Pathway CHC Support | CHC Eligibility Enquiry

Before you begin

Thank you for taking this first step towards understanding your NHS Continuing Healthcare (CHC) options.

Accessing the right guidance at the right time can make a meaningful difference and may help you avoid unnecessary consultancy costs. Our experienced team is here to support you every step of the way.

This short questionnaire allows us to gather the key information needed to provide clear, personalised guidance. Please note, it is not a formal assessment and does not guarantee CHC funding.

Section A: About You

Your full name *

Your email address *

Telephone number, optional

Your relationship to the person needing care *

Preferred contact method

Section B: About the Person Needing CHC

Approximate age, in years *

Current setting

Local NHS area / ICB, if known

Main diagnosis / conditions

Main reason care is required

Section C: Current CHC Position

Has an NHS CHC Checklist been completed?

Checklist date

Checklist outcome

Has a DST been completed?

DST date

DST outcome

Appeal timeframe

Any other deadlines?

Current funding, tick all that apply Local authority social care
NHS-funded Nursing Care (FNC)
CHC already in place
Self-funding
Other

Further funding details

Section D: Health & Care Needs Questionnaire

We’d like to understand your needs so we can provide the best possible care and support.

Please answer the questions as best you can. If you’re unsure about anything, that’s absolutely fine. Just select Not sure or leave a note.

Breathing

Does the person have any breathing or respiratory conditions?

Do they experience breathlessness at rest or when moving around?

Do they need oxygen therapy or any breathing support?

Have there been any episodes of severe breathing difficulty?

Nutrition – Food & Drink

Can the person eat and drink on their own?

Do they have any swallowing difficulties?

Is there any concern about weight loss, dehydration, or poor nutrition?

Do they need a special diet or feeding support, for example tube feeding?

Is support from a dietitian involved or needed?

Continence

Does the person have control over their bladder and bowel?

Do they use continence products or require a catheter?

Are there any concerns such as infections or skin issues?

Can they manage toileting independently?

Skin & Comfort

Are there any pressure sores, wounds, or skin conditions?

Is there a risk of skin breakdown?

Do they need regular repositioning or specialist equipment, for example a mattress?

Is ongoing wound care required?

Details

Mobility

How well can the person move around?

Are they at risk of falling?

Do they need assistance, equipment, or hoisting?

Can they change position, for example in bed or chair, on their own?

Are physiotherapy or occupational therapy services involved?

Communication

Can the person express their needs clearly?

Are there any communication difficulties?

Do they need help understanding others?

Emotional Wellbeing

Does the person experience anxiety, low mood, or other mental health concerns?

How much do these affect daily life?

Are there episodes of distress or emotional changes?

What support or treatment is currently in place?

Thinking & Memory

Are there any concerns about memory or thinking, for example dementia?

Can the person make decisions about their care?

Do they understand risks and consequences?

Do they need supervision to stay safe?

Has a formal assessment been carried out?

Behaviour & Support Needs

Are there behaviours that may be challenging, for example agitation or aggression?

How often do these occur?

Are there known triggers?

What helps manage or reduce these behaviours?

Are specialist services involved?

Medication & Treatment

Please list current medications

Are there complex treatments, for example injections or infusions?

Are there any difficulties taking or managing medication?

Are there side effects that need monitoring?

Is nursing support needed to give medication?

Episodes Affecting Consciousness

Does the person experience seizures, fainting, or blackouts?

How often do these happen?

What support is needed during these episodes?

Is there a clear care or management plan?

Additional Information

Please share anything else that may help us understand the person’s needs better

Consent & Processing Fee

I confirm I have authority to share this information and that it is accurate to the best of my knowledge.

I understand the information provided will be used to offer general guidance on NHS Continuing Healthcare (CHC).

I understand that a processing fee of £50 is required and that payment is taken securely online via Stripe.

Thank you for completing this form.

To proceed with your personalised care guidance, please continue to secure payment. The £50 fee covers review of your information and initial guidance.