best interests’ decision, bearing in mind the expectation that everyone who is potentially eligible for NHS continuing healthcare should have the opportunity to be considered for eligibility. Refer to paragraphs 86 to 96 of the national framework for guidance on the application of the Mental Capacity Act 2005 in such situations.

The fact that an individual may have significant difficulties in expressing their views does not necessarily mean that they lack capacity to make a decision. Appropriate support and adjustments should be made available in line with the Mental Capacity Act 2005 and with the Equality Act 2010.

The organisation proposing to share the individual’s health and/or care information with friends, family members and representatives must ensure personal data is processed in line with data protection laws and relevant regulations.

The duty to share information (for the purposes of providing an individual with health or adult social care) as set out in section 251B of the Health and Social Care Act 2012 applies equally to assessments for NHS continuing healthcare as it does to other health and/or care and support assessments.

How to complete the checklist

The checklist is intended to be relatively quick and straightforward to complete. It is not necessary to provide additional detailed evidence along with the completed checklist.

Practitioners should compare the domain descriptors (breathing, nutrition - food and drink, continence, skin and tissue viability, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies, altered states of consciousness) to the needs of the individual. They should then select level C, B or A, as appropriate, where C is a low level of care need and A represents a high level of care need (following the national framework, paragraph 113), choosing whichever most closely matches the individual.

If the needs of the individual are the same or greater than anything in the A column, then ‘A’ should be selected.

Practitioners should briefly summarise the individual’s needs that support the level chosen, recording references to evidence as appropriate.

A full assessment for NHS continuing healthcare is required if one of the following criteria is met:

• 2 or more domains which receive a score of A
• 5 or more domains receive a score of B, or one receives a score of A and 4 receive a score of B
• 1 priority domain (those marked with an asterisk) receives a score of A

There may be rare circumstances where a full assessment of eligibility for NHS continuing healthcare is appropriate even though the individual does not apparently meet the indicated threshold as set out above. Practitioners must give a clear rationale and follow local protocols in such circumstances.

The principles in relation to ‘well-managed need’ (that the decision-making rationale should not marginalise a need just because it is successfully managed - outlined in the ‘assessment of eligibility’ section in paragraphs 162 to 166 of the national framework) apply equally to the completion of the checklist as they do to the DST.

What happens next

Whether or not a referral for a full assessment of eligibility for NHS continuing healthcare is considered necessary, the outcome must be communicated clearly and in writing to the individual or their representative as soon as is reasonably practicable.

This should include the reasons why practitioners reached the checklist outcome. Normally this will be achieved by providing a copy of the checklist to the individual or their representative.

What happens following a negative checklist

A negative checklist means the individual does not require a full assessment of eligibility and they are not eligible for NHS continuing healthcare.

Where it can reasonably be anticipated that the individual’s needs are likely to increase in the next 3 months (for instance, because of an expected deterioration in their condition), this should be recorded and a decision made as to whether the checklist should be reviewed within a specified period of time.

If an individual has been screened out following completion of the checklist, they may ask the ICB to reconsider the checklist outcome.

The ICB should give this request due consideration, taking account all of the information available and/or including additional information from the individual, their representative or carer. However, there is no obligation for the ICB to undertake a further checklist.

What happens following a positive checklist

A positive checklist means that the individual requires a full assessment of eligibility for NHS continuing healthcare. It does not necessarily mean that the individual will be found eligible for NHS continuing healthcare (refer to paragraphs 134 to 137 of the national framework).

An individual should not be left without appropriate support while they wait for the outcome of the assessment and decision-making process.