Before the Assessment
How to Prepare for a CHC Assessment
Preparation is the single biggest factor in CHC assessment outcomes. The MDT will spend a limited time with your family. What you put in front of them \u2014 in writing, in advance \u2014 shapes how they score every domain. Most families arrive unprepared. The ones who succeed do not.
Understand what the assessment involves
The CHC assessment is carried out by a multidisciplinary team (MDT) \u2014 typically a nurse and a social worker. They complete a Decision Support Tool (DST) that maps needs across the 12 care domains, each scored from No Needs to Priority.
The MDT must consider all available evidence. They are not limited to what they observe in a single visit. Your written submissions, the care home's records, and clinical letters from the GP and specialists all feed into domain scoring.
You have the right to be present at the assessment meeting, to understand how each domain is being scored, and to challenge scores you believe are wrong before the DST is finalised.
Keep a care diary (start now)
A care diary is the most powerful evidence you can produce. It records the person's needs day by day, in specific detail \u2014 not “Mum needed help” but “Mum was incontinent at 2am, required full change of sheets and nightwear, was distressed and took 40 minutes to settle. Staff called twice.”
Keep the diary for at least two weeks before the assessment. Record:
- Every care intervention \u2014 what was needed, when, how long it took
- Every incident \u2014 falls, episodes of distress, wandering, refusals of care, aggressive behaviour
- Night-time needs \u2014 these are systematically underweighted unless you document them
- “I'm not sure” moments \u2014 times when you couldn't tell whether the person was in pain, distressed, or about to deteriorate
The diary does not need to be written by a clinician. Your observations as a family member carry weight precisely because you see the person at times and in ways that care staff do not.
Request all clinical records
Before the assessment, request copies of:
GP records \u2014 the full primary care record. Include the summary care record and any letters to and from specialists. Your GP surgery must provide these within one month under UK GDPR.
Hospital discharge summaries \u2014 every hospital admission is a clinical snapshot of needs at a specific moment. Discharge summaries often contain the clearest language about the nature and intensity of health needs.
Specialist letters \u2014 consultant neurologists, psychiatrists, geriatricians, and palliative care teams write letters that directly address the domains the MDT will score. Collect all of them.
Care home records \u2014 if the person is in a care home, request their care plan, risk assessments, medication administration records, and incident logs. The care home must provide these on request.
Read everything before the assessment. Identify the letters and summaries that support higher domain scores, and flag them specifically in your written submission.
Get letters from clinicians
Ask the person's GP, and any relevant specialists, to write a letter specifically for the CHC assessment. The letter should:
- Describe the person's condition and its trajectory
- Address the specific care domains where the clinician has expertise
- Use language that maps to DST scoring \u2014 “severe and unpredictable”, “requires registered nurse input”, “poses significant risk when unattended”
- Confirm whether needs are stable, deteriorating, or fluctuating
Clinicians are sometimes reluctant to write these letters because they are unfamiliar with CHC. Explain that you are requesting a CHC assessment and that the letter will help the MDT understand needs in clinical terms. Most will cooperate.
Write your own family submission
Submit a written statement from the family before the assessment meeting. Cover:
- Who the person is \u2014 their history, their personality, what they were like before their condition
- What a typical day looks like \u2014 hour by hour if possible
- What a bad day looks like \u2014 specific incidents, the level of response required
- Needs that are not visible in daytime visits \u2014 night behaviour, early morning confusion, the distress that happens when the routine changes
- Your concerns about specific domain scores \u2014 if you believe behaviour should be High rather than Moderate, say so and explain why
The submission does not need to be formal or legal. It needs to be specific, honest, and detailed. Assessors read these. They matter.
Know your rights in the meeting
You have the right to:
- Be present at the assessment meeting
- Hear how each domain is being scored as the meeting progresses
- Ask the assessor to explain why a particular score has been chosen
- Challenge a score at the time if you disagree
- See the completed DST before it is submitted to the ICB
- Submit written representations after seeing the DST
Do not be passive in the meeting. If a domain is being scored Low when you believe it should be High, say so politely but clearly, and give a specific example from your care diary or the clinical records.
Frequently asked questions
How much notice will we get of the assessment meeting?
ICBs are supposed to give reasonable notice. In practice this varies — some give weeks, some give days. If you receive short notice and are not ready, you are entitled to request a postponement. Do so in writing, explaining that you need time to gather evidence and prepare a submission.
Can the assessment happen in hospital before discharge?
Yes — and this is common. Hospital discharge teams sometimes initiate CHC assessments. Be cautious about assessments conducted under discharge pressure, where the implicit goal is to move the person out of hospital quickly. You have the right to insist on a proper assessment regardless of discharge timelines.
What if the care home discourages us from pursuing CHC?
Some care homes discourage CHC applications because they prefer the commercial relationship with the family over the NHS fee structure. This is a conflict of interest. You do not need the care home’s support to request an assessment — you can go directly to the GP or ICB.