NHS Continuing Healthcare, or CHC, is fully funded NHS care for adults with significant ongoing health needs. It is not means-tested. If your family member is eligible, the NHS pays for all reasonable care costs, at home or in a care home.
What CHC is
CHC is an NHS funding decision, made by your local NHS Integrated Care Board (ICB). It rests on a single test. Does your family member have a “primary health need”, as defined by the National Framework for NHS Continuing Healthcare?
If the answer is no, other support may still be open to you. That could be council-funded care, NHS-funded Nursing Care in a nursing home, or care you arrange and pay for privately.
Who qualifies
The National Framework lays out twelve “care domains” the assessment looks at:
- Behaviour
- Cognition
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition (food and drink)
- Continence
- Skin (including tissue viability)
- Breathing
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
For each domain, the assessor rates the level of need (priority, severe, high, moderate, low, no needs). The pattern of those scores drives the decision. So do the nature, intensity, complexity and unpredictability of the needs.
People with advanced dementia, complex neurological conditions or end-of-life needs are among those most likely to be eligible. So are people with several significant long-term conditions. Even so, the decision rests on the pattern of needs at assessment. A diagnosis on its own is not enough.
How the assessment works
There are two stages.
The Checklist. An initial screening by a nurse, social worker or other qualified professional. If it suggests CHC might be appropriate, your family member moves to the full assessment.
The Decision Support Tool (DST). A full multidisciplinary assessment led by the local ICB. A nurse assessor, a social worker and other professionals involved in the care go through the twelve domains together. You are usually there too, or asked to contribute. The DST drives the eligibility decision.
A Checklist is often done before someone leaves hospital. It can also happen in a care home or in someone’s own home.
The Fast Track route is for people with a rapidly deteriorating condition that may be entering its terminal phase. It bypasses the Checklist and triggers urgent CHC funding so care can start without delay.
Why top-ups are not permitted on CHC
Families cannot pay extra towards the core CHC care. That rules out paying for a particular provider, a higher-rate carer or longer visits. Under the National Framework, the NHS meets the full reasonable cost of the assessed needs. If the care the ICB offers doesn’t meet those needs, the route is to challenge it.
Families can pay separately for things that are not part of the assessed CHC care. Private hairdressing, for example, or social activities outside the care plan, or equipment that has not been agreed. These have to be clearly separate, and the ICB can tell you where the line falls.
CHC at home: practical considerations
CHC care at home is common, but the ICB has to be satisfied it can be delivered safely. That depends on:
- Whether the home can be adapted (hoists, hospital beds, accessible bathroom)
- Whether overnight care is needed, as sleeping nights or waking nights
- Whether one carer is enough for safe handling, or two are needed for some tasks
- Whether specialist clinical skills are required (PEG feeding, suctioning, ventilator management) and how those are met
We deliver CHC care at home that includes complex care competencies, overnight care, and end-of-life care where appropriate.
How we work with NHS CHC
When an ICB asks us to provide care, we agree the scope, staffing, skills needed and review cycle. The ICB pays us directly, so your family sees no invoice.
Reviews happen at three months from the start, then annually, or sooner if there’s a significant change. A review can confirm eligibility, change the care, or in rare cases withdraw CHC funding. You have rights of appeal if that happens.
If your family member is being assessed, call 01636 646915 to talk through how CHC care would work with us.
Where to get more help on CHC itself
Three places to start:
- The Age UK CHC factsheet, written for families
- The Beacon CHC information service, which offers free information and lower-cost paid advocacy
- Your family member’s GP, district nurse, or hospital discharge team, who can request a Checklist if they think CHC might be appropriate
