Continuing Healthcare (CHC) Assessors, Explained in Plain English

By Len Burgess, Senior Care Advisor · Published 29 July 2026

If your relative is being considered for NHS Continuing Healthcare (CHC), you will encounter a group of professionals whose job is to decide whether the NHS will pay for the full cost of their care. The decision one of these teams makes can be worth tens or even hundreds of thousands of pounds over the course of a person's care. Understanding who they are, what they are trained to look for, and how to work with them productively is one of the most valuable things any family can do.

The latest post in our Jargon Buster series covers the people who decide whether the NHS will fully fund your relative's care. Continuing Healthcare assessors: who they are, what they are looking for, what commonly goes wrong at the assessment, and how families can genuinely influence the outcome in 2026.

For families, the CHC assessment process is genuinely intimidating. It involves formal meetings, unfamiliar language, professionals writing scores in real time, and outcomes that shape everything that follows. Yet the vast majority of families arrive at CHC assessments with almost no preparation, no clear idea of who is in the room, and no strategy for the conversation.

This post explains who CHC assessors actually are, how they are trained, what happens at each stage of the assessment, what the common pitfalls are, and how families can get the best out of the process. It is written specifically for families with a relative in a care home, nursing home, or receiving home care.

It builds on our wider guides to Continuing Healthcare, the CHC Assessment, the Decision Support Tool, the multidisciplinary team, and the Independent Review Panel, so keep reading and get all the details.

What is a CHC assessor?

"CHC assessor" is not a single job title. Like hospital discharge assessors, it is a role played by several different professionals working together to complete the two stages of the Continuing Healthcare assessment process.

The people involved fall into two groups.

At the initial Checklist stage, the assessor is usually a single professional. This can be a registered nurse, a doctor, another qualified healthcare professional, or a social worker who has been trained to use the Checklist tool. Their job is to carry out a brief screening to decide whether your relative should be referred for a full assessment.

At the full assessment stage, the assessment is done by a multidisciplinary team (MDT) of at least two health or social care professionals. In practice, the core CHC MDT usually includes:

A CHC nurse assessor (employed directly by the local Integrated Care Board, often called a "clinical nurse assessor" or "senior nurse assessor"), who leads the assessment and completes the Decision Support Tool
A social worker, who brings the social care perspective and reflects on the person's wider circumstances
A doctor, often the person's GP or a specialist involved in their care
Other clinicians as needed, including specialist nurses (dementia, palliative, respiratory), physiotherapists, occupational therapists, or speech and language therapists
The person being assessed and their family, who can and should attend
The care home manager or senior nurse if your relative lives in a care home
An advocate if the family has arranged one

A few essentials to lock in:

CHC assessors do not decide eligibility on their own. The MDT makes a recommendation to the ICB. The ICB has final authority to accept, reject, or send it back for more work.
All CHC assessors work within the National Framework for NHS Continuing Healthcare, the statutory guidance that governs the whole process.
CHC nurse assessors are typically registered with the Nursing and Midwifery Council (NMC) and have significant post-registration experience, often in complex care.
Approximately less than one in three of those who pass the initial Checklist stage are ultimately found eligible for CHC at the full assessment. Understanding what assessors are looking for is genuinely important, because passing screening does not equal winning eligibility.

How does the CHC assessment process actually work?

The assessment happens in two stages, sometimes with a Fast Track pathway alongside for people who are rapidly deteriorating.

Stage 1: The Checklist. This is a screening tool used to decide whether your relative should have a full assessment. It looks at 11 care domains and assigns scores of A (high), B (moderate), or C (low or none) in each. If the pattern of scores meets a specific threshold (typically two As, or five Bs, or one A and four Bs), your relative is referred for a full assessment. A single professional can complete this stage.

Anyone can request a Checklist, including your relative, a family member, the GP, a district nurse, a hospital discharge team, or a care home manager. The Checklist should be completed in a stable setting, not while your relative is acutely unwell in hospital.

Stage 2: The full assessment. This is where the multidisciplinary team meets and completes the Decision Support Tool (DST). The DST scores your relative's needs across 12 care domains using six severity levels (No Needs, Low, Moderate, High, Severe, Priority). The MDT then applies the four key indicators of a primary health need (nature, intensity, complexity, and unpredictability) to the evidence to make an overall recommendation.

The full assessment typically lasts two to four hours, though it can be longer in complex cases. It involves reviewing detailed care records, discussion with the family, and formal scoring against each domain. We cover the DST and the four indicators in dedicated guides.

The ICB decision. After the MDT makes its recommendation, the ICB has 28 days from the date the Checklist was received to make a final eligibility decision. If the ICB unjustifiably takes longer than 28 days and eventually finds your relative eligible, they should refund any care costs incurred from day 29 onwards.

Fast Track pathway. For people rapidly deteriorating or entering the end of life stage, the Fast Track pathway bypasses the standard process entirely. A clinician completes a Fast Track tool, and the ICB should approve funding urgently (often within 48 hours), without means testing. We cover Fast Track in detail in our palliative care guide.

How does this apply to me?

These are the five questions families ask most often about CHC assessors.

1. What is the role of the CHC nurse assessor specifically?

The CHC nurse assessor is usually the senior professional in the room and the person who runs the meeting. They are employed by the ICB, trained specifically in the National Framework, and typically have several years of clinical experience in complex care before moving into the assessor role.

Their responsibilities include:

Chairing the MDT meeting and keeping it structured against the DST
Reviewing all the clinical evidence in advance and during the meeting
Scoring each of the 12 domains based on the evidence and the discussion
Applying the four key indicators (nature, intensity, complexity, unpredictability) to the pattern of scores
Producing a written MDT recommendation to the ICB
Explaining the outcome to families, both verbally at the end of the meeting and in a subsequent decision letter

Importantly, the CHC nurse assessor is not a decision maker in the final sense. Their role is to lead the assessment and make a recommendation. The ICB has the final decision. However, their recommendation carries substantial weight, and the way they interpret the evidence often shapes the outcome.

For families, the CHC nurse assessor is the person to build a productive relationship with. They will usually give you their contact details before the meeting, and you can ask questions in advance, share written evidence, and clarify anything you do not understand.

2. How difficult is it to get CHC funding, and what are the common pitfalls?

Getting CHC funding is genuinely difficult. Even at the full assessment stage, only around one in three of those who pass screening are ultimately found eligible. The National Framework describes CHC as being for people with a "primary health need", and the threshold for this is set high.

The most common pitfalls that lead to unnecessary refusals include:

The assessment happening while the person is acutely unwell in hospital, giving a distorted picture of their normal needs
Evidence based on a good day, not a bad day: assessors should consider needs at their worst, but families and care staff often describe an "average" or "typical" day, which understates the picture
Care home staff underplaying complexity in the interests of appearing well managed
Families not attending the meeting or attending without preparation
Insufficient written evidence: patchy care records, no incident logs, no specialist reports, no medication charts
Confusing the CHC test with the FNC test: FNC is a lower threshold for nursing home residents needing nurse input; CHC is a higher threshold for people whose primary need is a health need
Not asking about the specific scores given to each domain, so families cannot see where the case was weakest
Not appealing when the decision was borderline, or the evidence was incomplete

Families who prepare properly, attend the assessment, bring evidence in writing, and follow up with clear questions consistently do better than those who leave the process entirely to the professionals. This is not about being adversarial. It is about being an informed participant in a technical process.

3. Does dementia qualify for CHC?

This is one of the most common and most misunderstood questions. The answer is nuanced: dementia does not automatically qualify for CHC, but many people with advanced dementia genuinely do meet the criteria and are refused CHC because their needs are wrongly categorised as social rather than health.

The CHC test is based on the nature, intensity, complexity, and unpredictability of needs, not on any specific diagnosis. Advanced dementia often creates all four: complex behavioural and psychological symptoms, high intensity of care required, unpredictable episodes of distress or agitation, and needs that are not straightforward social care but require clinical judgement and input.

Common reasons dementia cases are wrongly refused include:

The assessor treats behavioural symptoms as social rather than clinical
The care home staff describe behaviour as "managed" without capturing how much clinical input is required to keep it managed
Family members are not present to describe the reality of care at its worst
Evidence from mental health nurses, memory clinics, or Admiral Nurses is not brought to the meeting

If your relative has dementia and is being assessed for CHC, this is one of the strongest arguments for bringing an advocate or specialist supporter to the meeting, and for gathering evidence from all the specialists who have been involved in their care. Our dementia care specialists guide covers this in more detail.

4. Can you get CHC in a residential home, or only in a nursing home?

CHC can be provided in any care setting, including a residential home, a nursing home, at home with a care package, in a hospice, or in supported living. The setting is not the deciding factor. What matters is whether the person's needs meet the primary health need threshold.

In practice, CHC awards are more common in nursing homes because nursing home residents typically have more complex clinical needs. But a resident in a residential home whose needs are health rather than social in nature is fully entitled to CHC.

An important note: if your relative is awarded CHC and is currently in a residential home, the ICB may commission care in a nursing home instead if the care they need cannot be safely provided in a residential setting. This is not automatic, but it can happen. The Choice Policy under the National Framework does allow the ICB to consider your relative's preferred setting alongside clinical appropriateness and cost.

5. What happens after a CHC assessment?

Once the MDT meeting has finished, several things happen. First, the CHC nurse assessor writes up the completed Decision Support Tool and the MDT's overall recommendation. This documentation is sent to the ICB, which formally makes the eligibility decision. The ICB should respond within 28 days of the original Checklist referral.

You will receive a written decision letter explaining the outcome. If your relative is found eligible, the ICB will arrange care funding, coordinate with your care home or care provider, and set a date for the first review (usually three months after the initial decision, then annually).

If your relative is found not eligible, the letter should explain why, and you have six months to request a local review of the decision. If the local review does not resolve it, you can escalate to an Independent Review Panel convened by NHS England. We cover the appeals process in detail in our IRP guide.

Regular reviews are important. Even a successful CHC award is reviewed at three months and then annually, and eligibility can be lost if needs change or improve. Reviews can also work the other way: if your relative was previously assessed as ineligible but their needs have since increased, you can request a new assessment.

Backdating is possible. If you believe your relative should have been assessed for CHC previously but were not, you can request a Previously Unassessed Period of Care (PUPoC) review, which can look back at care fees paid since 1 April 2012.

The takeaway

CHC assessors are one of the most consequential groups of professionals your family will interact with in the care system. Their assessment can determine whether the NHS pays for your relative's care in full or whether the family faces significant ongoing fees. Understanding who they are, what they are looking for, and how to work with them productively is one of the most financially and practically valuable things any family can do.

Three practical takeaways. Attend the MDT assessment in person, bring written evidence, and ask for the specific domain scores at the end of the meeting so you can see where the case was strongest and weakest. Consider an advocate, particularly for dementia cases, and know that free advocacy is available through Beacon CHC, Age UK, and Citizens Advice. And use the appeal process if the decision is borderline or the evidence was incomplete, because a significant proportion of appeals succeed and the six-month appeal deadline is genuinely enforceable.

Our funding calculator can show you how a successful CHC award would affect the overall cost of care for your relative, alongside FNC, Section 117 aftercare, and the means test. Our wider Jargon Buster series explains every term you will come across, including detailed guides to Continuing Healthcare, the CHC Assessment, the Decision Support Tool, the multidisciplinary team, and the Independent Review Panel.

This article is for general guidance only and reflects how NHS Continuing Healthcare assessment works in England as of 2026, under the National Framework for NHS Continuing Healthcare. Arrangements vary slightly by ICB. For specific advice, contact your relative's GP, the local ICB, or a specialist CHC advocacy organisation.

Sources

Frequently asked questions

What written evidence should we prepare for the MDT meeting?

Written evidence is one of the single biggest determinants of a strong CHC case, and most families prepare almost none. A well prepared evidence file should include: the care home's daily records or care logs for at least the previous three months, showing the reality of daily needs; incident reports for any falls, behavioural episodes, choking, wandering, or other significant events; medication charts including PRN (as needed) medication and any covert medication authorisations; specialist reports from every professional involved in the last year (GP, geriatrician, mental health nurse, physiotherapist, occupational therapist, speech and language therapist, dietitian, tissue viability nurse, palliative care team, dementia specialists); hospital discharge summaries from any recent admissions; weight and MUST screening records, particularly if malnutrition is a concern; skin integrity charts for any pressure areas; continence assessment records; and a family narrative of your own, describing the reality of care at its most demanding. Send this pack to the CHC nurse assessor at least a week before the meeting and bring hard copies to the assessment. Evidence not seen is evidence not scored.

Should we bring an advocate to the CHC assessment, and how do we find one?

For most families with a genuinely borderline or complex case, an advocate significantly improves outcomes. An advocate is someone independent of the ICB who understands the CHC process, can question domain scores, challenge weak evidence, and articulate the case for eligibility on your behalf. There are three main options. Free advocacy is available through Beacon CHC (a specialist national charity providing free CHC advice and, in some cases, assessment support), Age UK (through local branches, availability varies), and Citizens Advice (general advice, less CHC specific). Paid specialist advocates are available through firms such as Beacon CHC (they offer both free and paid services), Farley Dwek, and various regional specialists. Costs vary but typically start at around £500 to £1,500 for representation through an initial assessment, and no win no fee arrangements are sometimes available for appeals. A knowledgeable family member or friend can also fulfil the advocate role informally if they have researched the process. Whichever route you take, tell the CHC nurse assessor in advance that an advocate will be present, and share any documentation they intend to submit.

What do we do if the CHC nurse assessor seems dismissive or biased?

This is a genuine concern for some families, and it needs handling carefully. First, distinguish between an assessor who is professionally difficult and one who is genuinely inappropriate. Robust professional questioning is not bias. However, if the assessor appears to have decided the outcome before hearing the evidence, repeatedly interrupts family contributions, refuses to consider specific pieces of evidence, shows unfamiliarity with the person's diagnosis, or behaves discourteously, several options are available. Raise the concern in the meeting itself, calmly and specifically, and ask for it to be recorded in the minutes. Contact the CHC service manager at the ICB to raise concerns before the outcome is finalised. Request a different assessor if you have a genuine, documented concern; this is not routinely granted but can happen. Complete the process and then appeal, using the poor conduct as part of your appeal evidence. Escalate through PALS or a formal complaint to the ICB if the conduct is serious. Keeping a written record of the meeting from your own perspective (notes taken by a family member) is essential in any of these scenarios.

Can we challenge specific domain scores we disagree with?

Yes, and this is one of the most productive ways to influence an assessment. The Decision Support Tool scores each of the 12 domains against six severity levels, and the CHC nurse assessor writes justifications for each score during the meeting. At the end of the meeting, ask for each domain's score to be read out and explained. If you disagree with any specific score, raise it there and then: explain the specific evidence you believe justifies a higher score, ask what evidence would be needed to move it, and request that the disagreement is recorded in the DST documentation. After the meeting, if scores remain contested, write to the CHC nurse assessor within a few days with additional written evidence supporting the higher score. If the final ICB decision is unfavourable and specific scores are the sticking point, those scores become the focus of any subsequent appeal. Appeals that focus on specific, evidenced scoring disagreements consistently outperform general appeals asking for the whole decision to be reconsidered.

What is the difference between CHC funding and Funded Nursing Care (FNC), and can we get both?

CHC pays the full cost of care where the person has a primary health need, is not means tested, and applies in any care setting. FNC pays only the nursing element of care fees for a resident in a nursing home who has been assessed as needing the input of a registered nurse, and it is currently £267.68 per week in England for 2026/27. FNC is a lower threshold and a much smaller sum than CHC. You cannot receive both. If your relative is awarded CHC, this includes any nursing element and replaces FNC. If your relative does not qualify for CHC but has some nursing needs, they may qualify for FNC as a partial contribution. In practice, many nursing home residents who apply for CHC and are refused end up receiving FNC as an alternative, which is helpful but does not remove the need to self fund the majority of care. If you are pursuing CHC, make sure the assessor knows whether FNC has already been awarded, and ensure that the fallback of FNC is being properly considered if CHC is refused. We cover FNC in detail in a dedicated guide elsewhere in this series.