What Is the NHS Continuing Healthcare Checklist and How Does It Work?

The NHS Continuing Healthcare Checklist (formally known as Tool 11) is the first stage of the NHS Continuing Healthcare assessment process. It is a screening tool, not the full assessment, but it is one of the most important steps a family will face.

What is the Checklist for?

The Checklist is used to decide whether a person should proceed to the full Decision Support Tool (DST) assessment. A healthcare or social care professional completes it, usually a nurse, social worker, or occupational therapist.

If the person scores above a set threshold, they are referred for a full NHS Continuing Healthcare assessment. If they do not, NHS Continuing Healthcare is declined at this stage, without any further review of their needs.

What does it assess?

The Checklist looks at 11 areas of need:

• Breathing

• Nutrition (food, drink, and swallowing)

• Continence

• Skin integrity (including wounds and pressure areas)

• Mobility

• Communication

• Psychological and emotional needs

• Cognition

• Behaviour

• Drug therapies and medication

• Altered states of consciousness

Each area is rated as either None, Low, Moderate, High, or Priority. The overall pattern of scores determines whether the person progresses to the full assessment.

When should the Checklist be done?

The Checklist should be completed within 28 days of a referral. It can be triggered by a healthcare professional, a GP, a social worker, or by the family requesting it directly.

Families can (and should) request an NHS Continuing Healthcare Checklist if they believe their loved one's needs may meet the threshold. A referral can be made directly to the Integrated Care Board (ICB) responsible for the area.

What happens at the Checklist meeting?

The Checklist is usually completed during a meeting or visit with the person being assessed. A family member or representative has the right to be present and to contribute information about the person's care needs.

This is important. Professionals completing the Checklist often do not have a full picture of the day-to-day reality of a person's needs. A family member (or a nurse advocate) can ensure that the full picture is presented, not just what is recorded in clinical notes.

Can the Checklist be challenged?

Yes. A Checklist decision to screen someone out can be challenged. If the scoring does not reflect the person's actual needs, or if needs have been underestimated, there are grounds for review.

Many families are incorrectly screened out at the Checklist stage. This is one of the most common points at which an experienced nurse advocate makes a critical difference to the outcome.