NHS Continuing Healthcare for Adults

NHS Continuing Healthcare (CHC) is a package of care arranged and fully funded by the NHS for adults who have a primary health need — that is, where their overall care needs are primarily due to their health condition rather than social care needs.

CHC can fund:

• Care in a nursing home or residential care home
• Care at home, including personal care, nursing visits, and specialist therapies
• Any combination of the above

Crucially, CHC is free of charge to the recipient, unlike local authority funded social care which is means-tested. Families who are already paying for care should request a CHC assessment if they believe a loved one may qualify — NHS eligibility does not depend on your savings or income.

The CHC assessment process has two stages:

1. CHC Checklist: A brief screening tool completed by a nurse or other health/social care professional. It looks at 12 domains of need. If the checklist indicates the person may qualify, a full assessment is triggered. If it does not, CHC is not pursued further — but you can request a review of this decision.
2. Full Assessment using the Decision Support Tool (DST): A more detailed assessment carried out by a multidisciplinary team (MDT). The DST looks at the same 12 domains in depth (behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other needs). Each domain is rated as Priority, Severe, High, Moderate, Low, or No needs.

The MDT then makes a recommendation to the Integrated Care Board (ICB), which makes the final eligibility decision. The whole process should ideally be completed within 28 days of the checklist.

The central eligibility question is whether your primary need is a health need. This is not simply about the number or type of conditions — it is a holistic judgement based on the nature, complexity, intensity, and unpredictability of your needs.

A person with one or more Priority needs or two or more Severe needs in the Decision Support Tool is likely to be eligible for CHC. However, the MDT must consider the whole picture and cannot apply a purely mechanical approach.

Common reasons for CHC eligibility include: complex neurological conditions (e.g., advanced MS, acquired brain injury), end-of-life care with high medical need, severe dementia with complex behavioural needs, and conditions requiring frequent nursing interventions.

If CHC eligibility is refused and you believe this is wrong, you have the right to appeal:

1. Local review by the ICB: Request a local resolution meeting with the ICB within three months of the decision. Bring the DST and any supporting evidence (GP letters, specialist reports, care home records).
2. Independent Review Panel: If the local review does not resolve the issue, you can request an Independent Review Panel (IRP) via NHS England.
3. Parliamentary and Health Service Ombudsman: If you remain unsatisfied, the PHSO can investigate procedural failures in the CHC process.
4. Legal challenge: In some cases, judicial review may be an option if the ICB has acted unlawfully.

The CHC Alliance (chcalliance.org) provides free guidance and support for people navigating CHC assessments and appeals.