If you are helping a relative with serious, ongoing health needs, you may have heard about NHS Continuing Healthcare, often shortened to CHC. It is one of the most valuable forms of help available, yet also one of the least understood. This guide explains what it is, who might qualify and how the assessment works, in plain English.
This is general information to help you get your bearings, not personalised advice about your relative’s situation. Where we mention rules and processes, we have drawn on the official guidance from GOV.UK, NHS England and Age UK, and we link to free expert help at the end.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of care that is arranged and fully funded by the NHS for adults who have significant ongoing health needs. The crucial point for families is this: CHC is not means-tested. If your relative is found eligible, the NHS pays for the whole cost of their care, including personal care and accommodation if they live in a care home, regardless of their savings or income.
That is very different from ordinary social care, which is means-tested by the local council and which most people have to contribute towards. Because CHC removes that financial burden entirely, it is well worth understanding whether your relative might qualify.
Care funded through CHC can be provided wherever the person lives, including in their own home, in a care home or in a hospice.
Who is eligible?
CHC is not awarded for having a particular illness or diagnosis. Having dementia, Parkinson’s or cancer does not automatically qualify someone, and equally, no condition rules a person out. What matters is whether the person has what the rules call a “primary health need”.
In simple terms, that means the main reason they need care is to manage or treat a health problem, rather than to help with everyday living. An assessment looks at four features of the person’s needs:
- Nature — the type of needs and the kind of care, supervision or treatment required.
- Intensity — how severe the needs are and how much care is required, including throughout the night.
- Complexity — how the needs interact and how skilled the care has to be.
- Unpredictability — how much the needs fluctuate and the risks if the right care is not there.
Any one of these, or a combination, can point to a primary health need. It is the overall picture of care that counts, not a single label.
How the assessment works
There are normally two stages.
Stage one: the Checklist
The first step is a screening tool called the Checklist. A nurse, doctor or social worker completes it, and its only job is to decide whether a full assessment is needed. The Checklist is deliberately set at a low bar, so passing it does not mean your relative will get funding. It simply opens the door to the next stage. Anyone can ask a health or social care professional to carry one out.
Stage two: the full assessment
If the Checklist is positive, a multidisciplinary team, usually at least two professionals from different backgrounds such as a nurse and a social worker, carries out a full assessment using the Decision Support Tool. This looks at the person’s needs across 12 areas, known as care domains:
- Breathing
- Nutrition (food and drink)
- Continence
- Skin and tissue viability
- Mobility
- Communication
- Psychological and emotional needs
- Cognition
- Behaviour
- Drug therapies and medication (symptom control)
- Altered states of consciousness
- Other significant care needs
Each domain is scored from no needs up to, depending on the domain, severe or priority. As a general rule, a single “priority” score in one of the domains that allows it, or two or more “severe” scores, would be expected to lead to a recommendation that the person is eligible. Other combinations of high, moderate and severe needs can also qualify, which is why the team’s overall judgement matters so much.
The Integrated Care Board, which is the local NHS body responsible for the final decision, should normally tell you the outcome within 28 days of the positive Checklist.
The fast-track route for end-of-life care
There is a separate, much quicker process for people whose condition is deteriorating rapidly and who may be approaching the end of their life. An appropriate clinician, such as a GP or hospital consultant, can complete a Fast Track Pathway Tool, and that alone is enough to confirm eligibility. It replaces the Checklist and the full assessment, and the NHS is expected to put funding and care in place without delay so the person can be cared for in the place they choose.
How to ask for an assessment
You do not have to wait to be offered CHC. You can ask for an assessment at any time. The simplest route is to speak to a health or social care professional already involved with your relative and ask them to complete a Checklist. That might be their:
- GP
- Hospital nurse, consultant or ward staff (a good time to raise it is before discharge)
- District or community nurse
- Care home nurse
- Social worker
You can also contact your local Integrated Care Board directly and ask to speak to the Continuing Healthcare team. Throughout the process, keep your own notes and copies of any care records, as good evidence of your relative’s day-to-day needs is genuinely valuable.
What if you disagree with the decision?
Be prepared for the fact that CHC is complex and that being turned down is common, even in cases that feel clear-cut to the family. If you do not agree with a decision, you have the right to challenge it.
The first stage is local resolution, where you ask the Integrated Care Board to review its own decision and explain why you think it was wrong. If that does not resolve things, you can ask NHS England for an Independent Review Panel, which looks afresh at whether the assessment was carried out fairly and in line with the national rules. Appeals can take a long time, so it helps to keep clear records and to get support early.
Where to get free help
You do not need to navigate CHC alone, and you should not have to pay for help. Several trusted organisations offer free, independent support:
- Beacon CHC runs a free information and advice service funded by NHS England. You can call them on 0345 548 0300 for general guidance and up to 90 minutes of free advice from a specialist.
- Age UK has a free advice line on 0800 678 1602, open every day, and a detailed factsheet on CHC.
- Citizens Advice can help locally with the process and any related benefits or paperwork.
It is worth speaking to one of these services before an assessment if you can, so you understand what to expect and how to put your relative’s needs across clearly.
Comparing care while you wait
Whether or not your relative qualifies for CHC, you will often need to weigh up local care options, and that is where it helps to see what is available near you. You can browse and compare homes in your area on CareFinder, for example care homes in Bristol, care homes in Birmingham or care homes in Manchester, checking the type of care each home provides alongside its fees and facilities.
Understanding CHC early gives your family the best chance of getting the funding your relative is entitled to, and of choosing care with real confidence.
Compare local care homes for free on CareFinder to find the right support near you.