NHS Continuing Healthcare explained
NHS Continuing Healthcare can pay the full cost of care for people whose needs are mainly about health. This guide explains who qualifies and how the assessment works.
NHS Continuing Healthcare, or CHC, is a package of care arranged and fully funded by the NHS for adults with significant, ongoing health needs. Unlike council funding, it is not means-tested, so it does not matter how much you have in savings or whether you own a home. To qualify you must be assessed as having a primary health need. Assessment starts with a checklist and, if that is met, moves to a full multidisciplinary assessment. Decisions can be appealed.
At a glance
- What it isFully NHS-funded care for a primary health need
- Means-tested?No, it ignores your savings and home
- CoversThe full cost of care, in a home or your own home
- First stepThe CHC checklist
- ThenA full multidisciplinary assessment
- If refusedYou can ask for a review and appeal
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is free care arranged and funded entirely by the NHS for adults who have significant ongoing health needs. Where it applies, the NHS pays the full cost of care, whether that care is delivered in a care home or in the person's own home. Because it is health funding rather than social care, it is not means-tested: your savings, income and property are not taken into account.
This guide is for families and individuals. CHC applies in England; the other UK nations have similar but separate arrangements.
Who qualifies for CHC?
Eligibility turns on whether you have what the rules call a primary health need. That means your main need for care comes from your health condition rather than from help with daily living. It is about the nature, intensity, complexity and unpredictability of your needs, not about a particular diagnosis, so there is no fixed list of qualifying conditions. People with advanced, rapidly worsening or complex health needs are the most likely to qualify.
Having a serious illness such as dementia or cancer does not by itself qualify you. The assessment looks at how much care your needs require and how complex and unpredictable they are. Two people with the same diagnosis can get different decisions depending on their needs.
The checklist and full assessment
There are normally two stages. First a health or social care professional completes the CHC checklist, an initial screening tool. If the checklist is met, you move to a full assessment by a multidisciplinary team using the national Decision Support Tool, which scores needs across several care domains such as mobility, nutrition, behaviour and breathing.
- A professional completes the CHC checklist to screen your needs.
- If the checklist threshold is met, a full assessment is arranged.
- A multidisciplinary team assesses your needs using the Decision Support Tool.
- The team recommends whether you have a primary health need.
- The local NHS body makes the eligibility decision and tells you the outcome.
If your needs change, and fast-track funding
Eligibility is reviewed over time, usually within a few months of being awarded and then regularly, because health needs change. If needs reduce, funding can stop, and if they increase, you can be reassessed. Where someone is rapidly deteriorating and may be nearing the end of life, a fast-track pathway can put funding in place quickly without the full assessment process.
How to appeal a CHC decision
CHC is known for being difficult to obtain, and decisions are often disputed. If you disagree with a checklist outcome or an eligibility decision, you can ask for it to be reconsidered and, if needed, request a formal review by the local NHS body and then an independent review. Keep records of the assessment and ask for the reasons in writing.
- Ask for the decision and the reasons in writing
- Request a local review by the NHS body that made the decision
- If still unresolved, ask for an independent review
- Consider support from an advocate or a specialist CHC adviser
NHS Continuing Healthcare explained: common questions
Who qualifies for NHS Continuing Healthcare?
Adults assessed as having a primary health need, meaning their main need for care arises from a health condition rather than help with daily living. It depends on the nature, intensity, complexity and unpredictability of your needs, not on a particular diagnosis.
What are the criteria for CHC?
Eligibility is based on a primary health need, judged across four key characteristics of your needs: their nature, their intensity, their complexity and their unpredictability. A multidisciplinary team assesses these using the national Decision Support Tool across several care domains.
Is NHS Continuing Healthcare means-tested?
No. CHC is NHS health funding, so your savings, income and home are not taken into account. If you qualify, the NHS pays the full cost of your care whether it is provided in a care home or in your own home.
How hard is it to get NHS Continuing Healthcare?
It can be difficult, and decisions are often disputed. Eligibility depends on a detailed assessment of how complex and intensive your needs are, not just your diagnosis. If you are refused, you can ask for a review and, if needed, an independent review.
How do I apply for NHS Continuing Healthcare?
Assessment usually begins when a health or social care professional completes the CHC checklist. If that is met, a multidisciplinary team carries out a full assessment using the Decision Support Tool. You can ask your GP, hospital team or social worker to start the checklist.
Related guides
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