NHS Continuing Healthcare

NHS Continuing Healthcare is a package of ongoing health and personal care provided and fully funded by the NHS. It can be provided in a care home (including a nursing home), in your own home, or in another setting. Unlike social care funded by the council, CHC has no capital threshold — your financial situation is irrelevant to whether you qualify.

The key legal test is whether your primary need for care arises from health. This is sometimes called the "primary health need" test. If your most significant need is a health need (rather than a social or care need), the NHS is responsible for funding all your care. If your primary needs are social or personal care, the council may be responsible — and a means test will apply.

CHC is available to adults of any age — it is not limited to older people. It is particularly relevant for people with complex or severe health conditions such as advanced dementia, Huntington's disease, Parkinson's disease, cancer requiring intensive nursing care, or severe acquired brain injury.

CHC assessment happens in two stages:

1. The CHC Checklist — A brief screening tool completed by a health or social care professional (nurse, social worker, occupational therapist) to determine whether a full assessment is warranted. The checklist looks at 11 care domains. If the person has sufficient needs in enough domains, they proceed to a full assessment. Anyone can ask for a CHC checklist to be completed — you do not need to wait to be referred.
2. The Decision Support Tool (DST) — A multidisciplinary team (MDT) assessment using a standardised tool that rates the person's needs across 12 care domains — behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin integrity, breathing, drug therapies and symptom control, altered states of consciousness, and other significant needs — as Priority, Severe, High, Moderate, Low, or No needs. The MDT then makes a recommendation on CHC eligibility.

The MDT makes a recommendation; a healthcare professional at the Integrated Care Board (ICB) makes the final CHC eligibility decision. Under the National Framework the whole process should normally be completed within 28 days of the checklist. The process should involve the person and their family and should be explained clearly. You are entitled to a written record of the DST and the decision.

If the checklist is negative and CHC is not pursued, that screening decision can itself be reviewed — ask the ICB in writing to reconsider it.

The central eligibility question is whether the person's primary need is a health need. This is not a matter of counting diagnoses or naming a condition. It is a holistic judgement based on four characteristics of the person's needs:

• Nature — the type of needs and the kind of interventions they require;
• Complexity — how the needs interact and how skilled the response must be;
• Intensity — the quantity, severity and continuity of care needed;
• Unpredictability — how far needs fluctuate and what risk that creates.

A person with one or more Priority needs, or two or more Severe needs, in the Decision Support Tool is likely to be eligible. The MDT must still consider the whole picture, however, and cannot apply a purely mechanical scoring approach — a mechanical decision is one of the strongest grounds for challenging a refusal.

Needs commonly found to meet the test include complex neurological conditions (advanced MS, acquired brain injury, Huntington's or Parkinson's disease), end-of-life care with high medical need, severe dementia with complex behavioural needs, and conditions requiring frequent nursing intervention.

If CHC is refused, you have the right to challenge the decision. The process is:

1. Local review by the ICB — Request a local resolution meeting with the Integrated Care Board within three months of the decision. You should receive a written explanation of why CHC was not recommended, and the review must be completed within 3 months.
2. Independent Review Panel (NHS England) — If local resolution does not settle it, request an Independent Review Panel (IRP) via NHS England.
3. Parliamentary and Health Service Ombudsman (PHSO) — If you believe proper processes were not followed, you can complain to the PHSO.

Many families successfully overturn initial refusals on review. Our separate guide to challenging a CHC refusal covers each stage in detail — the evidence that actually shifts a decision, your right to an advocate or IMCA, what to do if funding is withdrawn mid-review, and how retrospective claims for privately funded care work.

If you receive CHC funding at home, you may be offered a Personal Health Budget (PHB). A PHB gives you greater control over how your NHS-funded care package is designed and delivered. Rather than receiving services commissioned entirely by the ICB, you receive an allocated sum and can use it to employ personal assistants, choose specific care providers, or purchase care that is personalised to your lifestyle and preferences.

NHS England introduced a right to request a PHB for CHC recipients in April 2014. The ICB must offer a PHB to anyone in receipt of NHS CHC funding who wants one, unless there are exceptional clinical or operational reasons why this is not appropriate. In practice, take-up remains relatively low — many CHC recipients are not informed of this right.

A PHB can be held in several ways:

• Notional budget — the ICB commissions care on your behalf but you have agreed the care plan and providers;
• Third-party managed budget — a nominated third party (such as a carer organisation) holds and manages the funds on your behalf;
• Direct payment — the ICB pays the money directly to you, giving maximum flexibility but also full responsibility for managing care arrangements, employment, and accounts.

If you would like a PHB, ask the ICB's CHC team explicitly. They must tell you about the option and give you enough information to make an informed decision. If you are refused a PHB without a clear clinical reason, this can be challenged through the ICB's complaints process. The NHS England national PHB programme page provides guidance on how PHBs work and how to request one.