NHS Continuing Healthcare: who qualifies and what it covers

NHS Continuing Healthcare (CHC) is fully funded care arranged and paid for by the NHS. If you qualify, the NHS meets the entire cost of your care package, whether that's at home, in a care home or in a nursing home. There's no means test; your savings, property and pension are irrelevant. The eligibility question is purely clinical: does your primary need arise from health, rather than social care? That distinction matters enormously in practice, because it determines whether you fund your own care or the NHS does.

Around 67,000 people in England are currently receiving CHC at any one time, according to NHS England data. Many more would be eligible if they, or their families, knew how to ask.

What is the "primary health need" test?

The legal framework is the NHS Continuing Healthcare (Responsibilities) Directions 2013 and the accompanying National Framework, last updated in 2022. The core concept is that a person has a "primary health need" when their care needs, taken together, are of a nature, intensity, complexity or unpredictability that they require care that only a health-led service can properly provide.

Social care needs, taken alone, don't qualify. If someone needs help washing and dressing but their condition is stable and predictable, that typically falls to the local authority under the Care Act 2014, and means testing applies. The boundary sits where healthcare needs become the dominant driver of what care is required.

In my experience, this distinction trips families up badly. A parent with advanced dementia who also has recurrent infections, complex medication, and episodes of aggression that require skilled nursing intervention may well qualify. A parent who has dementia but is medically stable may not. The conditions are similar; the level of complexity is not.

How does the assessment process work?

There are two stages: the checklist and the full assessment using the Decision Support Tool.

Stage one: the checklist. Any health or social care professional involved in your care can initiate this. It covers twelve care domains (behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other significant care needs). If the checklist indicates you may meet the threshold, the integrated care board (ICB) must arrange a full assessment. You or your family can also ask a GP, community nurse or social worker to complete a checklist; they can't refuse a reasonable request.

Stage two: the Decision Support Tool. A multidisciplinary team (MDT), usually including a nurse and a social worker, reviews your needs across the same twelve domains. Each domain is rated as no needs, low, moderate, high or severe/priority. The ratings feed into an overall recommendation. The MDT doesn't make the final decision; they recommend. The ICB makes the funding decision.

You have the right to be present at the MDT meeting, and you can bring someone with you. A family member, a friend or an advocate can all attend. I'd strongly suggest you take someone who knows the person well and can speak to the day-to-day realities of care, because the paperwork doesn't always capture what a bad night looks like.

Which conditions are most commonly associated with a CHC award?

No specific diagnosis guarantees eligibility. The assessment is needs-based, not diagnosis-based. That said, the conditions most commonly associated with CHC awards include advanced dementia with challenging behaviour, acquired brain injuries, progressive neurological conditions such as motor neurone disease or multiple sclerosis in later stages, complex wound care needs, and end-of-life care.

Someone who had a stroke and is now medically stable, mobile with a frame, and managing at home with minimal support is unlikely to qualify. The same person, six months later, with pneumonia complications, significant swallowing difficulties requiring a modified diet managed by a speech therapist, and pressure sores, is a very different picture.

The key word in the National Framework is "primary". If health needs are significant but secondary to social and personal care needs, the threshold isn't met. If health needs are the engine driving all other care requirements, it likely is.

What does CHC actually pay for?

If you're awarded CHC, the NHS funds your care package in full. That can include:

• A full care home placement, including all nursing costs
• A package of care at home (domiciliary care, night-sitting, specialist nursing visits)
• Equipment and aids needed as part of the care plan
• In some cases, adaptations, where they're integral to the health-led care package

What it doesn't typically cover: housing costs, food, or personal items. If you're in a care home, CHC pays the care home fees, but you remain responsible for any "hotel" top-up if you've chosen a room more expensive than the ICB's standard rate.

A separate, lower-level entitlement called NHS-funded nursing care (FNC) applies to people in nursing homes who need nursing input but don't meet the full CHC threshold. The FNC rate in 2024/25 is £235.88 per week, paid directly to the care home. It's worth knowing about because it's frequently not claimed; a referral to the ICB is all that's needed.

How do you request an assessment, and what if you're turned down?

Requesting an assessment: Ask any involved health or social care professional, including your GP, district nurse, community occupational therapist or hospital social worker. If you're in hospital and facing discharge, the discharge team has a duty to consider CHC eligibility before discharge is completed. Don't let that moment pass; it's much harder to arrange an assessment once someone has moved to a care home on a self-funding basis.

Disagreeing with the outcome: If the ICB decides you don't qualify, you can ask for a local review. If that doesn't resolve the dispute, you can request an independent review panel, arranged by NHS England. The charity Beacon offers free, specialist CHC support and is worth contacting early in a dispute; their advisers know the National Framework in detail and can identify where an assessment may have been conducted incorrectly.

The Ombudsman (Parliamentary and Health Service Ombudsman) is available as a last resort if you believe there has been maladministration in how the process was handled.

What about the fast-track pathway?

The fast-track pathway exists for people approaching the end of life. A clinician (a doctor, nurse consultant, or other registered professional involved in the person's care) can complete a fast-track tool if they believe the person has a rapidly deteriorating condition that may be entering a terminal phase. Fast-track decisions should be made within 48 hours. The full Decision Support Tool process doesn't apply.

This pathway matters practically because it removes weeks of assessment when time is short. Families in this situation often don't know it exists. If a consultant, palliative care nurse or GP believes someone is approaching end of life, ask them directly whether a fast-track CHC referral is appropriate.

A note on retrospective claims

If you or a relative funded care privately during a period when CHC should have been awarded, you may be able to claim reimbursement retrospectively. NHS England has run retrospective review programmes in the past, and individual claims can be made going back several years in some circumstances. These claims are complex and time-limited. If you believe this applies, get advice from Beacon or a solicitor specialising in CHC before approaching the ICB.

This won't suit everyone and the process is slow, but for families who spent significant sums on care that should have been NHS-funded, the sums involved can be substantial.

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For a broader overview of funding options for care at home and residential care, see our guide to mobility aids and home adaptations which covers Disabled Facilities Grants, direct payments, and local authority assessments alongside NHS entitlements.