NHS Continuing Healthcare: who qualifies, and how to ask
NHS Continuing Healthcare pays for the whole care package, at home as well as in a care home. Here is what a primary health need means and how the assessment runs.
Written by Terence Mafuva, Operations Manager
· 5 min read
Of all the funding routes families ask about, this is the one with the widest gap between what people expect and what they find. NHS Continuing Healthcare pays for everything, which sounds like the answer to every worry about money. It is also assessed strictly, refused often, and poorly understood by almost everyone approaching it for the first time. This is what it actually is.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare, usually shortened to CHC, is a package of care arranged and fully funded by the NHS for adults with significant ongoing health needs. Because it is health funding rather than social care funding, it is not means tested. Your savings, income and property are irrelevant to the decision.
That is the crucial difference. Social care is charged for according to what you can afford. CHC is not charged for at all. If someone is eligible, the NHS pays for the whole package, including personal care that social services would otherwise have assessed you to contribute towards.
Who qualifies for NHS Continuing Healthcare?
Anyone over 18 assessed as having a primary health need. That means the main reason you need care is a health need rather than a social one. It does not depend on a particular diagnosis, condition or setting, and it is not decided by how much care you need but by what kind.
The assessment weighs your needs against four key characteristics: nature, intensity, complexity and unpredictability. A district nurse visiting to change a dressing is a health task, but it may be routine and predictable. Needs that are unstable, hard to manage, that interact with each other, or that require skilled intervention at unpredictable times, point towards a primary health need.
| Characteristic | What it asks |
|---|---|
| Nature | What kind of needs are these, and what sort of skill do they demand? |
| Intensity | How severe are they, and how much support do they require? |
| Complexity | How do the needs interact, and how difficult is it to manage them together? |
| Unpredictability | How much do they fluctuate, and what is the risk if they are not met quickly? |
Does a dementia diagnosis qualify?
No. A diagnosis on its own never qualifies anyone, and dementia is the condition where that disappointment is felt most often. What can qualify is the way dementia presents in a particular person: unpredictable distress, risk behaviours, swallowing difficulties, or needs that require skilled management rather than familiar routine.
This is worth understanding before an assessment rather than after. Families who go in expecting the diagnosis to carry the argument tend to describe the condition. Families who describe the daily reality, what happened at three in the morning, what the risk actually was, how quickly things changed, give the assessors what the framework asks for.
How does the assessment work?
It runs in two stages. First a Checklist, a short screening tool that any health or social care professional can complete, decides whether you should be referred on. Then, if you are, a multidisciplinary team completes the Decision Support Tool, which scores twelve care domains and forms a recommendation.
- Ask a GP, hospital nurse, discharge coordinator or social worker to complete a Checklist
- If the Checklist is positive, a full assessment is arranged
- A multidisciplinary team completes the Decision Support Tool across twelve domains
- The team makes a recommendation, and the integrated care board makes the decision
- You are told in writing, with reasons, and you can ask for a review if you disagree
The Checklist is deliberately a low bar. It is designed to catch people who might be eligible, not to decide anything. Being referred on is not a promise, and not being referred on is something you can challenge.
What are the twelve domains?
The Decision Support Tool scores twelve areas of need, each on a scale from no needs up to priority. They are breathing, nutrition, continence, skin integrity, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, altered states of consciousness, and any other significant need.
One priority score, or two severe scores, normally indicates a primary health need. Beyond that, the recommendation is a judgement across the whole picture rather than a total. This is why preparation matters: a domain scored on a calm description of an average day looks very different from the same domain scored on an accurate account of a bad week.
Can it be provided at home?
Yes. CHC is not a care home product. It can fund care in your own home, and for many people that is exactly where it should be delivered. The NHS will consider cost and risk when deciding how to meet the need, but the setting is part of the conversation and you are entitled to make the case for home.
If a package is agreed at home, the integrated care board commissions it, often through a registered home care provider. Some areas also offer a personal health budget, which works in a similar spirit to a direct payment and lets you have a say in who delivers the care rather than simply receiving whoever is commissioned.
What can you do to prepare?
- Keep a diary for a fortnight: times, incidents, what was needed and how quickly
- Gather letters from the GP, consultants, district nurses and the falls team
- Ask for a copy of the Checklist and the Decision Support Tool before the meeting
- Attend the assessment, or send someone who knows the day-to-day detail
- Ask for the reasons in writing, whatever the outcome
Describe the worst days honestly rather than the composed version people give a professional out of pride. Assessors are looking at need, and a well-managed need that has been quietly absorbed by an exhausted family is still a need.
If you are turned down
Most people are. You can request a review of the decision through the integrated care board, and if that does not resolve it you can ask NHS England for an independent review. There are also related routes that are less well known: NHS-funded nursing care contributes towards nursing home fees, and Section 117 aftercare is free for people previously detained under certain sections of the Mental Health Act.
None of this is quick, and it is genuinely difficult to pursue while also providing the care day to day. If you are somewhere in this process and simply want someone to read the letter and explain in plain English what it means and what your options are, we are happy to talk it through, whether or not we end up being the provider.
Common questions
- Is NHS Continuing Healthcare means tested?
- No. It is health funding, so savings, income and property make no difference to eligibility. That is the single biggest way it differs from local authority social care funding.
- Who can request a Checklist?
- Any health or social care professional involved in the person’s care: a GP, a hospital nurse, a discharge coordinator or a social worker. You can ask any of them to complete one, and you should ask in writing if it is being avoided.
- How long does the process take?
- The Checklist is quick. A full assessment and decision should normally be completed within 28 days of the referral, though in practice it often runs longer. Ask for timescales in writing at the start.
- What is a personal health budget?
- It is the NHS equivalent of a direct payment: an amount agreed with the integrated care board that you can use to arrange your own care to meet agreed health outcomes. If you have CHC at home, it is worth asking whether one is available.
Where this comes from
- NHS continuing healthcare, NHS
- NHS continuing healthcare decision support tool guidance, Department of Health and Social Care
- NHS continuing healthcare checklist, Department of Health and Social Care
- NHS continuing healthcare and NHS-funded nursing care: public information leaflet, Department of Health and Social Care
This article is general information, not medical, legal or financial advice. Rules and rates change, and everyone’s situation is different. For advice about a specific person, speak to their GP, to Lincolnshire County Council adult social care on 01522 782155, or to an independent adviser. Crossways Care Services is registered with the Care Quality Commission since June 2023, not yet inspected.
