Guides · The basics
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is full NHS funding for a person's ongoing care in England, in a care home or at home, when their main need is a health need. The decision rests on the level and type of their day-to-day care needs, not on their diagnosis, their savings or where they live.
Most families first hear those three words in a crisis. A parent is ready to leave hospital, a condition has worsened, or a care home invoice has landed, and someone mentions in passing that the NHS might pay. For many people that mention comes late or never. CHC is set out in an official rulebook, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care(Department of Health and Social Care, July 2022 revised). Every claim in this guide comes from that Framework and its supporting guidance.
The Framework applies in England only. Scotland, Wales and Northern Ireland run their own systems. It also sets out a safety net worth knowing from day one: "There should be no gap in the provision of care" between the NHS and the local authority (National Framework, page 22).
Who qualifies for NHS Continuing Healthcare?
A person qualifies when the assessment finds they have a "primary health need", the single legal test the whole process turns on. In plain terms, it asks whether the main part of the care they need is about managing and preventing health needs, rather than help with everyday living alone.
"Having a primary health need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day-to-day care needs taken in their totality."
National Framework, page 22
To judge that, assessors weigh four characteristics of the person's needs (National Framework, pages 23 to 24):
- Nature: what the needs are like and the type of care they call for.
- Intensity: how much care is needed, how severe the needs are, and how continuous the support must be.
- Complexity: how the needs present and interact, and the skill it takes to manage them.
- Unpredictability: how much the needs fluctuate, and the risk to the person's health if care is not timely.
The Framework says each of these characteristics may, "alone or in combination", demonstrate a primary health need (National Framework, page 24). Our guide to the CHC eligibility criteria works through each test in detail. It also closes off a common wrong turn: "The diagnosis of a particular disease or condition is not in itself a determinant of eligibility" (National Framework, page 24). So there is no list of qualifying illnesses. A person with dementia, Parkinson's or the after-effects of a stroke may qualify or may not. What counts is the care their needs actually demand, day by day.
How is CHC decided?
The decision runs in two assessment stages. The first is the Checklist, a screening tool. A professional scores 11 areas of need, called domains, at level A, B or C, where A is the highest level of need. The domains cover breathing, nutrition, continence, skin, mobility, communication, psychological and emotional needs, cognition, behaviour, medication, and altered states of consciousness. Enough high scores, or one A in a priority domain, and the person must be referred for a full assessment. Our free screener walks you through those same 11 areas in plain English and shows whether a full assessment looks due. For the domains, the scores and the referral thresholds in detail, read our guide to the CHC Checklist.
The Checklist threshold "has intentionally been set low, in order to ensure that all those who require a full assessment of eligibility have this opportunity" (National Framework, page 40). A positive Checklist means the person requires a full assessment. It does not necessarily mean they will be found eligible (Checklist guidance, paragraph 26).
The full assessment uses the Decision Support Tool (DST). A multidisciplinary team (MDT) works through 12 care domains and rates each one on a scale that runs from no needs up to severe, and in four domains up to priority. The team then recommends a decision to the integrated care board (ICB), the NHS body that holds the funding. The DST guidance expects a clear recommendation of eligibility where there is one priority level need, or two or more severe level needs (Decision Support Tool guidance, paragraph 35). Other combinations of high and moderate needs may also indicate a primary health need.
One rule matters at every stage, because good care so often hides the very needs being assessed:
"The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs."
National Framework, page 51
If your relative seems settled because carers manage their medication, their behaviour or their skin care well, those needs still count. The Framework even suggests asking the care provider to keep a detailed diary to demonstrate the nature and frequency of the needs and interventions (National Framework, page 51).
Is CHC means tested?
No. Money plays no part in the eligibility decision. For the full picture of the three ways care gets paid for, see who pays for care home fees. The Framework states the CHC position in one line:
"Financial issues should not be considered as part of the decision on an individual's eligibility for NHS Continuing Healthcare."
National Framework, page 24
This is where CHC differs from council-arranged social care. The Framework describes local authority funding as "subject to the person's means" (National Framework, page 22). NHS funding carries no such condition. Savings, income, property and pensions are all irrelevant to whether someone qualifies. A family that would never pass a council means test can still receive CHC, because the test looks only at health needs.
Where can CHC be provided?
Anywhere the care is needed. The Framework is explicit that the setting is irrelevant to eligibility:
"NHS Continuing Healthcare may be provided in any setting (including, but not limited to, a care home, hospice or the person's own home). Eligibility for NHS Continuing Healthcare is, therefore, not determined or influenced either by the setting where the care is provided or by the characteristics of the person who delivers the care."
National Framework, page 24
So a parent living at home with visiting carers can qualify on the same basis as someone in a nursing home. Who delivers the care makes no difference either. The question stays the same in every setting: does this person have a primary health need?
What is the process, step by step?
The full route runs from a screening Checklist to, if every appeal is needed, the Parliamentary and Health Service Ombudsman. The timescales below come from the Framework and NHS England's own guidance. Most are expectations rather than hard rules, so hold the ICB to them in writing.
| Step | Stage | What happens | Timescale in the guidance |
|---|---|---|---|
| 1 | Checklist | A professional screens 11 domains of need at level A, B or C and sends the form to the ICB. | Sent "without delay". The outcome is put in writing as soon as is reasonably practicable. |
| 2 | DST and MDT | A multidisciplinary team completes the Decision Support Tool across 12 domains and recommends a decision. | Positive Checklist to eligibility decision should not exceed 28 calendar days in most cases. |
| 3 | ICB decision | The integrated care board decides eligibility, and should explain how to challenge the decision and the timescales for doing so. | The ICB normally responds to the MDT recommendation within 48 hours. |
| 4 | Local resolution | The ICB's own published process for disagreements about the decision. | No national deadline. Each ICB must publish its own process and timescales. |
| 5 | Independent Review Panel | NHS England reviews the primary health need decision, or the procedure the ICB followed. | Application form returned within six weeks. The process typically takes three to six months. |
| 6 | Ombudsman | The Parliamentary and Health Service Ombudsman can consider a complaint if the decision is upheld and the challenge continues. | No timescale stated in the Framework. |
There is also a faster route for the hardest situations. Where a person has a rapidly deteriorating condition that may be entering a terminal phase, a clinician completes the Fast Track Pathway Tool instead. It replaces the Checklist and the DST. The ICB must accept and immediately action a properly completed Fast Track tool, and the care package should not usually take more than 48 hours to agree and commission (National Framework, page 79).
If you would rather hand the process over than run it yourself, our Case Report and Case Manager plans prepare each of these steps for you.
What is NHS-funded Nursing Care?
NHS-funded Nursing Care (FNC) is the lower of the two awards the National Framework covers. The document's full title names them both: the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. CHC is the full package, with the NHS funding the person's assessed care in full. FNC is the smaller award that sits beneath it in the same guidance. Our guide to how FNC works covers it in detail.
If your relative has been given FNC and you believe their needs run deeper, that is worth testing. The Checklist route to a full CHC assessment stays open.
Common questions
Does a dementia diagnosis mean someone qualifies for CHC?
No single diagnosis qualifies or disqualifies anyone. The National Framework says a diagnosis is not in itself a determinant of eligibility. Assessors look at the level and type of day-to-day care needs in their totality. Two people with the same condition can receive different decisions.
Who pays for care while a CHC decision is pending?
The guidance says a person should not be left without appropriate support while they wait for the outcome. If the ICB takes more than 28 days without good reason and the person is then found eligible, it should refund the care costs from day 29 to the decision date.
Can CHC funding be taken away later?
Funding should be reviewed within three months of the decision, then at least once a year. The Framework says neither an ICB nor a council should withdraw from an existing funding arrangement without a joint reassessment, with alternative funding agreed and in place before any withdrawal.
How long does a CHC decision take?
The National Framework (page 55) says the ICB receiving a positive Checklist to its eligibility decision should not exceed 28 calendar days in most cases. In hospital, when the person is ready to leave, it should take far fewer days. The ICB normally responds to the team within 48 hours.