NHS Continuing Healthcare, often shortened to NHS CHC, is a package of ongoing care arranged and funded entirely by the NHS for adults whose assessed needs demonstrate a primary health need.
Accessing this funding usually involves an initial screening, a detailed assessment and a formal eligibility decision. The process can be difficult to navigate, particularly when you are already arranging care for someone with significant, complex or changing needs.
Our experienced team can guide you through each stage, help you prepare the relevant evidence and ensure that you understand what happens next.
FAQs
How do I apply for NHS Continuing Healthcare?
The process usually starts with an NHS Continuing Healthcare Checklist, which helps decide whether a full assessment is needed. This can be requested through a GP, social worker, care home, hospital discharge team or the relevant NHS body. We can help you understand the process and prepare the right evidence before an assessment takes place.
What happens during a NHS CHC assessment?
If a full assessment is needed, a multidisciplinary team will review your loved one’s care needs using the Decision Support Tool. They will consider areas such as mobility, cognition, behaviour, nutrition, continence, medication, skin integrity and other health needs before making a recommendation on eligibility.
What is the difference between NHS Continuing Healthcare and social care funding?
NHS Continuing Healthcare is arranged and funded by the NHS for adults with a primary health need and is not means-tested. Social care funding is usually arranged by the local authority and is financially assessed, meaning savings, income and assets may be taken into account.
STEP TWO
For most applicants, the formal process begins with an NHS Continuing Healthcare Checklist.
The Checklist is a screening tool used to identify people who should be referred for a full assessment of eligibility. It is not the final NHS CHC assessment and does not decide whether someone qualifies for funding.
A Checklist can be completed by an appropriate health or social care professional in a variety of settings. Depending on the circumstances, this could include a nurse, social worker, doctor or another professional involved in the person’s care.
The person or their representative can ask for an assessment by speaking to:
- Their GP
- A social worker
- A district or community nurse
- Care-home staff
- A hospital discharge team
- The relevant Integrated Care Board
The Checklist considers the person’s needs across a number of care domains. The scores determine whether the threshold for a full assessment has been met.
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Can I challenge a past NHS CHC decision?
Yes, in some cases. If your loved one was refused NHS Continuing Healthcare, you may be able to challenge the decision if needs were not properly considered, evidence was missed, or the criteria were not applied correctly. Time limits can apply, so it is important to seek advice promptly.
Can someone receive NHS CHC funding at home?
Yes. NHS Continuing Healthcare can fund care in a person’s own home, as well as in a care home, nursing home or other care setting. Eligibility depends on the person’s assessed health and care needs, not where they receive care.
How can you help with appeals?
We can review the decision, identify potential grounds of challenge, gather supporting evidence and help present your loved one’s needs clearly under the NHS Continuing Healthcare criteria. We can also support you through local resolution and, where appropriate, further review stages.
Can you help recover care fees that were wrongly paid?
Yes, where there may be grounds to argue that your loved one should have been assessed or found eligible for NHS Continuing Healthcare during a past period of care. We can advise on whether a retrospective review may be possible and help prepare the evidence needed to pursue a claim.
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How does NHS Continuing Healthcare work?
Understanding the NHS CHC process, one step at a time
The process at a glance
1
2
3
4
5
Identify
Checklist
Full Assessment
Decision
Funding or appeal
Identify whether you or your loved one could be eligible for NHS Continuing Healthcare funding
If eligible, arrange a Checklist with the local Integrated Care Board to assess needs ahead of the full assessment
A full assessment, called the Decision Support Tool, is arranged to determine eligibility and suitability for funding
A decision is reached based on the outcome of the DST. You should hear within 28 days following the assessment
If eligible, the full cost of care will be covered. If ineligible, you may have grounds for appeal.
2. Requesting the NHS CHC Checklist
Get help with the NHS CHC Checklist
We offer a Checklist Assessment Support service for anyone looking to arrange a NHS CHC Checklist. This service includes:
Arranging the Checklist assessment on your behalf
Obtaining and reviewing the necessary records
Identifying the evidence relevant to the Checklist
A preparation meeting before the assessment
Oversight of the Checklist process
Advice about the outcome and next steps
STEP ONE
The first step is identifying whether the person’s care needs should be considered for NHS Continuing Healthcare.
Eligibility does not depend on a particular diagnosis, the person’s age beyond being 18 or over, the value of their assets or whether they live at home or in a care facility.
Instead, the assessment considers the person’s overall health-related needs and whether the nature, intensity, complexity or unpredictability of those needs demonstrate a primary health need.
Different needs should not be viewed entirely in isolation. The way they interact, fluctuate and affect the person’s safety can be central to the eligibility decision.
It may be appropriate to explore NHS CHC where the person requires significant support involving areas such as:
1. Recognising that NHS CHC may apply
Breathing
Nutrition
Continence
Skin and tissue viability
Cognition
Psychological or emotional needs
Communication
Mobility
Behaviour
Drug therapies and medication
Altered states of consciousness
Other significant care needs
Not sure if this applies?
Understanding eligibility for NHS Continuing Healthcare funding is rarely straightforward. A consultation with our experts will help you know where you stand.
Positive Checklist
A positive Checklist means that the person should usually progress to a full NHS Continuing Healthcare assessment.
It does not mean that NHS CHC funding has been awarded or that the person will necessarily be found eligible. It means there is enough potential evidence to justify a more detailed assessment.
Negative Checklist
A negative Checklist means that the person will not ordinarily progress to a full assessment at that time.
You should be given a copy of the completed Checklist and a written explanation of the outcome. Where the person’s needs have been inaccurately recorded, relevant evidence has been overlooked or the process has not been properly followed, it may be appropriate to ask the Integrated Care Board to reconsider the outcome.
STEP THREE
Following a positive Checklist, the Integrated Care Board should arrange a comprehensive assessment of the person’s health and associated care needs.
This is not simply a review of their medical diagnoses. The assessment should build a detailed picture of the care, supervision, monitoring and intervention the person requires.
Evidence may include:
- GP and hospital records
- Care-home notes
- Care plans
- Medication records
- Risk assessments
- Incident, fall or behaviour records
- Nutrition and weight records
- Tissue viability records
- Reports from nurses, therapists and other professionals
- Statements from relatives and carers
Records should describe not only what conditions the person has, but how those conditions affect their daily life and what could happen if the necessary support were not provided.
3. Preparing for the Decision Support Tool
Get help with the Decision Support Tool
We can help you prepare thoroughly for the full NHS CHC assessment. The aim is to ensure that you understand the assessment process and are prepared to explain the person’s needs clearly and accurately.
Our service includes:
Obtaining essential records
Reviewing relevant care and medical documentation
Advising on the strengths and limitations of the available evidence
Preparing a detailed evidence document
Completing a pre-assessment check
Holding a 90-minute preparation meeting
STEP FOUR
The full assessment is normally completed by a multidisciplinary team, often referred to as the MDT.
The team should usually include at least two professionals from different healthcare disciplines, or one healthcare professional and one social care professional, who are knowledgeable about the person’s needs.
The MDT uses the Decision Support Tool, commonly called the DST, to bring together the available evidence and make a recommendation about eligibility.
What does the Decision Support Tool consider?
The DST examines 12 care domains:
- Behaviour
- Cognition
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition
- Continence
- Skin and tissue viability
- Breathing
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
A level of need is recorded within each relevant domain. However, eligibility should not be decided solely by adding up scores.
The multidisciplinary team must also consider the totality of the person’s needs and the following four key characteristics.
4. The multidisciplinary team assessment
Nature
The type and effect of the person’s needs, including the interventions required to manage them.
Intensity
The quantity, severity and continuity of the care required, including how frequently intervention is needed.
Complexity
How the person’s needs interact and whether specialist skill or knowledge is required to manage them.
Unpredictability
The extent to which the person’s needs fluctuate, deteriorate or create risks that require timely intervention.
A person does not necessarily need to demonstrate all four characteristics. The question is whether their needs, considered in their totality, establish a primary health need.
Can family members take part?
The person being assessed should be involved wherever possible. With the appropriate consent or legal authority, relatives, carers, advocates and representatives can also participate.
Family evidence may be particularly important where the person:
- Has difficulty communicating
- Lacks capacity to make relevant decisions
- Has fluctuating needs
- Receives substantial informal support
- Behaves differently when professionals are present
- Has records that do not fully reflect their daily needs
You can raise concerns, explain the person’s history and identify where the documentary evidence does not accurately describe the support required.
STEP FIVE
Once the assessment has been completed, the multidisciplinary team makes a recommendation about whether the person has a primary health need.
The relevant Integrated Care Board then makes the final eligibility decision. The Integrated Care Board should usually accept the multidisciplinary team’s recommendation except in exceptional circumstances where there are clear reasons not to do so.
You should receive the decision in writing, together with clear reasons and a copy of the completed Decision Support Tool.
The full NHS CHC assessment and decision should normally be completed within 28 calendar days of the Integrated Care Board receiving a positive Checklist or another request for a full assessment, although there are circumstances in which it can take longer.
5. The eligibility recommendation and final decision
STEP SIX
Where the person is found eligible, the NHS becomes responsible for arranging and funding a package that meets their assessed health and associated social care needs.
The funded package may be delivered:
- In the person’s own home
- In a residential care home
- In a nursing home
- In another appropriate care setting
Depending on the care plan, NHS CHC funding may cover:
- Care-home accommodation
- Personal care
- Nursing care
- Support from carers at home
- Medication management
- Specialist equipment
- Therapies
- Other services needed to meet the assessed needs
NHS Continuing Healthcare is not means-tested. The person’s income, savings, investments or property should not affect their eligibility.
Agreeing the care package
The Integrated Care Board should work with the person and their representative to develop an appropriate care and support plan.
The package should reflect the individual’s assessed needs, safety and reasonable preferences. However, the NHS is not necessarily required to fund every preferred arrangement regardless of cost or clinical suitability.
6. If NHS CHC funding is awarded
Will funding continue permanently?
NHS CHC eligibility is reviewed because a person’s needs may change.
An initial review will commonly take place within three months of the package beginning, followed by further reviews at least annually. A review should primarily consider whether the care package continues to meet the person’s needs.
Funding should not be withdrawn without an appropriate reassessment and a properly reasoned eligibility decision.
STEP SEVEN
A refusal does not necessarily mean that the application process has been handled correctly or that there are no grounds to challenge the outcome.
Potential concerns may include:
- Relevant evidence being overlooked
- Care needs being understated
- Needs being considered separately rather than together
- Excessive focus on diagnoses rather than actual needs
- Managed needs being treated as though they no longer exist
- Family or representative evidence being disregarded
- Inaccurate care-domain levels
- Insufficient consideration of nature, intensity, complexity or unpredictability
- Failure to follow the correct assessment procedure
- Reasons that do not adequately explain the final decision
The first stage of a formal challenge is usually the Integrated Care Board’s local resolution process.
Where the matter cannot be resolved locally, the person or their representative may be able to apply to NHS England for an Independent Review Panel. If they remain dissatisfied after that process, they may consider making a complaint to the Parliamentary and Health Service Ombudsman.
7. If NHS CHC funding is refused
Our NHS CHC Appeal Viability Review
Before committing to a full appeal, we can review the decision and advise whether there appear to be reasonable grounds for challenging it. This gives you a clearer understanding of the strengths, weaknesses and potential proportionality of an appeal.
Our service includes:
A post-assessment consultation with your lawyer
A review of the Integrated Care Board’s decision documents
Consideration of the decision against the evidence
Identification of potential factual or procedural issues
A written opinion on whether an appeal is appropriate
A written action plan explaining the recommended next steps
Choose the level of support that you need
Free Initial Consultation
Free
Speak to one of our specialist solicitors in a free 30-minute consultation. We'll discuss your circumstances, answer your questions and assess whether you or your loved one may be eligible for NHS Continuing Healthcare funding.
Eligibility Assessment & Action Plan
£250 +VAT
Understand whether your loved one may qualify for NHS Continuing Healthcare. This 60-minute consultation includes a review of agreed care information and a written action plan outlining evidence gaps and practical next steps.
Complete Checklist Service
£1,800 +VAT
Get expert support preparing for an NHS Continuing Healthcare Checklist assessment. We review and organise agreed evidence, build your written case and prepare your submission, with guidance on the screening process and next steps after the outcome.
DST Representation Service
£750 +VAT
Get expert representation at your Decision Support Tool (DST) meeting. We discuss your prepared case beforehand, attend to present evidence and raise questions, record the outcome and agreed actions, and explain your immediate next steps.
Appeal Eligibility Assessment
£300 +VAT
Find out whether a negative NHS Continuing Healthcare decision may be worth challenging. We review agreed key papers, check deadlines and identify potential issues, then provide a written initial assessment outlining your options and recommended next steps.
Local Resolution Viability Review
£2,000 +VAT
We review agreed records in detail and provide a written report assessing potential grounds, evidence gaps, risks and whether further costs are justified based on your prospects for a successful appeal.
Each service can stand alone. Clients can begin with advice and add further support only where needed. No matter where you are in the process, we always start with an initial free consultation.
Checklist Advocacy Service
£750 +VAT
Feel supported at your NHS Continuing Healthcare Checklist meeting. We review your prepared case, meet with you beforehand and attend to present evidence, ask questions and raise concerns, then explain the outcome and immediate next steps.
Positive Checklist Consultation
£300 +VAT
Understand what happens after a positive NHS Continuing Healthcare Checklist. We explain the Decision Support Tool (DST) assessment, review agreed key papers and provide a written action plan covering evidence priorities, next steps and recommended support.
DST Assessment Support Service
£3,000 +VAT
Prepare for your Decision Support Tool (DST) assessment with a clear, evidence-based case. We review agreed records, analyse care needs and prepare written submissions, with preparation meetings and guidance on the outcome and next steps.