NHS Continuing Healthcare (CHC) is one of the most significant and least understood funding options available to people with complex health needs in England. If a person qualifies, the NHS covers the full cost of their care, whether that is in a care home, a nursing home or at home. There is no means test, no upper savings threshold, and no contribution required from the individual regardless of their financial circumstances.

Despite this, many families who are entitled to CHC funding never receive it, either because they were never assessed, did not understand the process, or had an application turned down without realising they could challenge the decision. This guide explains clearly what NHS Continuing Healthcare is, who is eligible, how the assessment works, and what to do if you think a loved one has been unfairly refused.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of free services for health and social care arranged and funded by the NHS. It is available to adults aged 18 and over in England who have complex, ongoing health needs that meet a specific threshold. Continuing Healthcare is not means tested, meaning the amount of savings, income and assets a person has does not affect their eligibility. If the criteria are met, a person qualifies regardless of their financial circumstances.

This is fundamentally different from local authority care funding, which is means tested and assessed against capital thresholds. CHC funding sits entirely within the NHS budget and is administered by Integrated Care Boards (ICBs), which are the NHS organisations responsible for commissioning health services in each local area.

For families in the areas served by our homes, the relevant ICBs include NHS Herefordshire and Worcestershire ICB for families near Bricklehampton Hall, NHS Hampshire and Thames Valley ICB for families near Broadmead in Newbury, NHS North West London ICB covering Coppermill Care in Harefield, NHS Leicestershire and Rutland ICB for Hayes Park, NHS Birmingham and Solihull ICB for New Day, and NHS Buckinghamshire, Oxfordshire and Berkshire West ICB for families near The Lindens in Milton Keynes.

What is a Primary Health Need?

The central concept in CHC eligibility is the primary health need. A person will have a primary health need if the main reason they require care is to support their health needs or prevent them from getting worse. The question is not simply whether a person has health problems, but whether their overall care needs are primarily driven by those health needs rather than by social care needs.

Eligibility for NHS Continuing Healthcare is not dependent on any particular disease, diagnosis or medical condition. What matters is the nature, complexity, intensity and unpredictability of the care a person requires. A person with dementia may or may not qualify depending on the severity and complexity of their needs. The same is true of Parkinson’s disease, motor neurone disease, stroke or any other condition.

This is where many families and even some professionals get confused. A serious diagnosis alone does not guarantee eligibility, and a person without a named diagnosis can still qualify if their care needs meet the threshold.

The 12 Care Domains

When assessing eligibility, assessors use a Decision Support Tool (DST) that looks at a person’s needs across 12 care domains. Each domain is scored to reflect the level of need.

Each domain is scored as No Needs, Low, Moderate, High, Severe or Priority. A person is likely to be eligible for CHC if they have a Priority level need in any one domain, a Severe level need in at least two domains, or a combination of High and Severe needs across multiple domains that together indicate a primary health need.

How Does the Assessment Process Work?

The CHC assessment process follows a defined pathway set out in the National Framework for NHS Continuing Healthcare.

Step One: The Checklist Screening

A health or social care professional carries out a brief initial assessment of the person’s health needs to see if they might be eligible for NHS Continuing Healthcare. This is known as the Checklist Tool. It is a screening exercise rather than a full assessment, and it can be triggered by a hospital discharge, a review of care needs, or a request from a family member or GP.

If the checklist indicates that a full assessment may be appropriate, the person is referred to the next stage. If the checklist does not indicate eligibility, families have the right to request that a full assessment is carried out anyway if they believe it is warranted.

Step Two: The Full Multidisciplinary Assessment

If a person is referred for a full assessment, evidence is collected from all relevant health and social care professionals about their physical, mental health and social care needs. A team of health and social care professionals then meets to look at this evidence, complete the Decision Support Tool, and make their recommendation on whether the person is eligible.

Family members and the person being assessed have the right to attend and contribute to this meeting. It is worth preparing in advance by gathering relevant medical records, GP letters, care home notes and your own observations about the person’s day-to-day needs. The more evidence the assessment team has, the better placed they are to make the right decision.

A decision about whether the person is eligible for NHS Continuing Healthcare should be made within 28 days of the assessment.

Step Three: The Fast Track Pathway

If the person you care for is terminally ill and their condition is rapidly deteriorating, they should be considered for a Fast Track Pathway. This is a quicker process completed by a medical professional. If accepted, the person’s care package should be in place within two days. The Fast Track Pathway is designed for people approaching the end of life and removes the need for a full multidisciplinary assessment.

“NHS Continuing Healthcare is something many families we support have never heard of until they reach out to us. It can make an enormous difference to the financial pressure of care, and it is absolutely worth pursuing if you think your relative may qualify. Our admissions teams across all of our homes are happy to help families understand whether it is worth seeking an assessment.”

Blissful Care Homes

What Happens if a Person is Eligible?

If a person is found eligible for NHS Continuing Healthcare, a case coordinator will be assigned who will be the main point of contact. They will arrange the care and support the person needs, which could be provided in a care home, nursing home or in the person’s own home. The NHS meets the full cost of the care package, including accommodation in a care home where this is the agreed setting.

Eligibility is reviewed regularly, as a person’s needs may change over time. If needs reduce and a person is found no longer eligible at a review, they will need to transition to local authority funded or self-funded care. This can come as a shock to families who have not been prepared for it, so it is worth understanding from the outset that CHC funding is not always permanent.

What if a Person Does Not Qualify for CHC?

If a person is not eligible for full CHC funding but lives in a nursing home and has been assessed as needing nursing care, they may qualify for NHS-funded Nursing Care (FNC). This means the NHS will pay a contribution towards the cost of registered nursing care in a nursing home. This is a flat-rate contribution rather than full funding, but it reduces the amount the individual or local authority needs to pay.

A person who does not qualify for CHC may still be eligible for local authority support toward their care costs, depending on the outcome of a care needs assessment and means test. Our article on who pays for care homes in the UK explains the full funding landscape including local authority contributions and self-funding.

Why Are so Many Applications Refused?

According to the Nuffield Trust, only 21% of people assessed for Continuing Healthcare between January and March 2024 were found eligible. Eligibility rates vary significantly between ICBs, which suggests that the assessment process is not always applied consistently.

Common reasons applications are refused include:

• Missing or incomplete documents, including detailed care records, GP notes or hospital reports
• Assessors not considering the risks that would arise if current high-quality care were withdrawn
• Health needs being misclassified as social care needs, which are means tested
• Assessors interpreting the eligibility criteria too narrowly, focusing on diagnosis rather than the overall intensity, complexity and unpredictability of needs
• Families not attending or contributing to the assessment meeting
• The person’s needs not being fully or accurately recorded in their care documentation

How to Challenge a Refusal

A refusal is not the end of the process. Families have the right to request a review if they believe the decision was wrong. The steps are:

• Request a copy of the completed Decision Support Tool and the rationale for the decision
• Ask the ICB to reconsider the decision at a local review. This is the first stage of the appeals process
• If the local review does not change the outcome, request an independent review by NHS England
• At any stage, seek independent advice. NHS England funds an independent information and advice service through a social enterprise called Beacon, which provides up to 90 minutes of free personalised advice from a trained CHC adviser. Beacon can be reached on 0345 548 0300.

Many successful CHC applications have come after an initial refusal was challenged. The key is to be persistent, gather strong supporting evidence, and to make sure the assessment reflects the full picture of a person’s needs on their worst days, not just their average ones.

“We always encourage families to pursue a CHC assessment if they think their relative may be eligible. The process can feel daunting, but it is worth understanding properly. At our homes in Birmingham, Leicester, Worcestershire, Berkshire and Middlesex, our teams have supported many families through this process and we are always happy to point people in the right direction.”

Blissful Care Homes

How to Request a CHC Assessment

There is no single referral route, but the following steps are the most straightforward:

• Speak to the person’s GP, consultant, hospital discharge team or social worker and ask them to initiate a CHC checklist assessment
• Contact your local ICB directly and request that your relative is considered for CHC assessment
• If your relative is in hospital and due to be discharged, make sure the ward team is aware that you would like a CHC assessment to be completed before or shortly after discharge
• Keep a detailed record of all care needs, incidents, medication, and professional involvement. This evidence is invaluable at assessment

Frequently Asked Questions

Does NHS Continuing Healthcare cover care home fees in full?
Yes. If a person is found eligible and a care home is the agreed setting for their care, the NHS meets the full cost of that care including the accommodation element. There is no contribution required from the individual regardless of their savings or assets.

Can someone apply for CHC while already living in a care home?
Yes. A CHC assessment can be triggered at any point, not just at the moment of moving into care. If a person’s needs have increased significantly since they moved in, or if they were never assessed at the point of admission, it is worth requesting an assessment now.

Is CHC available for people living at home?
Yes. NHS Continuing Healthcare can be provided in a residential home, nursing home or at the patient’s own home. The funding covers the care package itself, not the person’s general living costs if they are at home.

What is the difference between CHC and NHS-funded Nursing Care?
CHC covers the full cost of care for people with a primary health need. NHS-funded Nursing Care (FNC) is a flat-rate contribution toward the nursing element of care home fees for people in nursing homes who do not meet the full CHC threshold. The two are assessed separately, and a person who does not qualify for CHC may still be entitled to FNC.

How long does the CHC assessment process take?
A decision should be made within 28 days of the full assessment. The initial checklist stage and referral can add additional time. In urgent cases, the Fast Track Pathway can result in a care package being in place within 48 hours.

Can CHC funding be withdrawn?
Yes. Eligibility is reviewed regularly and if a person’s needs reduce or change, they may no longer meet the threshold. Families should be prepared for this possibility and understand what alternative funding may be available if CHC is withdrawn following a review.

Talk to Our Team

If you are supporting a relative with complex care needs and would like to understand whether NHS Continuing Healthcare could be relevant to your situation, our teams across Bricklehampton Hall, Broadmead, Coppermill Care, Hayes Park, New Day and The Lindens are happy to talk it through. We are not CHC assessors, but we have supported many families through this process and can point you toward the right next steps.

You may also find our articles on who pays for care home fees in the UK and understanding the care needs assessment process helpful as you navigate the funding landscape.

Get in touch with our team today.