When a loved one has complex health needs, the question of who pays for their care can be confusing and stressful. One area that is often misunderstood is NHS Continuing Healthcare (CHC) – a package of care that is fully funded by the NHS for people with significant, ongoing health needs.
This blog explains what NHS CHC is, who may be eligible, how the assessment works, and why many people who qualify never receive it.
What Is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is free care funded entirely by the NHS. It is available to adults (18+) whose primary need is a health need, rather than a social care need.
CHC can cover:
- Care in your own home
- Care in a care home or nursing home
- All care costs, including accommodation, nursing, personal care, equipment, and support services
Importantly, CHC is not means‑tested. This means your income, savings, property, and assets are irrelevant.
Who Is Eligible for NHS CHC?
Eligibility is based on the nature, intensity, complexity, and unpredictability of a person’s needs – not on diagnosis or age.
People who may qualify often have:
- Advanced dementia or Alzheimer’s disease
- Severe physical disabilities
- Complex neurological conditions
- Long‑term, progressive or life‑limiting illnesses
- Significant behavioural or psychological needs
This list is not exhaustive however, these are common features.
A common myth is that CHC is only for people at end of life – this is not true. While some people receive CHC under fast‑track arrangements, many others qualify for long‑term funding.
What Is a “Primary Health Need”?
To be eligible for CHC, a person must have a primary health need. Whilst there is no legal definition of a primary healthcare need, this oftentimes means the individuals care needs are mainly due to health issues rather than assistance with daily tasks alone.
The NHS considers:
- How intense the care is
- How complex the condition and care needs are
- How unpredictable the health situation may be
- Whether skilled clinical oversight is required
These factors are assessed holistically rather than in isolation.
How Does the CHC Assessment Process Work?
- The CHC Checklist
The first stage is a screening tool called the Checklist. It decides whether a full assessment should take place.
✅ A positive checklist does not guarantee funding, but it means the person should move to the next stage.
❌ A negative checklist can be challenged if you believe it was completed incorrectly.
- The Decision Support Tool (DST)
If the checklist is positive, a full assessment using the Decision Support Tool follows.
This looks at 12 care domains, including:
- Breathing
- Nutrition
- Continence
- Skin Integrity
- Mobility
- Communication
- Psychological and Emotional Needs
- Cognition
- Behaviour
- Drugs & therapies
- Altered States of Consciousness
- Other (any additional requirements not included in the 11 other domains)
Each domain is scored between a low level of need and a priority level of need, and the overall picture determines eligibility.
- The Final Decision
A recommendation is made to the Integrated Care Board (ICB) by the Multi-Disciplinary Team (MDT), which issues a final decision.
If successful, funding is usually backdated to the date of the DST, or on occasion, further.
Why Are So Many People Wrongly Refused CHC?
Despite clear national guidance, NHS CHC is widely described as a postcode lottery.
Many eligible people are refused funding due to:
- Incorrect completion of assessments
- Understated needs during reviews
- Over‑emphasis on diagnosis rather than care needs
- Lack of family involvement
- Pressure to classify needs as “social care”
As a result, families often pay thousands of pounds unnecessarily.
Can You Appeal a CHC Decision?
Yes – and many people do so successfully.
You can challenge:
- A negative checklist
- A refused CHC decision
- A withdrawal of existing CHC funding
Appeals can involve:
- Local resolution meetings/Local resolution panels
- Independent Review Panels by NHS England
- Retrospective claims (sometimes going back years)
Strong evidence, accurate care records, and professional support can make a significant difference.
CHC vs Social Care: What’s the Difference?
| NHS Continuing Healthcare | Social Care |
| Fully funded by NHS | Means‑tested |
| Not based on diagnosis | Based on daily living needs |
| Covers all care costs | Often requires self‑funding |
| No financial assessment | Assets and income assessed |
Understanding this difference is crucial, as many people are wrongly directed toward local authority funding instead of being assessed properly for CHC.
How Families Can Protect Their Rights
If you believe your loved one may qualify for NHS CHC:
- Request an assessment in writing to your local ICB
- Attend all meetings and reviews
- Keep detailed care records
- Challenge inaccuracies immediately
- Seek specialist advocacy services if needed
Early action can prevent unnecessary financial hardship and ensure your loved one receives the care they are entitled to.
Final Thoughts
NHS Continuing Healthcare can be life‑changing, but it is also complex and often poorly explained. Awareness is the first step toward fairness.
If your loved one has complex, ongoing health needs, do not assume you must pay for care. NHS CHC exists to protect patients and families – but sometimes it must be pursued assertively.
Simply CHC provide free advice and guidance to help people navigate this complex process. Please do get in touch with us for free, tailored advice. Email Danielle directly – danielle.whitfield@simplycontinuinghealthcare.co.uk or call us on 01733 595 456. Alternatively, please feel free to fill in our contact form with as much detail as possible – https://simplycontinuinghealthcare.co.uk/contact/ – and one of our dedicated team will be in touch. We are not location specific and cover many areas across England and Wales.