NHS Continuing Healthcare explained: who qualifies and how the assessment works
NHS Continuing Healthcare pays the full cost of someone's care — at home or in a care home — when their need for care arises primarily from health. It is not means-tested. It does not matter what you own. And it is the single funding route families are most often walked straight past.
What NHS Continuing Healthcare actually is
NHS Continuing Healthcare — usually shortened to CHC — is a package of care arranged and fully funded by the NHS for adults who have a “primary health need”. Where someone is eligible, the NHS meets the whole cost: the care itself and, if they are in a care home, the accommodation and living costs too. There is no financial assessment, no capital limit and no contribution from the person.
What “primary health need” means
There is no list of qualifying conditions, and this is where most families are misled. Eligibility is decided by looking at the totality of someone's needs against four characteristics:
- Nature — the type of needs, and the effect they have on the person
- Intensity — how severe the needs are and how much support they require
- Complexity — how the needs interact, and how skilled the response has to be
- Unpredictability — how much needs fluctuate, and the risk if they are not managed
The question is not “are they ill?” It is whether, taken as a whole, the care they need goes beyond what a local authority can lawfully provide as social care. Someone with a modest diagnosis and chaotic, unpredictable needs may qualify where someone with a serious diagnosis and stable, routine needs does not.
Where CHC can be delivered
Anywhere. CHC is not a care home benefit. It can fund a package of care in someone's own home, in a care home, in a nursing home or in supported living. Families are sometimes told they must move into a nursing home to be considered. That is not the rule.
CHC is not the same as NHS-funded Nursing Care
If someone is in a nursing home and is not eligible for full CHC, the NHS pays a flat weekly contribution towards the registered nursing element — £267.68 a week from April 2026. That is NHS-funded Nursing Care, or FNC. It is worth having, but it is a fraction of what full CHC is worth, and being awarded FNC is not a reason to stop pursuing CHC.
- Care is being arranged mainly because of a health condition rather than age or frailty
- Needs change often, or are hard to predict from one day to the next
- There is significant cognitive impairment, or behaviour that is difficult to manage safely
- A registered nurse is regularly involved in the care
- A nursing home has been recommended rather than a residential one
- Someone is being discharged from hospital with a substantial care package
- You were told to self-fund without any assessment of health needs
How the CHC assessment actually works
The Checklist
A short screening tool that anyone in health or social care can complete. It is deliberately set at a low bar: it decides only whether a full assessment happens, not whether you qualify. Ask for a copy, dated and signed.
The Decision Support Tool
The full assessment. Needs are scored across twelve care domains by a multidisciplinary team, with evidence attached. This is the document that decides the outcome, and it is the one worth getting right.
The MDT recommendation
At least two professionals from different disciplines meet, agree the domain levels and make a recommendation. You or your relative should be invited and are entitled to contribute.
The ICB decision
The Integrated Care Board makes the final decision. It should normally accept the MDT recommendation. From checklist to decision should usually take no more than 28 calendar days.
Review
Eligibility is normally reviewed at three months and then at least annually. Needs change, and eligibility can be removed as well as granted — reviews deserve the same preparation as the first assessment.
What the Decision Support Tool actually scores
Needs are rated in each domain, usually from “no needs” up through low, moderate, high, severe and — in some domains — priority. It is the pattern across domains, not any single score, that produces the recommendation.
| Care domain | What the assessors are looking at |
|---|---|
| Behaviour | Risk to self or others, resistance to care, how predictable and manageable it is |
| Cognition | Understanding, memory, orientation, capacity to recognise risk |
| Psychological and emotional needs | Mood, distress, anxiety, the level of support required to maintain wellbeing |
| Communication | Ability to express needs and to be understood, including by unfamiliar staff |
| Mobility | Transfers, falls risk, positioning, equipment and the number of people required |
| Nutrition | Eating and drinking, swallowing difficulties, weight loss, tube feeding |
| Continence | Management, catheter or stoma care, associated skin risk |
| Skin integrity | Pressure damage, wounds, dressings, prevention and how often it is needed |
| Breathing | Oxygen, suction, tracheostomy, ventilation, respiratory instability |
| Drug therapies and medication | Complexity of regimes, symptom control, risk if not managed correctly |
| Altered states of consciousness | Seizures, blackouts, episodes requiring intervention |
| Other significant care needs | Anything material that the other eleven domains do not capture |
How the pattern is read: broadly, a single “priority” level, or two or more “severe” levels, would usually indicate a primary health need. A range of high, moderate and severe levels across several domains can also indicate eligibility, particularly where the needs interact. This is a judgement, not a formula — which is exactly why the evidence you supply matters.
The six problems families run into
Nobody mentions it
The most common failure by far. No checklist is completed, the family self-funds, and nobody ever raises the question. Ask for a checklist in writing.
“They won't qualify”
Said casually, often by someone with no authority to decide it. Only a full assessment can determine eligibility, and a screening checklist is deliberately easy to pass.
Assessed on a bad day — or a good one
A snapshot taken on an unrepresentative day can wreck an assessment. Records over weeks, not impressions over an hour, are what carry weight.
Evidence never arrives
Care plans, daily notes, incident logs, falls records, medication charts and specialist letters all count. If nobody brings them, the domain levels default low.
The family is not there
You are entitled to be involved and to have your account recorded. Families see the unpredictability that professionals visiting once a fortnight simply do not.
Deadlines quietly pass
There are time limits for asking for a decision to be reviewed. Miss them and a winnable case can become unwinnable. Get it looked at properly →
What to do when CHC is refused
A refusal is a decision, not a verdict. A great many refusals are overturned, and the ones that succeed are almost always the ones where somebody went back to the evidence rather than back to the argument.
Ask for the paperwork first
Request the completed Checklist, the Decision Support Tool, the MDT notes and the ICB's decision letter. Read what was actually recorded in each domain. In a large number of cases the disagreement is not about the law at all — it is that the domain descriptions do not match the care that is actually being delivered.
Local resolution
The first stage is asking the Integrated Care Board to review its own decision. Put the request in writing, be specific about which domains you disagree with and why, and attach the evidence that supports a higher level. Vague dissatisfaction gets a vague reply.
Independent review
If local resolution does not resolve it, you can ask NHS England for an Independent Review Panel. Beyond that, the Parliamentary and Health Service Ombudsman can consider complaints about how the process was handled.
Time limits matter
There are deadlines for requesting reviews of eligibility decisions, and separate deadlines that have applied to claims for periods of care already paid for. They are not generous and they are not always explained. If a decision has already been made and you are unhappy with it, find out where you stand on timing before you do anything else.
Fast Track
Where someone has a rapidly deteriorating condition that may be entering a terminal phase, an appropriate clinician can complete a Fast Track Pathway Tool. This bypasses the full assessment and should result in funding being put in place immediately, not in weeks. If a Fast Track has been refused because “the paperwork was not right”, that is a process problem, not an eligibility problem.
- The current care plan and any risk assessments
- Daily care records covering several weeks, not days
- Falls, incident and behaviour logs
- Medication charts, including PRN and as-needed use
- Wound care and pressure area records
- Letters from consultants, GPs and specialist nurses
- Your own diary of a typical fortnight, with dates and times
NHS Continuing Healthcare: your questions
Does having dementia mean you qualify for CHC?
No — and equally, it does not disqualify you. Eligibility is never based on a diagnosis. What matters is the nature, intensity, complexity and unpredictability of the care that the condition creates. Advanced dementia with unpredictable behaviour, swallowing risk and complex medication can look very different in a Decision Support Tool from stable dementia with a settled routine.
Does having savings affect a CHC decision?
Not at all. CHC is not means-tested. If anyone raises savings, income or the family home during a CHC assessment, that is a sign the conversation has drifted into social care funding — which is a different question with different rules. Means testing is explained here.
How long should the assessment take?
The national framework expects the decision to be made within 28 calendar days of the checklist being received, in most circumstances. Delays are common. If you are past that point, ask in writing for the reason and the expected date — it is remarkable how often that alone moves things along.
Who pays while we are waiting?
This is the awkward part. Care usually still has to be paid for while a decision is pending, and if eligibility is later confirmed, funding should be backdated appropriately. Keep every invoice and every receipt from the date the checklist was completed.
Can we claim back care fees already paid?
Sometimes. Where care needs should have qualified in an earlier period, a retrospective claim may be possible — but there have been strict deadlines attached to different periods, and they are unforgiving. Establish the timing position first, before spending months assembling evidence.
Can CHC be taken away?
Yes. Eligibility is reviewed at three months and then usually annually. If needs have genuinely reduced, funding can be withdrawn. Prepare for a review as carefully as for a first assessment, with current evidence — a review is not a formality.
Can CHC pay for care at home?
Yes. CHC funds care wherever it is delivered, including someone's own home, and a personal health budget can sometimes be used to give families more control over how it is arranged. Being told CHC only applies in nursing homes is simply incorrect.
What is the difference between CHC and Section 117 aftercare?
Section 117 aftercare is a separate duty on the NHS and local authority to provide free aftercare to people who have been detained under certain sections of the Mental Health Act. It is also free of charge, and it applies regardless of means. Where it applies, it should be considered before CHC.
Do we need a solicitor?
Usually not at the start. Most CHC cases turn on evidence and on how needs were described, which is nursing work rather than legal work. Where a case genuinely does need legal input we will say so. We do not carry out reserved legal activities.
What can you actually do for us?
Look at the paperwork and the care records with a registered nurse's eye, tell you honestly whether there is a case, and if there is, help you evidence it properly. That is the CHC Review. If there is not, we will say so rather than sell you a process.
Test your position
CHC checklist tool
Twelve domains, twelve questions, an honest indication of whether it is worth pursuing.
Hospital discharge
Where CHC is most often missed, and what to ask on the ward.
Care costs explained
What happens if CHC does not apply, and who pays then.
CHC Funding Review
An independent, nurse-led review of your case for £325.
You don’t need to know which service you need.
Just tell us what’s happening.
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