Common scoring errors with Continuing Healthcare Checklists
The Continuing Healthcare Checklist is the screening tool used by the NHS to decide whether a person should progress to a full assessment for NHS Continuing Healthcare (CHC).
If the information in the checklist doesn’t accurately reflect the day-to-day needs, and/or the “scores” are applied incorrectly, the person might not progress to the next stage of the NHS CHC funding process. Errors on the checklist can also shape later decision-making, because this document becomes part of the person’s record, so accuracy is crucial.
In this guide, we explain in more detail what the NHS CHC Checklist is and how the care domains are scored, plus common scoring errors. We also set out what you can check in the paperwork, what to do if you believe the outcome is wrong and how to reduce the risk of problems arising when completing the checklist.
In this article:
- What is a Continuing Healthcare Checklist?
- Who Completes the NHS Continuing Healthcare Checklist?
- How the Continuing Healthcare Checklist is Scored
- CHC Checklist Scoring Errors
- Example of a completed CHC Checklist
- What Happens if the Checklist is Scored Incorrectly?
- How to Ensure the Checklist is Completed Properly
- Why Early Errors Can Affect the Entire CHC Process
- CHC Checklist Advice
- FAQs
What Is a Continuing Healthcare Checklist?
The Continuing Healthcare checklist is a screening tool used at the beginning of the NHS CHC assessment process to determine whether an individual requires a full assessment using the Decision Support Tool (DST).
The Checklist sits within the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care and is the first step in the assessment process. CHC Checklists are a screening tool, not a final decision on eligibility.
For a more in-depth overview, read our article about CHC checklists.
Who Completes the NHS Continuing Healthcare Checklist?
The Continuing Healthcare Checklist should be completed by a health or social care professional who is trained in the CHC process, is familiar with the person’s care needs and has enough evidence to score each domain properly.
The Checklist is based on how needs present day to day, not on assumptions or a snapshot, so you, and your relative where possible, should be fully informed and involved in the process. Read our guidance on completing a CHC checklist.
Checklists are often completed shortly after a change in circumstances – following hospital discharge or moving into a care home. This can mean that records don’t reflect reality, or that available evidence is limited. If you want help before the checklist is completed, we can support you.
How the Continuing Healthcare Checklist Is Scored
The CHC checklist considers needs across eleven care domains and uses a simple scoring approach – A, B, or C, with A indicating the highest degree of need and C the lowest.
To meet the criteria for a full assessment, an individual needs to “score” one of the following combinations:
- Two or more As
- Five or more Bs
- One A and four Bs
- One A in an asterisked domain (behaviour, breathing, medications or altered states of consciousness)
CHC Checklist Scoring Errors
Below, we’ve highlighted some common issues we see with CHC checklist scoring:
1. Scoring based on out-of-date care records
It is important that the checklist is completed using up to date care records, otherwise scores may not reflect reality. The CHC checklist is a screening tool and intentionally has a lower threshold to ensure everyone who might be eligible receives a full assessment. If scoring is completed using older care records, this could result in an inaccurate outcome.
2. Scoring on a ‘good day’ scenario
Checklists are sometimes completed when the person is at their best, meaning the scores fail to reflect an accurate picture of their needs over a 24-hour period. This is especially problematic in conditions such as dementia or Parkinson’s disease, where care needs often fluctuate significantly throughout the day and night. The Checklist is meant to capture maximum need, not just a snapshot in time.
3. Dismissing needs as “routine” due to a particular diagnosis
Scores might be minimised if the needs are considered “typical” for someone’s condition. For example, psychological and behavioural needs, such as distress or non-compliance, in those suffering from dementia. CHC is about care needs, not the reason care is required. The checklist should consider each individual need in turn, regardless of whether it is expected due to a diagnosis.
4. Downplaying cognitive impairment in dementia or brain injury cases
Professionals sometimes record ‘confusion’ or ‘needs prompting’ in the Cognition domain on the checklist but fail to consider other factors such as risk awareness, insight, communication and compliance. These details often impact a person’s needs across multiple domains and affect the holistic picture.
5. Minimising occasional Behavioural needs
Behaviour may be incorrectly scored lower because incidents are described as “occasional”. This can fail to reflect the severity of challenging behaviour and the risk this poses to self and others. The behaviour domain looks at both frequency AND severity: even infrequent incidents can justify a higher score, if the risk is significant and/or skilled intervention is required.
6. Downgrading Cognition because an individual can converse
A person may appear socially engaged during an assessment but still have severe cognitive impairment affecting decision-making, safety awareness, memory, orientation or ability to meet basic needs. Brief observations, and a failure to dig deeper, can lead assessors to underestimate confusion, executive dysfunction or fluctuating presentation.
7. Downgrading Communication because an individual can verbalise
Many people with dementia or other conditions affecting their cognition retain an apparent ability to communicate, sometimes quite convincingly. However, when scoring the Communication domain, what matters is the reliability of their communication. Are they really making and expressing reliable choices, or are they just saying yes or no out of habit or politeness? As with Cognition, it’s vital to ask the right questions before applying a score.
8. Under-assessment in Skin due to wounds being “stable”
Scores in the Skin domain are sometimes downgraded because wounds are not getting worse. However, this can overlook the risks arising from skin damage, as well as the intensity and/or complexity of the treatment regime. Effective care does not mean the underlying need is low: well-managed needs are still needs.
Example of a completed CHC Checklist
If you’re unsure what to look for in the paperwork, a helpful starting point is to check:
- The domain scores, and whether they match the reality of day-to-day needs
- The evidence cited, and whether it is accurate, specific, dated and consistent with care notes
- The rationale, and whether it reflects long term care needs, rather than a snap-shot observation
- Any missing detail, including fluctuations, nighttime needs, falls risk, behaviour patterns, nutrition risks and skin integrity
What Happens If the Checklist Is Scored Incorrectly?
If the checklist outcome does not reflect your relative’s needs, the scoring is inaccurate or the evidence has been misunderstood, you can challenge it.
Practical next steps usually include:
- Requesting a copy of the completed Checklist and the rationale for the decision
- Asking what records were relied on, including care notes, risk assessments and professional input
- Submitting a short, written response identifying the errors and pointing to supporting evidence
- Requesting reconsideration, or a repeat Checklist where appropriate
- Making a formal complaint
How to Ensure the Checklist Is Completed Properly
You can reduce scoring errors by preparing evidence carefully, in a way that is easy to use during completion.
Examples include:
- Providing written examples of day-to-day needs, including nights, rather than just broad descriptions
- Asking the care provider for up-to-date care plans, daily records, incident reports and risk assessments
- Checking that records accurately reflect what’s happening, including supervision, distress, refusals and escalation
- Attending the Checklist, so misunderstandings can be corrected immediately
If you want structured support with completing the checklist stage, read our guidance on completing a CHC Checklist.
Why Early Errors Can Affect the Entire CHC Process
The CHC Checklist is the gateway to a full NHS assessment. If scored incorrectly, someone who is eligible for NHS continuing healthcare and NHS funded nursing care may never reach the stage where the NHS properly considers the full evidence.
That can leave families funding care that should have been covered by the NHS, or stuck in delays while needs continue to increase.
CHC Checklist Advice
Farley Dwek can support you through the whole CHC process, as well as providing initial advice on whether your circumstances suggest progression through the continuing healthcare assessment checklist process.
To speak with our expert team, contact us online or call 0161 272 5222.
FAQs
Can I See a Relative’s CHC Checklist?
Yes. You should be given a copy of the completed checklist, and the professionals completing it should record their reasons in writing. If you have not been given it, you can request it from the relevant NHS team or Integrated Care Board.
Does a diagnosis of dementia automatically mean a positive Checklist?
No – a diagnosis alone does not decide the outcome. The checklist looks at needs in the round, and the impact dementia has on the person’s overall care requirements.
What score is needed to pass the CHC Checklist?
A full assessment should be arranged if the Checklist records two or more As, five or more Bs, one A and four Bs, or one A in an asterisked domain such as behaviour, breathing, symptom control or altered states of consciousness.
Where can the CHC checklist be completed?
It can be completed in the community, including in your relative’s own home, a family member’s home, or a care home. It is generally not completed in hospital, except in limited circumstances, because the checklist should reflect longer-term needs rather than a short inpatient snapshot.
