NHS Continuing Healthcare

The NHS CHC assessment follows the National Framework for NHS Continuing Healthcare (last revised 2022). A multi-disciplinary team (MDT) first completes a Checklist screening tool; those who meet the threshold proceed to a full assessment using the Decision Support Tool (DST), which scores needs across 12 care domains. A person is eligible if they have a 'primary health need' — determined by the nature, intensity, complexity, or unpredictability of their needs. Eligibility is not linked to a diagnosis, setting of care, or what care costs. Integrated Care Boards (ICBs) are responsible for CHC in England. Families can request a review if they disagree with a decision and have the right to an independent review by NHS England. Retrospective reviews can be requested for past periods of care, subject to a 12-year limitation period.

In practice, the assessment turns on four key indicators applied to the whole picture of someone's needs: nature, intensity, complexity and unpredictability. Families lose winnable cases by describing what care is currently provided rather than what the person actually needs, and by letting the panel treat well-managed needs as though they were mild. A need that is only stable because skilled staff are managing it hour by hour is still an intense and complex need.

Worked example: Bill has advanced Parkinson's with swallowing difficulties, frequent falls, unpredictable freezing episodes and fluctuating cognition. The Checklist screens him in. At the full assessment, the multi-disciplinary team scores him high in Breathing, Nutrition and Mobility and severe in Behaviour on some days. His daughter asks for the care home's daily notes and the district nurse records in advance, brings a two-week diary showing three falls and two choking incidents, and asks that the fluctuation itself be recorded rather than averaged out. She also asks for the reasons behind each domain score in writing, because those reasons are what any later review will scrutinise.

The common misconceptions matter financially. CHC eligibility is not about a diagnosis, a setting, or how expensive the care is — someone at home can qualify and someone in a nursing home may not. It is not means-tested, so savings and property are irrelevant, and no financial assessment should be carried out until eligibility is decided. If needs are rapidly deteriorating and the person may be approaching the end of life, the Fast Track pathway can be used by an appropriate clinician and should produce a decision within days rather than weeks. Families should also know that a decision not to fund can be challenged: first through local resolution, then by asking NHS England for an independent review.

CHC sits directly above NHS-funded nursing care, which is the lower-value contribution paid when someone needs nursing input but does not meet the primary health need test, and it displaces the council's duties following a care needs assessment. Start with our guide to NHS Continuing Healthcare, and see the Fast Track route if the situation is deteriorating quickly.