What Happens at a CHC Assessment — How to Prepare

A CHC assessment can feel daunting — particularly if you are already dealing with the stress of caring for a loved one with complex needs. Understanding what to expect and how to prepare makes a significant difference to the outcome. Families who attend assessments informed, organised and ready to advocate consistently achieve better results than those who do not.

The Two Stage Process

Stage 1 — The CHC Checklist

The process begins with a CHC Checklist — a short screening assessment completed by a health or social care professional. Its purpose is to identify whether your relative should proceed to a full assessment. The threshold is deliberately set low — most people should pass it and move to the next stage.

If you are told your relative does not meet the threshold, ask for a written explanation. If you disagree, you can challenge the decision through the NHS complaints process.

Stage 2 — The Full Assessment (MDT Meeting)

If the Checklist is positive, your relative is referred for a full assessment. This is carried out by a Multi-Disciplinary Team (MDT) — typically a nurse assessor from the ICB and a social worker — who assess needs across the 12 care domains using the Decision Support Tool (DST).

Your right to attend

You have the right to attend the MDT assessment, to be fully involved in the scoring process and to bring a representative or advocate. The National Framework states clearly that families should have the opportunity to participate — not just observe. If you are not offered this, request it in writing.

How to Prepare for the Assessment

Before the assessment — your preparation checklist

✓Request all relevant documents in advance — care records, GP notes, hospital discharge letters and existing care plans. You are entitled to these.

✓Write a structured needs summary — one to two pages covering your relative's needs across the 12 domains with specific examples, dates and frequencies.

✓Keep a care diary for two to four weeks before the assessment if time allows — documenting daily interventions, incidents and the bad days. The bad days matter especially.

✓Learn and use the National Framework language — nature, intensity, complexity, unpredictability. Speaking this language in the room makes your evidence land more effectively.

✓Confirm your attendance in writing and ask who will be present at the MDT.

The Most Common Assessment Errors

Knowing what can go wrong means you can challenge it in the room:

Scoring based only on care records without gathering evidence from family, specialists or carers
Discounting well-managed needs — scoring lower because a condition is being controlled, rather than recognising the intervention required
Focusing only on average or stable periods rather than the full picture including bad days and episodes of deterioration
Conducting scoring privately without family involvement, contrary to the National Framework
Rushing the assessment without adequate time to consider each domain properly
Completing assessments in hospital where the person appears more stable than usual

Short notice assessments

Some ICBs schedule assessments at very short notice, hoping to catch families underprepared. You are entitled to a reasonable timeframe to prepare. If you are given insufficient notice, request a postponement in writing and document your request.

What to Do During the Assessment

Do not allow scores to be agreed without your input — insist on being involved in the scoring process
If you disagree with a score, say so clearly with specific evidence and domain language
Note the name and role of all MDT members present
Ask for a copy of the completed DST at the end — or confirm when you will receive it
If any domain appears to have been skipped or rushed, raise it immediately

Present the full picture

The principle of well-managed needs means that a need being managed by skilled care still counts as a need. Present evidence of the level of intervention required — not just the outcome of that intervention. And include the bad days and unpredictable episodes, not just the average presentation.

Complete Assessment Preparation Guide

Our plain-English guide includes everything you need to prepare for a CHC assessment — including a full action plan, the complete domain scoring levels and how to present your case effectively.

Download the Guide — £14.99 ↓

Instant PDF download · For information only · Not legal advice