A Guide To NHS Continuing Healthcare Funding
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Paying for long-term care can be a significant concern for individuals and their families. However, where a person’s care needs are primarily health-related rather than social care-related, they may be entitled to NHS Continuing Healthcare (CHC) funding.
This guide explains what CHC is, who may be eligible, how the assessment process works, and what to do if you disagree with a decision.
On this page:
- What is NHS Continuing Healthcare?
- What is a Primary Health Need?
- What Is the Difference Between Healthcare and Social Care?
- How Does the CHC Assessment Process Work?
- Who Should Be Assessed?
- When Should You Request a Review?
- Can You Obtain a Copy of the Assessment?
- What Happens if CHC Funding Is Refused?
- Common Mistakes Families Make
- Frequently Asked Questions (FAQs)
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults aged 18 or over who have significant ongoing healthcare needs.
Unlike Local Authority social care funding, CHC is not means-tested. This means that eligibility is based solely on the nature and extent of an individual’s health needs, regardless of their income, savings, or assets.
CHC funding may cover care provided in:
- A care home
- A nursing home
- A hospice
- The person’s own home
- Supported living accommodation
The key question is whether the person has a primary health need.
What is a Primary Health Need?
A person may be eligible for CHC if their care needs are primarily healthcare needs rather than social care needs.
Factors that may indicate a primary health need include:
- Medical conditions that require regular monitoring and intervention
- Unstable or rapidly changing conditions
- Unpredictable health needs
- Complex care requirements involving multiple conditions
- Intensive nursing support
- Significant risks to health or safety
The assessment considers:
Nature
What care is required and why.
Intensity
The quantity and severity of care required.
Complexity
How different care needs interact and affect one another.
Unpredictability
The extent to which care needs fluctuate and require immediate intervention.
What Is the Difference Between Healthcare and Social Care?
Healthcare needs generally relate to the prevention, treatment, control, or management of a disease, illness, or disability.
Examples include:
- Complex medication regimes
- Wound management
- Respiratory support
- Managing severe behavioural issues linked to medical conditions
- Specialist nursing interventions
Social care needs often include assistance with:
- Washing and dressing
- Eating and drinking
- Mobility
- Personal care
- Housekeeping
Although social care needs are considered during an assessment, eligibility for CHC depends on whether the person’s overall needs amount to a primary health need.
How Does the CHC Assessment Process Work?
Stage 1 - The Checklist Assessment
The process usually begins with a CHC Checklist Assessment.
This is a screening tool used to identify whether a full assessment should take place.
The Checklist may be completed by:
- Hospital staff
- GPs
- Community nurses
- Social workers
- Other healthcare professionals
Passing the Checklist does not guarantee eligibility. It simply means that a full assessment should be carried out.
Stage 2 - The Full Assessment
Where appropriate, a full assessment is completed using the Decision Support Tool (DST).
The DST examines the individual’s needs across eleven care domains.
The Eleven Care Domains
- Behaviour
- Cognition (understanding and memory)
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition (food and drink)
- Continence
- Skin integrity
- Breathing
- Drug therapies and medication
- Altered states of consciousness
Each domain is scored according to the severity of need.
The assessment then considers the overall picture and whether the person has a primary health need.
Who Should Be Assessed?
Anyone with significant health needs may be considered for CHC.
Common examples include individuals with:
- Dementia
- Parkinson’s disease
- Multiple sclerosis
- Stroke-related disabilities
- Brain injuries
- Motor neurone disease
- Severe learning disabilities
- Complex neurological conditions
- End-stage illnesses
An assessment may also be appropriate following a significant deterioration in health.
When Should You Request a Review?
You should consider requesting a review if there has been a substantial change in any of the following areas:
- Behaviour
- Cognition
- Emotional wellbeing
- Communication
- Mobility
- Nutrition
- Continence
- Skin condition
- Breathing
- Medication requirements
- Episodes such as mini-strokes, seizures, or periods of altered consciousness
You should also seek a review if needs have become:
- More intense
- More complex
- More unpredictable
Can You Obtain a Copy of the Assessment?
Yes.
The individual who is the subject of the assessment is entitled to see:
- The Checklist
- The Decision Support Tool
- The recommendation
- The final decision
Family members may also access these documents where they have:
- The individual’s consent
- A Health and Welfare Lasting Power of Attorney
- Deputyship authority granted by the Court of Protection
Always request copies of assessment documents and decision letters for your records.
What Happens if CHC Funding Is Refused?
A refusal does not necessarily mean the decision is correct.
You may challenge a decision where:
- CHC funding was refused following assessment
- Existing CHC funding has been withdrawn
- You believe a deceased person should have qualified for CHC during their lifetime
There are formal review and appeal procedures available through the NHS.
Because CHC decisions can be complex, many families seek specialist legal or professional advice before commencing an appeal.
Common Mistakes Families Make
- Assuming dementia automatically qualifies for CHC
- Focusing on diagnoses rather than care needs
- Failing to keep detailed records of care requirements
- Not attending assessment meetings
- Accepting a refusal without seeking further advice
- Missing appeal deadlines
Frequently Asked Questions (FAQs)
Is NHS Continuing Healthcare means-tested?
No. Eligibility is based solely on health needs and not on a person’s finances, income, savings, or property.
Does having dementia automatically qualify someone for CHC?
No. A diagnosis alone does not determine eligibility.
The assessment focuses on the nature, intensity, complexity, and unpredictability of the person’s care needs.
Can someone receive CHC funding at home?
Yes. CHC funding can be provided in a person’s own home where this is considered appropriate.
What happens if someone is in hospital?
Before discharge, healthcare professionals should consider whether a CHC Checklist assessment is required.
If there is evidence that the person may have a primary health need, a full assessment should be arranged.
Can CHC funding pay for all care home fees?
Yes. If a person qualifies for CHC, the NHS is generally responsible for meeting the full cost of their assessed care package.
What is NHS Funded Nursing Care (FNC)?
FNC is a contribution paid by the NHS towards nursing care provided by a registered nurse in a nursing home.
It is different from CHC and provides only a contribution rather than full funding.
Can CHC funding be withdrawn?
Yes.
Funding may be reviewed periodically and can be withdrawn if the NHS determines that the person’s needs no longer amount to a primary health need.
Can family members attend assessments?
Yes. Family members, attorneys, deputies, or representatives are usually encouraged to participate in assessments and provide evidence regarding the person’s needs.
What evidence is helpful during an assessment?
Useful evidence includes:
- Medical records
- Care home records
- Incident reports
- Medication charts
- Risk assessments
- Hospital discharge summaries
- Statements from family members and carers
How long do I have to challenge a decision?
Appeal deadlines can vary depending on the stage of the process. You should seek advice and notify the relevant NHS body as soon as possible after receiving the decision.
Can I claim retrospectively if a relative has died?
Potentially, yes.
If you believe a deceased relative should have been eligible for CHC funding during their lifetime, it may be possible for the personal representatives of the estate to pursue a retrospective claim.
Need Further Advice?
If you believe that you or a family member may qualify for NHS Continuing Healthcare, it is important to seek advice as early as possible.
Early intervention can help ensure that:
- Assessments are carried out correctly.
- Relevant evidence is considered.
- Deadlines are not missed.
- Funding entitlements are protected.
Every case is unique, and eligibility will depend on the individual’s specific care needs and circumstances.