What Is NHS Continuing Healthcare?
If you're trying to work out how you'll pay for a parent's care, it's worth knowing early on that not all long-term care is means-tested. NHS Continuing Healthcare, usually shortened to CHC, is a package of care arranged and funded in full by the NHS for people assessed as having significant, ongoing healthcare needs. Unlike the social care your local council arranges, which is means-tested against income, savings and property, CHC is free regardless of how much money someone has in the bank or whether they own their home.
If a person is found eligible, the NHS pays for the whole package of care, not just the medical or nursing elements. In a care home, that means the accommodation and daily living costs are covered too, not just a contribution towards them. It's a different funding route entirely from the local authority means test, and it's worth understanding both before assuming you know which one applies to your situation.
This article focuses on the process in England, where eligibility is assessed against the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, published by NHS England and the Department of Health and Social Care. Scotland has its own scheme, known as Hospital Based Complex Clinical Care, and Wales operates NHS Continuing NHS Healthcare with its own rules and forms. If your relative lives in either nation, the underlying principle is similar, but check the guidance that applies there rather than assuming the English process transfers across.
CHC Versus Council-Funded Social Care
It helps to keep two systems distinct in your mind. Council-funded social care, sometimes called local authority care, is means-tested against income, savings and property: if someone has assets above the relevant threshold, they're expected to contribute towards, or pay for, their own care. NHS Continuing Healthcare works on a completely different basis — there is no means test at all. Eligibility depends solely on the nature and extent of someone's health needs, as judged through a formal NHS assessment process, not on their financial circumstances.
Two people with identical savings could have very different outcomes: one assessed as eligible for CHC and paying nothing, the other assessed as not eligible and facing the local authority means test instead. It's also possible to be assessed for CHC and found not eligible, but still receive NHS-funded nursing care, a smaller weekly payment towards the nursing costs of a care home place, while the rest of the fees remain means-tested. CHC and NHS-funded nursing care are assessed through a related process, but they are not the same thing, and it's the CHC assessment that matters most if you're hoping care costs will be covered in full — see NHS.uk's guide to continuing healthcare for how the two interact.
The Eligibility Process, Step by Step
CHC isn't something you apply for by filling in a form, in the way you might claim Attendance Allowance. It's identified through a two-stage assessment process that should be triggered whenever someone's health and care needs suggest CHC might be relevant, whether that's during a hospital stay, at the point of moving into a care home, or when needs at home increase. The two stages are the Checklist and, if that indicates possible eligibility, the full Decision Support Tool assessment.
Step One: The Checklist
The Checklist is a screening tool, not a decision in itself. It's usually completed by a nurse, social worker or other health or care professional who already knows the person — often a hospital discharge team, a district nurse, or care home staff working alongside the local Integrated Care Board (ICB), the NHS body that replaced Clinical Commissioning Groups (CCGs) in 2022 and is now responsible for arranging and funding CHC in each area.
The Checklist scores need across the same broad areas used in the full assessment, but at a lower level of detail. It exists to filter out people who clearly won't meet the CHC threshold, while identifying everyone who might, so that the more detailed full assessment isn't needed for every person receiving care. NHS guidance suggests a decision on whether someone should go forward to a full assessment should usually be made within 28 days of the Checklist being completed. If the Checklist indicates possible eligibility, the case moves to the second stage.
Step Two: The Decision Support Tool
If the Checklist suggests CHC might apply, the case is referred for a full assessment using the Decision Support Tool (DST). This is carried out by a multidisciplinary team (MDT), made up of at least two professionals from different healthcare backgrounds — for example a nurse and a social worker, or an occupational therapist and a GP — who don't already have a role in making funding decisions for the case.
The DST itself isn't a new set of tests. It's a structured framework, set out in NHS England's Decision Support Tool guidance, for pulling together all the evidence already gathered — from care records, professional observations and family input — and recording it against a defined set of care domains. The MDT then uses that record to form a professional recommendation about whether the person has what the framework calls a primary health need.
The 12 Care Domains Assessed
The DST organises a person's needs into twelve care domains, each rated from no needs up to severe or priority, depending on the domain. These are:
- Breathing — from mild breathlessness to needs requiring specialist respiratory support
- Nutrition — food and drink intake, swallowing difficulties, and the need for tube feeding
- Continence — bladder and bowel needs, including catheters or stoma care
- Skin and tissue viability — the risk of, or presence of, pressure sores and wounds
- Mobility — the ability to move safely and the risk of falls
- Communication — the ability to make needs known and understand others
- Psychological and emotional needs — anxiety, distress, or mental health needs linked to the person's condition
- Cognition — memory, orientation and understanding, often relevant in dementia
- Behaviour — behaviour that challenges, and the risk it poses to the person or others
- Drug therapies and medication — how complex or high-risk a person's medication regime is
- Altered states of consciousness — seizures, blackouts, or fluctuating consciousness
- Other significant care needs — anything relevant that isn't captured by the other eleven domains
Not every domain needs to show a high level of need for someone to be eligible. It's the overall pattern across all twelve, combined with the four key indicators below, that the multidisciplinary team weighs up.
The Four Key Indicators: Nature, Intensity, Complexity, Unpredictability
Alongside the twelve domains, the National Framework sets out four key indicators that the multidisciplinary team uses to judge whether someone's overall needs amount to a primary health need. These aren't a separate checklist; they're the lens through which the domain ratings are interpreted.
- Nature — the type of need and what it means for the person, for example whether it is physical, psychological, or both, and what kind of intervention it calls for
- Intensity — how much care is needed and how severe it is, including whether support has to be continuous rather than occasional
- Complexity — how different needs interact with and affect each other, and how much skill and knowledge staff need to manage them safely
- Unpredictability — how much a person's needs fluctuate, and how difficult that makes it to plan and deliver consistent care
As a general guide, the framework indicates that a recommendation of eligibility is expected where the DST records at least one domain rated Priority, or Severe ratings in two or more domains. This is a helpful signpost, but the National Framework is explicit that it isn't a mechanical scoring system: reaching those levels doesn't automatically confirm eligibility, and falling short of them doesn't automatically rule it out either. The MDT is required to step back and consider the four key indicators together, in the round, to decide whether the totality of the person's needs amounts to a primary health need that is mainly about managing health, rather than day-to-day social care. The completed DST and the MDT's recommendation are then passed to the Integrated Care Board, which is expected to accept the recommendation in the great majority of cases.
Why CHC Isn't Always Raised by Default
Given how significant a fully funded package of care can be, it's natural to wonder why CHC assessments aren't offered automatically to everyone who might qualify. In practice, CHC is not always raised by default, so knowing to ask matters.
There are practical reasons for this rather than any single cause. Integrated Care Boards manage the assessment process alongside significant demand and finite specialist staff time, and completing a Checklist or DST properly takes time from nurses and social workers who are often stretched across many cases. Awareness of CHC among some frontline staff, particularly outside specialist teams, can also be inconsistent, so a Checklist isn't always suggested at the moments it should be, such as hospital discharge or a change in a care home resident's condition.
None of this means a family has to wait passively. You can ask, at any point, for a Checklist to be completed, whether your relative is in hospital, already living in a care home, or being cared for at home. Asking early, and asking in writing, is often the simplest way to make sure the process starts when it should.
If You're Refused: Your Appeal Rights
If the Integrated Care Board decides someone is not eligible for CHC, or changes the domain ratings the MDT recommended, you have the right to challenge that decision. The outcome letter you receive should set out the reasons for the decision and explain how to appeal.
The first stage is local resolution, where you ask the Integrated Care Board to look again at the decision, often by providing further evidence or challenging specific domain scores. If that doesn't resolve things to your satisfaction, you can request an Independent Review Panel, arranged by NHS England rather than the Integrated Care Board itself. The panel includes an independent chair appointed by NHS England, along with representatives from the Integrated Care Board and the local authority's social services department, as set out in NHS England's independent review process guide.
There are set timescales worth knowing. You generally have six months from the date of the outcome letter to request an Independent Review, and six weeks from that request to submit your supporting evidence. NHS England aims to complete the review within around three months of the request, though in practice, especially where a case is complex or contested, it can take considerably longer. It's a formal process, so keeping copies of assessments, care records and correspondence from the outset makes it far easier to build a case later if you need to.
For a full step-by-step walkthrough of the appeal process itself, see our guide to appealing an NHS Continuing Healthcare rejection.
If you're trying to understand how funding decisions like this fit into the bigger picture of paying for care, RightCareHome's care home funding assessment can help you map out the options alongside a CHC claim, rather than instead of one.
Fast Track CHC for Rapidly Changing Needs
There's a separate, faster route for people whose health is deteriorating quickly, often because they're approaching the end of their life. Rather than going through the Checklist and the full DST, a senior clinician who already knows the person — such as a GP, hospital consultant, or specialist nurse — can complete a Fast Track Pathway Tool. This sets out why the person's needs mean they should be considered for CHC without delay.
Because time matters in these situations, a decision on Fast Track funding should typically be made within 48 hours of the tool being completed, so that care can be arranged quickly rather than someone waiting through a lengthier assessment process. Fast Track CHC is a distinct pathway from the standard Checklist and DST route described above, though it sits within the same overall CHC funding system and is assessed by the same Integrated Care Boards.
What to Do Next
If you think a parent or relative's needs might meet the CHC threshold, the most useful first step is simply to ask their GP, hospital discharge team, or care home manager for a Checklist to be completed. You don't need to wait to be offered one, and you're entitled to request an assessment at any stage, including if circumstances have changed since an earlier Checklist found needs weren't significant enough at the time.
Keep a record of care needs as they present day to day, particularly anything relating to the twelve domains covered above, since this evidence often turns out to matter later, whether in the original assessment or in an appeal. Understanding CHC alongside the means-tested social care system, as explained on Age UK's continuing healthcare pages, will also help you make sense of any funding decision you receive, and plan realistically for the months ahead.
Frequently Asked Questions
Is NHS Continuing Healthcare means-tested?
No. Unlike council-funded social care, CHC has no means test at all. Eligibility depends entirely on the level and type of a person's health needs, not their income, savings or property.
Who decides if someone is eligible for CHC?
A multidisciplinary team of at least two health and social care professionals from different backgrounds completes the Decision Support Tool, and the local Integrated Care Board makes the final funding decision based on their recommendation.
Can someone already living in a care home still be assessed for CHC?
Yes. CHC eligibility can be assessed at any point, including after someone has already moved into a care home, if their needs change or a Checklist wasn't completed earlier.
What's the difference between CHC and NHS-funded nursing care?
NHS-funded nursing care is a smaller weekly payment towards the nursing costs within a care home, paid when someone isn't eligible for full CHC but does have some assessed nursing need. The rest of their care home fees remain means-tested.
How long does a CHC assessment take?
Timescales vary by area and case complexity, but NHS guidance suggests a decision on whether to proceed from Checklist to full assessment should usually be made within 28 days. The full Decision Support Tool assessment and subsequent Integrated Care Board decision can take longer, particularly if a panel review is involved.
What happens if my relative is refused CHC?
You can ask the Integrated Care Board to reconsider the decision locally, and if that doesn't resolve things, request an Independent Review Panel through NHS England, generally within six months of the outcome letter.