NHS Continuing Healthcare, often called NHS CHC, is one of the most important but least understood types of care funding in England. It can pay for a full package of care for adults with significant ongoing health needs, whether that care is provided at home, in a care home, or in another setting.
Many families first hear about NHS Continuing Healthcare when a relative is already in hospital, moving into a care home, or paying large care fees. Others only discover it after months or years of privately funding care. This can be frustrating, because CHC is not based on savings, income or property. It is based on whether a person has a primary health need.
This guide explains what NHS Continuing Healthcare is, who may qualify, how the assessment works, how to apply, what evidence may help, and what to do if you disagree with a decision.
Important: NHS Continuing Healthcare applies to adults aged 18 or over. It is different from local authority social care funding and different from NHS-funded nursing care. Eligibility is not means-tested, but the assessment can be detailed and evidence-based.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of ongoing care that is arranged and funded by the NHS for adults who have been assessed as having a primary health need. NHS England describes it as a package of care for adults aged 18 or over that is arranged and funded solely by the NHS, following assessment by an integrated care board, or ICB, using a prescribed decision-making process. NHS England explains NHS Continuing Healthcare here.
CHC can cover care in different settings. If someone is eligible, the NHS may fund care:
- in their own home
- in a care home
- in a nursing home
- in another suitable care setting
At home, CHC may cover healthcare and personal care needs, depending on the agreed care package. In a care home, it may cover care home fees related to the assessed package of care. The exact arrangement depends on the person’s needs and what the ICB agrees is appropriate.
If you are still comparing types of support, you may also find our guide to home care: types of support, funding and how to choose useful.
Is NHS Continuing Healthcare means-tested?
No. NHS Continuing Healthcare is not means-tested. This means eligibility does not depend on how much money someone has, whether they own a home, or whether they have savings.
This is one of the biggest differences between CHC and local authority social care funding. Local authority social care support usually includes a financial assessment. CHC is based on health needs, not finances.
However, this does not mean everyone with care needs qualifies. Many people need help with washing, dressing, meals, medication reminders or supervision but do not meet the threshold for CHC. The question is whether the person’s overall needs are primarily health needs rather than social care needs.
For a wider explanation of local authority support, see our guide to how social care funding works in the UK.
What does “primary health need” mean?
The phrase primary health need is central to CHC. It does not mean the person has a specific diagnosis. It means that, looking at the person’s overall needs, the nature, intensity, complexity or unpredictability of those needs means they should be funded by the NHS rather than by social care.
This can be confusing because many people in care homes have medical conditions such as dementia, Parkinson’s disease, stroke, heart failure, diabetes or frailty. A diagnosis alone does not automatically qualify someone for CHC. The assessment looks at the actual care needs created by those conditions.
For example, a person with dementia may or may not qualify. The assessment would consider issues such as behaviour, cognition, communication, mobility, nutrition, continence, skin integrity, medication needs, risks, supervision, and whether needs are complex, intense or unpredictable.
If dementia is part of the picture, our guide to early signs of dementia may be useful for families beginning to understand care needs.
Who may qualify for NHS Continuing Healthcare?
There is no simple list of conditions that automatically qualify. Instead, eligibility depends on the level and type of care someone needs.
A person may need a CHC assessment if they have significant, ongoing needs linked with:
- advanced dementia or severe cognitive impairment
- complex behaviour that needs skilled management
- severe mobility problems or high risk of falls
- complex medication or treatment needs
- skin breakdown, pressure ulcers or high tissue viability risk
- difficulty eating, drinking or swallowing
- breathing problems requiring ongoing monitoring or intervention
- altered states of consciousness, seizures or blackouts
- significant communication difficulties
- rapidly deteriorating health or end-of-life care needs
Someone does not need to have all of these needs. Equally, having one of them does not automatically mean they will qualify. The assessment looks at the whole picture.
CHC is about needs, not diagnosis
This point is worth repeating because it is where many families become understandably frustrated. A diagnosis such as dementia, stroke, multiple sclerosis, Parkinson’s disease, motor neurone disease or brain injury may explain why someone needs care, but CHC eligibility depends on the level of need.
The assessors consider whether the needs are beyond what a local authority could legally provide as social care. This is why evidence matters. A clear record of daily risks, interventions, supervision, behaviour, falls, nutrition, medication, infections and deterioration can be more useful than diagnosis labels alone.
If someone has multiple long-term conditions, it may help to gather clinic letters, hospital discharge summaries, care plans, medication lists, risk assessments and daily care notes before an assessment.
What is the difference between CHC and NHS-funded nursing care?
NHS Continuing Healthcare and NHS-funded nursing care are often confused.
NHS Continuing Healthcare can fund a full package of care for someone who qualifies because they have a primary health need.
NHS-funded nursing care, often called FNC, is a contribution paid by the NHS towards registered nursing care for someone living in a nursing home who does not qualify for CHC but has been assessed as needing nursing care from a registered nurse.
In simple terms, CHC may cover the whole assessed care package. FNC is a nursing contribution. If someone is in a residential care home without nursing, FNC does not usually apply.
If you are comparing care settings, our guide to care homes in the UK: types, costs and ratings may help.
How does the NHS Continuing Healthcare assessment process work?
The CHC process usually has two main stages:
- a Checklist, which is a screening tool
- a full assessment, usually using the Decision Support Tool, if the Checklist suggests this is needed
The NHS says the assessment process usually starts with a screening tool called the Checklist, followed by a full assessment if the Checklist indicates this is required. The full assessment uses a Decision Support Tool to help assess the nature, complexity, intensity and unpredictability of needs. The NHS explains the CHC assessment process here.
Step 1: The NHS Continuing Healthcare Checklist
The Checklist is a screening tool used to decide whether someone should be referred for a full CHC assessment. It is not the final decision on eligibility.
The Checklist should usually be completed by a trained health or social care professional. This might be a nurse, social worker, hospital discharge professional, care home nurse or another professional involved in the person’s care.
The GOV.UK CHC Checklist is described as a screening tool to help identify people who may need referral for a full assessment of eligibility for NHS Continuing Healthcare. You can view the NHS Continuing Healthcare Checklist on GOV.UK.
The Checklist looks at several areas of need, often called care domains. These include areas such as breathing, nutrition, continence, skin, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, and altered states of consciousness.
Can families ask for a Checklist?
Yes. If you believe someone may have a primary health need, you can ask for a CHC Checklist to be completed.
You might ask:
- the GP
- a district nurse
- a hospital discharge team
- a social worker
- a care home manager or care home nurse
- the local integrated care board’s CHC team
It can help to make the request in writing and keep a copy. Explain briefly why you believe the person may need a CHC assessment, focusing on health needs, risks and care required rather than finances.
Step 2: The full assessment and Decision Support Tool
If the Checklist indicates that a full assessment is needed, the person should be referred for a full CHC assessment. This is usually carried out by a multidisciplinary team, often called an MDT.
The MDT should bring together information from people involved in the person’s care. This may include nurses, doctors, social workers, therapists, care home staff, family carers and the person themselves where possible.
The assessment usually uses the Decision Support Tool, or DST. GOV.UK describes the DST as a tool that supports consistent, evidence-based recommendations and decisions on eligibility for NHS Continuing Healthcare. You can view the NHS Continuing Healthcare Decision Support Tool on GOV.UK.
The DST looks at care domains and records the level of need in each area. The team then considers the overall picture, including the nature, intensity, complexity and unpredictability of needs.
The care domains used in the Decision Support Tool
The Decision Support Tool considers care needs across a number of domains. These are used to structure the assessment and make sure key areas are considered.
Domains include:
- breathing
- nutrition, including food and drink
- continence
- skin, including tissue viability
- mobility
- communication
- psychological and emotional needs
- cognition
- behaviour
- drug therapies and medication
- altered states of consciousness
- other significant care needs
The DST is not simply a scoring exercise. The final recommendation should consider how the needs interact. For example, a person may have moderate needs in several areas, but the combination may create complexity, intensity or unpredictability that needs careful review.
What evidence helps with a CHC assessment?
CHC decisions should be based on evidence. Families often know the person best, but it helps to present concerns clearly and with examples.
Useful evidence may include:
- care home daily records
- home care notes
- hospital discharge summaries
- GP records or clinic letters
- medication lists and records of medication changes
- falls records
- skin charts, pressure ulcer records or tissue viability notes
- nutrition and fluid charts
- weight loss records
- behaviour charts or incident reports
- mental capacity assessments, where relevant
- risk assessments
- reports from physiotherapists, occupational therapists, dietitians, speech and language therapists or mental health teams
Try to be specific. Instead of saying “Mum needs a lot of help”, give examples such as “Mum needs two carers for transfers, has fallen three times in two months, resists personal care, has lost weight, and needs prompting and supervision throughout meals because she forgets to swallow safely.”
Preparing for the assessment meeting
If you are invited to a CHC assessment meeting, it is worth preparing in advance. Families can sometimes feel overwhelmed during the meeting, especially if several professionals are present.
Before the meeting:
- ask for copies of the Checklist, care plans and relevant notes
- write down examples for each care domain
- note how often care is needed, not just what care is needed
- include night-time needs as well as daytime needs
- record risks, such as choking, falls, pressure sores, aggression, wandering or missed medication
- think about what happens if care is not provided
- ask whether the person can attend or be represented
- take someone with you for support if possible
Age UK says people should be given the option to participate fully and have their views considered at all stages of the assessment process, and can ask a relative or carer to help and support them. Age UK’s CHC guidance is a helpful family-friendly overview.
How long does the CHC process take?
Timescales can vary. The NHS states that, if someone is eligible, their care package will normally be reviewed within three months and then at least once a year. The initial assessment and decision process should usually be completed promptly, but families often experience delays depending on local systems and evidence gathering.
If the person is in hospital, CHC should not be used to delay safe discharge unnecessarily. Assessment may happen in hospital in some situations, but in other cases it may be more appropriate once the person’s longer-term needs are clearer.
If there are delays, keep written records of who you contacted, when, and what was agreed.
Fast-track NHS Continuing Healthcare
There is a fast-track pathway for people whose health is deteriorating quickly and who may be nearing the end of life. This is different from the standard Checklist and full assessment route.
The NHS says that if someone’s health is deteriorating quickly and they are nearing the end of life, they should be considered for the fast-track pathway so that an appropriate care and support package can be put in place as soon as possible, usually within 48 hours. The NHS CHC page explains fast-track assessment.
Fast-track CHC is usually completed by an appropriate clinician. It is designed to avoid unnecessary delays when someone needs urgent care and support at the end of life.
Can someone receive CHC at home?
Yes. NHS Continuing Healthcare can be provided at home if that is the agreed care setting and the care package is suitable. This may include support from carers, nurses, equipment, therapies or other services depending on assessed needs.
Families sometimes assume CHC only applies in care homes, but this is not the case. The question is whether the person qualifies and what package of care is needed to meet assessed needs safely.
If you are weighing up home care, live-in care and residential care, our article on the cost of live-in care vs care home in the UK may be useful.
Can someone in a care home receive CHC?
Yes. A person can receive CHC in a care home or nursing home if they qualify. If CHC is awarded, the NHS becomes responsible for arranging and funding the assessed package of care.
If someone is already paying care home fees and their needs have increased, it may be appropriate to request a CHC Checklist. This is especially relevant after a major deterioration, repeated hospital admissions, worsening dementia, increased nursing needs, pressure ulcers, swallowing problems, complex medication needs or escalating risks.
For general care home cost information, see our guide to care home fees.
What if the person lacks mental capacity?
Many CHC assessments involve people who have dementia, brain injury, severe illness or communication difficulties. If the person lacks capacity to take part or make decisions about the assessment, the process should still consider their wishes, feelings, needs and best interests.
A family member, attorney, deputy, advocate or other representative may be involved. If there is a health and welfare lasting power of attorney, this should be made clear to professionals. If there is no suitable family member or representative, an independent advocate may be needed in some cases.
The assessment should not exclude the person’s perspective simply because communication is difficult. Observations from carers and family can be important evidence.
What happens if CHC is awarded?
If the person is found eligible, the ICB should arrange and fund a care package that meets the assessed health and care needs. This may involve care at home, a care home placement, nursing input, equipment or other support.
The care package should be reviewed, usually within three months and then at least annually. Reviews should check whether the care package is meeting needs and whether eligibility remains appropriate.
Eligibility can change. Some people continue to qualify long term, while others may improve or stabilise and no longer meet the criteria. If CHC is removed, there should be a proper review and planning for alternative support.
What happens if CHC is refused?
If CHC is refused after a Checklist, the person may not proceed to full assessment. If CHC is refused after a full assessment, the ICB should explain the decision and provide information about how to challenge it.
If you disagree, ask for:
- a written copy of the decision
- the completed Checklist or Decision Support Tool
- the reasons for the decision
- the local review or appeal process
- the deadline for requesting a review
It may help to compare the decision with your evidence. Look for missing information, factual errors, under-recorded needs, or areas where risks were minimised. For example, if the assessment says someone “needs prompting with meals” but care notes show choking risk, weight loss and supervision throughout meals, that difference matters.
How to appeal or challenge a CHC decision
The first stage is usually to ask the local ICB to review the decision. This is often called local resolution. If you remain unhappy after local resolution, there may be a route to an independent review through NHS England.
Scope explains that the appeal process normally starts with local resolution with the ICB, and can then move to an independent review if the issue is not resolved. Scope’s guide to appealing a CHC decision gives a practical overview.
When challenging a decision, focus on evidence and the CHC criteria. It is usually more effective to explain why the assessment underestimated the nature, intensity, complexity or unpredictability of needs than to argue only that the person cannot afford care.
Can CHC be backdated?
In some cases, families may ask for a retrospective review if they believe someone should have been assessed or should have qualified earlier. Retrospective claims can be complex and time limits may apply, so it is sensible to seek advice promptly.
If you think CHC should have been considered during a hospital discharge, after a major deterioration, or before someone started paying care fees, ask the local ICB’s CHC team what retrospective review process is available.
Common mistakes families make
The CHC process can be difficult to navigate, especially when a relative is unwell. Common mistakes include:
- assuming a diagnosis automatically qualifies someone
- focusing only on care costs rather than health needs
- not asking for a Checklist when needs increase
- attending assessment meetings without evidence
- understating needs because the person seems settled on a good day
- forgetting night-time needs or hidden risks
- not asking for copies of completed forms
- missing appeal or review deadlines
It is also common for family carers to downplay how much they do. If you are providing constant supervision, prompting, medication support, transfers, personal care, behaviour management or night-time help, that should be clearly explained.
CHC and hospital discharge
CHC often comes up when someone is leaving hospital. Families may be told that care needs to be arranged quickly, but they may not be clear who is paying, whether the person has had a CHC Checklist, or whether needs are temporary or long term.
Ask hospital discharge staff:
- Has a CHC Checklist been considered?
- If not, why not?
- Are the person’s needs expected to improve or remain long term?
- Who is arranging interim care?
- Who is paying for care during any assessment period?
- When will longer-term needs be reviewed?
If you are trying to understand the wider hospital pathway, our guide to how hospital referrals work in the UK may help with the broader system.
CHC, dementia and care needs
Dementia is one of the areas where families often feel confused about CHC. A person may have advanced dementia, need 24-hour supervision, and still be told they do not qualify. This is because the assessment looks not only at diagnosis and supervision, but at the level and type of health need.
However, dementia can contribute to high or complex needs in several domains, including cognition, behaviour, nutrition, continence, mobility, communication, medication and skin integrity. If the person has risks such as aggression, severe distress, wandering, falls, choking, weight loss, pressure damage, refusal of care or unpredictable behaviour, these should be fully evidenced.
Our guide to dementia vs depression vs mild cognitive impairment may help families understand memory and cognition concerns more broadly.
Practical wording when requesting a CHC Checklist
If you are writing to request a Checklist, you might keep it simple:
Example wording:
I am requesting that an NHS Continuing Healthcare Checklist is completed for [name]. Their care needs have increased and I believe they may have a primary health need. In particular, I am concerned about [briefly list key needs, such as mobility, cognition, behaviour, nutrition, medication, skin integrity or risks]. Please confirm who will complete the Checklist and when we can expect this to happen.
Keep a copy of the request. If you speak by phone, follow up with an email or letter confirming what was discussed.
Where to get help with CHC
CHC can be stressful, especially when large care fees or urgent care decisions are involved. Support may be available from:
- the local ICB CHC team
- the person’s GP, district nurse or hospital team
- adult social care
- care home nurses or managers
- Age UK
- Beacon CHC, an organisation that provides information and support about CHC
- specialist advisers or solicitors, particularly for complex appeals
Before paying for professional help, check what is included, what fees apply, and whether they take a percentage of any recovered funding. Some families benefit from specialist advice, but not every case needs a paid representative.
Final thoughts
NHS Continuing Healthcare can make a major difference for people with significant ongoing health needs and for families facing care decisions. But it is not automatic, and it is not based on diagnosis or financial hardship. Eligibility depends on whether the person has a primary health need.
If you think someone may qualify, ask for a CHC Checklist. Gather evidence, keep clear records, take part in the assessment, and ask for written reasons if CHC is refused. If you disagree with the decision, use the review process and focus on the nature, intensity, complexity and unpredictability of the person’s needs.
For official information, see the NHS guide to NHS Continuing Healthcare, NHS England’s NHS Continuing Healthcare page, and the GOV.UK Checklist and Decision Support Tool.
This article is for general information only and should not replace medical, legal, financial or social care advice. If you are making decisions about care funding, speak to the relevant NHS Continuing Healthcare team, local authority adult social care, or an appropriate adviser.
Frequently asked questions
Who qualifies for NHS Continuing Healthcare?
Adults aged 18 or over may qualify if they are assessed as having a primary health need. This means their overall care needs are mainly health-related because of their nature, intensity, complexity or unpredictability. Eligibility is based on assessed needs, not diagnosis, savings or property.
Is NHS Continuing Healthcare means-tested?
No. NHS Continuing Healthcare is not means-tested. It does not depend on income, savings or home ownership. It is different from local authority social care funding, which usually includes a financial assessment.
Can someone with dementia get NHS Continuing Healthcare?
Yes, someone with dementia can qualify, but dementia does not automatically mean eligibility. The assessment looks at the person’s actual needs, such as cognition, behaviour, mobility, nutrition, continence, medication, skin care, supervision and risks.
How do I apply for NHS Continuing Healthcare?
You can ask for a CHC Checklist through the GP, district nurse, hospital discharge team, social worker, care home manager or local ICB CHC team. If the Checklist indicates that a full assessment is needed, a multidisciplinary team should assess eligibility using the Decision Support Tool.
Can NHS Continuing Healthcare pay for care at home?
Yes. CHC can fund care at home if the person qualifies and the agreed package of care can safely meet their assessed needs. It can also apply in care homes, nursing homes or other suitable settings.
What is the CHC Checklist?
The CHC Checklist is a screening tool used to decide whether someone should be referred for a full NHS Continuing Healthcare assessment. It is not the final eligibility decision.
What is the Decision Support Tool?
The Decision Support Tool, or DST, is used during the full CHC assessment. It considers care needs across domains such as breathing, nutrition, mobility, cognition, behaviour, medication and skin integrity, then helps the multidisciplinary team make an eligibility recommendation.
What if NHS Continuing Healthcare is refused?
Ask for the decision in writing, including the completed Checklist or Decision Support Tool and reasons for refusal. If you disagree, you can ask the ICB to review the decision through local resolution. If unresolved, there may be a route to independent review.
What is fast-track NHS Continuing Healthcare?
Fast-track CHC is for people whose health is deteriorating quickly and who may be nearing the end of life. It is designed to put an appropriate care package in place quickly, usually without the standard Checklist and full DST process.
Can CHC funding be reviewed or stopped?
Yes. If CHC is awarded, the care package and eligibility should be reviewed, usually within three months and then at least annually. If needs change, eligibility may be reconsidered. Any decision to remove funding should be properly explained and can be challenged if you disagree.
