NHS Continuing Healthcare: Full Guide for Families

Topic cluster: Care Home Costs & Funding | Reading time: 7 min

NHS Continuing Healthcare (NHS CHC) is one of the most valuable — and most underused — sources of care funding in the UK. If your parent's care needs are complex, intense, and unpredictable, the NHS may fund their care in full, including accommodation. This guide explains what NHS CHC is, how to apply, and what to do if your parent is refused.

What Is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of care arranged and fully funded by the NHS for adults aged 18 or over who have a 'primary health need'. When someone qualifies, the NHS pays for all their care costs — including their care home fees and accommodation — regardless of their income or savings.

NHS CHC is not means-tested. A self-funder with £500,000 in assets can qualify, and a person with no assets can be refused. Eligibility is based entirely on care needs.

What Is a 'Primary Health Need'?

This is the central concept — and it is deliberately not defined by a specific diagnosis. Your parent does not need to have a particular condition to qualify. Instead, eligibility depends on whether their overall care needs are:

Complex — multiple interacting needs that are difficult to manage
Intense — needing care frequently throughout the day and night
Unpredictable — needs that change rapidly or without warning, requiring skilled responses

Conditions that frequently lead to NHS CHC eligibility include advanced dementia, Parkinson's disease, stroke, multiple sclerosis, motor neurone disease, and certain cancers — but eligibility depends on individual need, not diagnosis.

How Is Eligibility Assessed?

Step 1: Checklist screening A healthcare professional (nurse, social worker, or therapist) completes a CHC Checklist. If the checklist indicates potential eligibility, a full assessment follows.

Step 2: Full multi-disciplinary assessment A team of health and social care professionals (the Multi-Disciplinary Team, or MDT) assesses your parent using a Decision Support Tool (DST). The DST covers 12 care domains:

Behaviour
Cognition
Communication
Psychological and emotional needs
Mobility
Nutrition (food and drink)
Continence
Skin (including pressure areas)
Breathing
Drug therapies and medication
Altered states of consciousness
Other significant care needs

Each domain is rated on a scale (Priority, Severe, High, Moderate, Low, or No Needs). High or Priority ratings in one or more domains typically indicate eligibility.

Step 3: Decision by the Integrated Care Board (ICB) In England, Integrated Care Boards (formerly Clinical Commissioning Groups) make the final eligibility decision based on the MDT's assessment.

How to Request an Assessment

Your parent should be referred for a CHC checklist by a healthcare professional — GP, hospital consultant, community nurse, or social worker. You can ask any of these to initiate the process.

If you believe your parent's needs meet the criteria but no referral has been made, you can:

Request a referral directly from the GP or hospital discharge team
Contact the local Integrated Care Board and request a checklist
Seek advice from Age UK or a specialist advocate

You have the right to be present during the CHC assessment (with your parent's consent). Being present allows you to ensure your parent's needs are accurately represented.

Common Reasons for Refusal

Many applications are refused — according to the Nuffield Trust, only around 21% of those assessed between January and March 2024 were found eligible. Common reasons for refusal include:

Needs assessed as primarily social (personal care) rather than healthcare
Individual domains rated too low individually, even if the overall picture is severe
Assessments conducted when the person is at their best, not during a typical or difficult episode
Assessors not fully understanding the complexity of the person's needs

Keep a care diary in the weeks before assessment — recording incidents, falls, medication requirements, episodes of distress or confusion, and sleep disruption. This evidence can significantly support an assessment.

What to Do If Refused

Step 1: Request a review You have the right to request that the ICB reviews the decision. Provide additional evidence — your care diary, clinical letters, the GP's view.

Step 2: Independent review If the first review is unsuccessful, request an independent review.

Step 3: NHS England review If still unsuccessful, NHS England's National Dispute Resolution Process is available.

Step 4: Parliamentary and Health Service Ombudsman As a last resort, complaints about NHS CHC decisions can be taken to the Parliamentary and Health Service Ombudsman.

Many families find specialist advocacy or legal support helpful when challenging a refusal.

NHS CHC and the Care Home

If your parent is in a care home and subsequently qualifies for NHS CHC, the NHS takes over funding — including the accommodation element. The NHS then commissions the care, working with your parent to ensure the home can meet their needs.

Fast-Track NHS CHC

A Fast-Track process is available for people who have a rapidly deteriorating condition and may be approaching the end of life. This can be agreed by a clinician within 24 hours and ensures funding is put in place immediately — without waiting for a full multi-disciplinary assessment.

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