Before anyone gets a full NHS Continuing Healthcare (CHC) assessment, they are supposed to pass through a much smaller, much less talked-about hurdle first: the CHC Checklist. It is a five-minute screening form, not a funding decision, and most families never see one because nobody in the discharge process told them it existed. That gap matters. A Checklist that should have been completed and never was is one of the most common, and most overlooked, grounds for reclaiming care fees that were wrongly paid out of someone’s own pocket.
What the NHS Continuing Healthcare Checklist actually is
The Checklist is the first stage of a two-stage process for deciding whether someone’s ongoing care needs are "primarily health-related" enough to be funded in full by the NHS, rather than means-tested and part-paid by the individual through the local council. It is meant to be completed by a trained health or social care professional who knows the person — a discharge coordinator, district nurse, social worker, GP, or care home manager are all common examples. Family members cannot complete it themselves, but they can and should ask, in writing, for one to be done.
Ideally the Checklist is completed once someone’s needs have settled after a hospital stay, not while they are still acutely unwell. It scores the person across 11 care domains — things like mobility, nutrition, continence, skin condition, and cognition — with each domain marked A (high need), B (moderate need) or C (low or no need). The threshold for moving on to a full assessment is deliberately set low, on the principle that it is better to over-refer than to filter someone out too early.
The scoring that decides whether you get a full assessment
A Checklist result is described as "positive" or "negative." A positive result means the case goes forward to a full multidisciplinary assessment using the Decision Support Tool — it does not mean CHC funding is guaranteed, only that the question is now properly open. A negative result means it stops there, at a five-minute form, unless someone challenges it.
| Checklist outcome | What triggers it |
|---|---|
| Two or more "A" scores | Any two domains marked as high-level need |
| One "A" in a priority domain | A high score in Behaviour, Breathing, Drug Therapies & Medication, or Altered States of Consciousness — the four domains treated as especially significant |
| Five or more "B" scores | Five or more domains marked as moderate need, even with no "A" scores at all |
| One "A" plus four or more "B" scores | A combined pattern of one high and several moderate domains |
Any one of those four patterns is enough on its own to trigger a full assessment. In practice this means the bar to get past the Checklist stage is not especially high — which is exactly why a Checklist that was never done at all is such a striking gap in someone’s care record.
Why a missing Checklist is grounds for a retrospective claim
A retrospective CHC claim is different from an appeal. An appeal challenges a recent decision that has already been made. A retrospective claim goes back and asks a different question: should an assessment have happened at all, and was it ever offered? Retrospective claims generally cover care provided from April 2012 onwards, and there is no fixed deadline for making one — although records, and the staff who could confirm what happened, become harder to track down the longer a family waits.
If someone was discharged from hospital straight into a care home and no Checklist was ever completed, that omission is itself something an Integrated Care Board (ICB) is expected to consider. The ICB must respond in writing to a request for a retrospective review. It will then look back through the clinical record from that period — GP notes, hospital discharge summaries, nursing and care home records — to work out whether the person’s needs at the time would, in fact, have met the CHC threshold. If the review concludes that CHC should have been in place, the ICB is required to repay the care fees paid during that period, with interest.
This is worth saying plainly: a missing Checklist is not proof that funding was owed. It is proof that the question was never properly asked. The two are different, but the second is still a legitimate reason to ask an ICB to look again, and families are often surprised to learn how routinely this particular gap turns up once records are actually pulled.
What to check before you assume nothing can be done
A few practical questions are worth asking early, before engaging in a longer review process:
- Was a Checklist completed at all? Hospital discharge records, GP correspondence, or the care home’s own admission paperwork should reference one if it happened.
- Who was told what, and when? Families are entitled to request copies of any Checklist or Decision Support Tool that was carried out, and to see the reasoning behind a negative score.
- Has the person’s condition changed since admission? A negative Checklist from years ago does not settle the question forever — deteriorating needs can justify a fresh one being requested at any point.
- Is the request going to the right ICB? Responsibility sits with the ICB that covered the person’s GP registration at the relevant time, which is not always the ICB covering where the care home itself is located.
The bottom line
The NHS Continuing Healthcare Checklist is a small, procedural step, and that is exactly why it gets missed. It carries real consequences: a person who should have been referred for a full assessment, and wasn’t, can end up self-funding care that should have been provided free by the NHS. Before accepting that a loved one’s care fees were correctly charged, it is worth establishing one simple fact first — whether that initial screening ever actually took place.