NHS continuing healthcare funding guide
NHS continuing healthcare, usually called CHC, is NHS-funded care for adults in England who have a primary health need. It is not means-tested, not based on diagnosis alone, and not limited to care homes. The decision turns on the nature, intensity, complexity and unpredictability of the person's needs, so the strongest applications are built around evidence of daily care needs, risk and skilled intervention, not just a list of conditions.1
Key facts
- CHC is for adults aged 18 or over in England whose assessed needs are primarily health needs, rather than mainly social care needs.1
- Eligibility is not decided by a diagnosis, savings, home ownership, age or whether the person is in hospital, at home or in a care home.
- The usual route is a CHC checklist, followed by a full multidisciplinary assessment using the Decision Support Tool if the checklist is positive.3
- A fast-track pathway exists for people with a rapidly deteriorating condition who may be entering a terminal phase.5
- If CHC is refused but the person needs care from a registered nurse in a nursing home, NHS-funded nursing care may apply.6
What NHS continuing healthcare pays for
CHC is a package of ongoing care arranged and funded by the NHS when a person has been assessed as having a primary health need. It can cover care in the person's own home, a care home, hospice or another setting. Depending on the care plan, funding may cover personal care, nursing care, therapy, specialist equipment and accommodation in a care home if that is part of the assessed package.2
The key point is that CHC is not social-care means-testing. If someone is eligible, their income, savings and property are not used to decide whether the NHS funds the assessed package. That makes CHC financially important, but the test is clinical. Being very frail, disabled, older or diagnosed with dementia does not automatically qualify someone.
This guide is about England. Wales, Scotland and Northern Ireland use different systems and language, so families outside England should check their local route.
Practical rule: CHC evidence should show care needs and risk over time: what happens, how often, how severe, how unpredictable, what skilled care is needed, and what goes wrong when care is not provided.
How eligibility is decided
The National Framework says the central question is whether the person has a primary health need. The assessment looks at the totality of need across four characteristics: nature, intensity, complexity and unpredictability.1
"Nature" means the type of needs and the interventions required. "Intensity" means the quantity, severity and continuity of care. "Complexity" means how needs interact, how hard they are to manage, and how much skill is needed. "Unpredictability" means how much needs fluctuate, how quickly risk can escalate, and how difficult it is to anticipate or prevent deterioration.
The Decision Support Tool, or DST, organises evidence across care domains such as behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin, breathing, drug therapies, altered states of consciousness and other significant needs.4 A high score in one domain is not the whole decision. The multidisciplinary team must consider the overall picture.
| Stage | What happens | What to prepare |
|---|---|---|
| Trigger for checklist | A professional identifies that the person may need CHC screening. | Ask for a checklist if needs are complex, intense, unpredictable or mostly health-related. |
| Checklist | A screening tool decides whether full assessment is needed. | Bring recent care notes, hospital letters, medication list, falls, wounds, behaviour logs and risk incidents. |
| DST assessment | A multidisciplinary team considers evidence across care domains. | Challenge missing evidence, vague wording and under-recorded night-time or crisis needs. |
| ICB decision | The integrated care board makes the eligibility decision, usually based on the MDT recommendation. | Ask for the completed DST, rationale, domain levels and appeal route in writing. |
| Fast track | For rapidly deteriorating conditions that may be entering a terminal phase. | Ask the appropriate clinician whether fast-track CHC applies and request urgent completion if it does. |
| Review | Eligibility and package can be reviewed if needs change. | Keep care records because reductions or withdrawals should be evidence-based. |
The checklist and DST process
The checklist is a screening tool. It does not award CHC. It identifies people who need a full assessment. Government guidance says the checklist should be used proportionately and should not replace professional judgement.3 If the checklist is negative but the family believes major needs have been missed, ask for the completed checklist and the reasons.
If the checklist indicates full assessment, the DST should be completed by a multidisciplinary team. Family members or representatives should have the opportunity to contribute. This matters because care homes and relatives often know about night-time needs, behavioural risk, choking episodes, falls, pressure damage, medication refusal, agitation, continence care and rapid deterioration that may not appear in a clinic letter.
The DST has levels of need in each domain. The framework gives strong indicators of eligibility where there is a priority level in any domain, or severe levels in two or more domains. Eligibility may also arise from one severe level with needs in other domains, or a combination of high and moderate needs, depending on nature, intensity, complexity and unpredictability.4 This is why the narrative matters as much as the tick boxes.
Fast-track CHC is different. It is for people with a rapidly deteriorating condition that may be entering a terminal phase, where an appropriate clinician completes the fast-track pathway tool so care can be arranged quickly.5 Families should not be told to wait for a full DST if fast-track criteria clearly apply.
Evidence that makes the difference
CHC decisions often turn on records. A phrase such as "needs help with mobility" is weaker than "requires two carers and a hoist for all transfers, has fallen three times in six weeks, cannot follow safety instructions because of cognitive impairment, and becomes distressed during personal care". Specificity shows intensity, complexity and risk.
Useful evidence includes care-home daily notes, incident reports, falls logs, skin charts, wound photographs, turning charts, food and fluid charts, weight loss, choking episodes, medication administration records, behaviour logs, hospital discharge summaries, therapy notes, GP records, safeguarding notes and family observations. The best evidence shows frequency and consequence.
Do not rely only on diagnosis labels. Dementia, Parkinson's disease, stroke, multiple sclerosis, motor neurone disease, brain injury or frailty may be relevant, but CHC asks what care the person actually needs. Two people with the same diagnosis can have very different eligibility outcomes.
Safety point: if discharge from hospital is being planned and care needs are high, ask whether CHC screening or interim funded care should be considered before discharge. Unsafe discharge should be challenged through the ward team, discharge coordinator or PALS.
If CHC is refused
If CHC is refused, ask for the written decision, completed checklist or DST, domain levels, rationale and appeal route. Read the rationale against the evidence. Common problems include missing night needs, minimising behavioural risk, treating managed needs as absent needs, ignoring complexity between domains, or relying on diagnosis rather than actual care requirements.
Age UK advises that people can challenge a CHC decision and should ask the integrated care board about its review process if they disagree.7 The usual route is local resolution first. If disagreement remains, the case may be considered through an independent review process, and after that, complaints about process may reach the Parliamentary and Health Service Ombudsman.
If the person is not eligible for CHC but lives in a nursing home and needs care from a registered nurse, NHS-funded nursing care may apply. Government guidance explains that NHS-funded nursing care is a contribution paid by the NHS to nursing homes for eligible residents who need registered nursing care but do not qualify for CHC.6
What to ask the GP, hospital or care team
The right question is not "can we have funding?", but "do these needs suggest a primary health need?" Bring evidence. If you need help organising the care story before an appointment or assessment, Start here.
Use the health library to understand the underlying condition, and insights for evidence-based navigation. If medications, supplements or care-home drug charts are part of the risk picture, the stack builder can help you prepare a cleaner medicines list for review.
- Does the person need a CHC checklist, full DST assessment, fast-track assessment or review of an existing decision?
- Who is responsible for requesting the checklist or assessment, and when will it happen?
- Can the assessment include care-home notes, night needs, family evidence, risk incidents and recent hospital records?
- If the person is being discharged, is the care plan safe while CHC eligibility is considered?
- If CHC is refused, what is the local review route and deadline for challenging the decision?
CHC is difficult because it sits between health care, social care and family finances. The best way through is calm evidence: show what care is needed, why it is health-related, how intense or unpredictable it is, and what happens without skilled support.
References
- Department of Health and Social Care, 2022. National framework for NHS continuing healthcare and NHS-funded nursing care. link
- Department of Health and Social Care, 2022. NHS continuing healthcare and NHS-funded nursing care: public information leaflet. link
- Department of Health and Social Care, 2022. NHS continuing healthcare checklist. link
- Department of Health and Social Care, 2022. NHS continuing healthcare decision support tool. link
- Department of Health and Social Care, 2022. NHS continuing healthcare fast-track pathway tool. link
- Department of Health and Social Care, 2022. NHS-funded nursing care practice guidance. link
- Age UK, updated 2026. NHS continuing healthcare. link
Nine free tools on this site help you act on what you just read: keep a think-out-loud health journal, prepare a GP appointment, check a supplement stack before buying more, or decode blood results.
Symptom Decoder · Health Journal · GP Script Generator · Stack Risk Checker · Lab Result Primer · Health MOT · All tools. Want it all synced and organised in one private map? The Club, £10/month.
This article is educational and does not constitute medical advice, diagnosis, or a treatment recommendation. Medication uses described as “off-label” are not licensed for that purpose in the UK and should only be considered under qualified clinical supervision. Always speak to your GP, pharmacist, or a registered specialist before starting, stopping, or changing any treatment. If you have severe or alarm symptoms - unintentional weight loss, blood in your stool, difficulty swallowing, persistent vomiting, a fever, or severe pain - seek urgent medical care.