CHC decision support tool explained


The NHS continuing healthcare (CHC) decision support tool helps to decide if someone is entitled to ongoing publicly funded healthcare. It’s used by a multidisciplinary team made up of social workers, psychiatrists and other specialised healthcare professionals. It's similar to the CHC checklist, which covers many of the same areas and is used by GPs and social workers.

What is it?

The CHC decision support tool is a framework used by the multidisciplinary teams (MDTs) that assess whether someone is eligible for NHS continuing healthcare. The team sends their findings to the appropriate CCG.

How does it work?

The patient is assessed against various criteria, being graded either: no needs, low, moderate, high, severe or priority for each, based on the intensity, frequency and unpredictability of each of the criteria, or ‘care domains’.

What are the criteria?

There are 12 ‘care domains’ that currently make up the assessment. Some have ‘priority’ as the highest category of need, and some (such as ‘Continence’) only go up to ‘severe’ or ‘high’.

  • Breathing
  • Nutrition - Food and Drink
  • Continence
  • Skin (including tissue viability)
  • Mobility
  • Communication
  • Psychological and Emotional Needs
  • Cognition
  • Behaviour
  • Drug Therapies and Medication
  • Altered States of Consciousness
  • Other significant care needs

    What determines eligibility for continuing healthcare?

    If a patient scores ‘priority’ for any of the care domains with that classification, the MDT will recommend them for continuing healthcare. Examples for ‘priority’ ratings include being ‘unable to breathe independently, requires invasive mechanical intervention’ in ‘Breathing’, or ‘unremitting and overwhelming pain despite all efforts to control pain effectively’ in ‘Drug therapies and Medication’.

    Alternatively, if someone scores ‘severe’ in two or more care domains, they should be eligible for continuing healthcare. In cases where someone scores one ‘severe’ rating with other needs or ‘a number of domains with high and/or moderate needs’, the team will further consider the ‘nature, intensity, complexity or unpredictability of the individual’s needs’, to determine whether the existing needs combine to create a ‘primary health need’.

    It’s worth noting that the guidelines for the tool say that it’s not possible to calculate across domains – so two ‘high’ ratings can’t be given the same weight as one ‘severe’, for example.

    What does it look like?

    Each domain has its own section, and looks like the picture below. You can download the full form here.

    CHC decision support tool criteria

    What happens once the tool has been completed?

    Once the recommendations have been agreed by the MDT, the completed CHC decision support tool and the MDT’s summary will be sent to the relevant commissioning body to action. If it’s decided that the individual isn’t eligible for NHS continuing healthcare, alternative options will be discussed with them, which include partially funded nursing care.

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