NHS Continuing Healthcare and CHC Funding: Who Qualifies and How the Assessment Works

NHS Continuing Healthcare, almost always shortened to CHC, is a package of care arranged and paid for entirely by the NHS for an adult whose need for care is primarily a health need. It is not means-tested, so savings, a house and a pension make no difference, and it can be provided in a care home or at home. For a family paying several hundred pounds a week, CHC funding is the single biggest thing that could change.

The honest headline is that the bar is high, and most people with substantial care needs do not meet it. Eligibility has nothing to do with a diagnosis, an age, a setting or the number of care hours; it turns on whether the care somebody needs is primarily a health need rather than the personal and social care a council arranges. People who need help with everything, day and night, are often found ineligible because their needs are stable and safely met by trained care staff. That is how the test is written, and knowing it early tells you what evidence to gather.

What NHS Continuing Healthcare actually is

CHC operates in England under the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, and the decision is made by the local integrated care board. Wales has its own version, Scotland replaced its scheme in 2015 with hospital based complex clinical care, and Northern Ireland differs again, so check the detail locally.

Where somebody is found eligible, the NHS pays for the whole package. In a care home that includes the accommodation part of the fee, not just the nursing. At home it means funded care, equipment and nursing input, with nothing to pay. That is why the test is applied so strictly.

Why CHC funding is so hard to get

The test is a legal one, and it rests on four things, usually called the key characteristics of need:

• Nature. What kind of need is it, and what skill does meeting it require? Managing a complex wound is a different kind of need from helping somebody wash.
• Intensity. How much support is needed, how often, and for how long at a time? Both the amount of care and whether it must be continuous.
• Complexity. How many needs interact, and how hard are they to manage together? Conditions that pull in opposite directions, so that treating one worsens another, score here.
• Unpredictability. How much does the picture change, how quickly, and what happens if the right response is not there in time? A steady, easily planned need scores low however heavy it is.

That last one surprises families most. Very heavy but very settled needs, met safely for years, often point away from eligibility rather than towards it. The framework is looking for needs beyond what a council could lawfully arrange, not needs that are simply large.

The two stages: the checklist, then the full assessment

Almost everybody goes through two stages. The first is the Continuing Healthcare Checklist, a short screening tool completed by a health or social care professional such as a nurse, social worker or GP. Its threshold is deliberately low, so passing the CHC checklist means only that a full assessment must be arranged. It is not a sign that anyone expects you to qualify: a positive checklist raises hopes the second stage then flattens.

The second stage is the full assessment, carried out by a multidisciplinary team of at least two professionals from different disciplines using the Decision Support Tool. It works through twelve care domains, from breathing, nutrition, continence and skin to mobility, communication, cognition, behaviour and medication, each scored from no needs through low, moderate, high and severe. The team weighs those scores alongside the four key characteristics. It is not arithmetic, although a priority level in one domain, or severe in two or more, points strongly towards eligibility.

A decision should normally be reached within 28 days of the checklist reaching the integrated care board, though in practice it often takes longer. Chasing politely and in writing helps, and gives you a record.

Fast Track, when somebody is deteriorating quickly

There is a separate and much faster route for anyone with a rapidly deteriorating condition that may be entering a terminal phase. A clinician responsible for that person's care, usually a hospital doctor, GP or specialist nurse, completes a Fast Track pathway tool, and funding should be in place within days rather than weeks. No checklist and no multidisciplinary assessment are needed.

Fast Track is under-used, and families are often never told it exists. If somebody is being discharged home for end of life care, ask the clinician whether a Fast Track referral is appropriate. Ask early: a decision that arrives after somebody has died helps nobody.

How to prepare, and what evidence actually counts

Anyone can ask for a checklist to be considered, including the person and their family, although a professional has to complete the form. The usual triggers are a hospital discharge, a move into a care home or a deterioration at home. If things have changed and nobody has mentioned it, ask.

• Keep a care diary. Two or three weeks of dated notes covering what happened, when, how often and what had to be done is worth more than any adjective. Nights count as much as days.
• Collect the records. Care home daily notes, medication and repositioning charts, district nurse records, falls logs and hospital letters are what the team will actually weigh.
• Be present at the assessment. You are entitled to be there, to contribute, and to ask for a copy of the completed Decision Support Tool afterwards. Read it: scores are often recorded lower than the notes support.
• Describe the bad days as well as the good. An assessment held on a calm afternoon can capture a version of the person that is not representative. Say so if it is.
• Bring functional evidence. An occupational therapist's account of what somebody can and cannot do, how much it varies through the day and what happens when help is not there speaks to intensity and unpredictability. Our functional assessments and reports service exists for this.

How CHC differs from nursing care funding and council care

Three pots of money get muddled constantly, and knowing which one you are arguing about saves a lot of wasted effort.

• NHS Continuing Healthcare. The NHS pays for the entire package. Not means-tested. Decided by the assessment above.
• NHS-funded Nursing Care. A flat weekly amount, set nationally, paid by the NHS to a care home with nursing to cover a registered nurse's input. It applies in a nursing home where somebody is not eligible for full CHC; the rest of the fee remains theirs or the council's.
• Council social care. Means-tested against income, savings and capital, and arranged after a Care Act needs assessment. Our guide to the Care Act needs assessment covers that one.

These are sequential rather than alternatives. The continuing healthcare question is asked first, because if the NHS is responsible the council cannot lawfully charge for the same care.

Reviews, appeals and the claims companies

An award of CHC is normally reviewed after about three months and at least once a year after that. Reviews can and do withdraw funding when needs become more settled, which is brutal to hear when nothing feels easier at home. The same evidence and appeal route apply.

If you disagree with a decision, the first step is local resolution with the integrated care board, in writing, and there is a time limit, so do not sit on it. If that does not settle it, you can ask NHS England for an independent review. Both stages are free.

That word matters, because no-win-no-fee companies advertise heavily here, particularly for retrospective claims covering care already paid for. Some do useful work; many charge a large percentage of anything recovered for work a determined relative, or a free adviser, could have done. Before signing anything, talk to Beacon, the independent continuing healthcare advice service, or to Age UK.

One practical caution: do not delay care somebody needs now while waiting for a funding decision. Funding can be backdated; a pressure sore, a fall or a hospital admission cannot be undone.

Frequently asked questions

Who qualifies for CHC funding?

An adult qualifies if a multidisciplinary team decides they have a primary health need, judged on the nature, intensity, complexity and unpredictability of their care needs rather than on any diagnosis, setting or number of care hours. Most people with heavy but stable needs are found ineligible: evidence about variability and risk matters more than evidence about volume.

What is the continuing healthcare checklist and who fills it in?

It is a short screening form completed by a health or social care professional such as a nurse, social worker or GP. Its threshold is deliberately low, so passing it means only that a full assessment must be arranged, not that anyone thinks you will qualify. A family can ask for one but cannot complete it themselves.

Does dementia mean you qualify for NHS continuing healthcare?

No. Dementia is not a qualifying diagnosis, and many people with advanced dementia are found ineligible because their needs, although heavy, are steady and manageable. Where dementia brings unpredictable risk or needs that change quickly, that is what the assessment looks at. Our page on occupational therapy for dementia covers the daily-life side.

Can I ask for a continuing healthcare assessment myself?

Yes. Ask the ward, the care home manager, the GP, the district nurse or adult social care to arrange a checklist, and put the request in writing so there is a date on it. If they decline, ask for the reasons in writing too.

Next steps

If an assessment is coming, start the care diary today and gather the records, because the evidence is what the decision rests on. Get free independent advice before signing anything with a claims company. Whichever way the funding goes, daily life still needs sorting out, and that is what an occupational therapist is for. Find your local occupational therapist via our areas we cover page, or see our prices.