What is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for people with a "primary health need." If someone qualifies, the NHS pays for their care — whether that's at home, in a care home, or in a hospice. This includes care that would otherwise have to be funded privately or by the local authority.
It's means-tested: free regardless of savings, property, or income. But getting it is far from straightforward.
Who might qualify?
CHC is for people whose care needs are primarily health-related rather than social. There's no list of qualifying conditions, but it's most commonly awarded to people with:
- Advanced dementia with complex needs
- Severe neurological conditions (stroke, brain injury, motor neurone disease)
- End-of-life care needs
- Complex nursing needs that go beyond what social care provides
The key question is whether the person has a "primary health need" — assessed through a framework called the Decision Support Tool (DST).
The assessment process
- Checklist screening: A basic screening tool (the CHC Checklist) is completed — usually by a nurse or social worker. If it indicates potential eligibility, a full assessment follows.
- Multidisciplinary team (MDT) assessment: A team of health and social care professionals assesses the person across 12 "care domains" (breathing, nutrition, mobility, cognition, etc.) using the Decision Support Tool.
- Decision: The local Clinical Commissioning Group (or Integrated Care Board) makes the final funding decision based on the DST.
The whole process can take several weeks to months. During this time, existing care arrangements continue.
Your rights as a family
- You can request a CHC assessment at any time — you don't need a professional to refer you
- You have the right to be present at the MDT assessment and contribute your knowledge of the person's needs
- You should receive a written explanation of the decision
- If you disagree with the outcome, you can request a review
If you're turned down
Many initial CHC applications are declined. This doesn't necessarily mean your loved one doesn't qualify — it may mean the assessment didn't fully capture their needs. You can:
- Request a review: Ask the ICB to reconsider the decision. Provide additional evidence — care logs, incident reports, medication records.
- Appeal: If the review upholds the decision, you can escalate to the NHS England Independent Review Panel.
- Get help: Organisations like Beacon (beaconchc.co.uk) specialise in helping families navigate CHC appeals.
Why this matters financially
Without CHC, care home fees (often £800–£1,500+ per week) fall to the individual until their savings drop below the local authority threshold. CHC can mean the difference between a family losing their parent's home and having care fully funded. It's worth understanding and pursuing.