NHS continuing healthcare, explained

NHS Continuing Healthcare, usually shortened to CHC, is the most valuable care entitlement most families have never heard of. If someone qualifies, the NHS pays for all of their assessed care, including the accommodation costs in a care home, and none of it is means-tested. This guide explains who it is for, how the assessment works, and how to ask for one.

The short answer. CHC is free care, funded by the NHS, for adults whose need for care is primarily about their health rather than day-to-day living support. Your savings, income and home are irrelevant to whether you get it. What matters is the nature of your needs.

What CHC actually is

CHC is a package of ongoing care for adults aged 18 and over, arranged and funded by the NHS, for people whose main need is a primary health need. It is not tied to any particular illness or diagnosis. It can be provided in a care home, a nursing home, or in your own home.

The distinction matters because of how care is funded in England. Care arranged by a council is means-tested, so you may pay a great deal. Care funded by the NHS is free at the point of use. So the question of whether someone's needs count as health needs or social care needs can be worth tens of thousands of pounds a year.

Why this is worth checking early. A full CHC package can cost the NHS £50,000 to £150,000 a year, which is exactly why it is worth testing for. Around 60,000 people in England receive CHC at any one time. Many more would qualify if they were assessed properly.

How the assessment works

There are two main stages, plus a fast route for urgent cases.

Stage 1: the Checklist. A nurse, doctor or social worker completes a short screening tool called the Checklist. The threshold is deliberately set low, so that anyone who might be eligible gets a full assessment. A positive Checklist does not mean you qualify, only that you move to the full assessment.

Stage 2: the Decision Support Tool. A multidisciplinary team (an MDT, made up of at least two professionals from different backgrounds) carries out a full assessment using the Decision Support Tool, or DST. It scores your needs across 12 care domains:

• breathing
• nutrition (food and drink)
• continence
• skin (including wounds and pressure areas)
• mobility
• communication
• psychological and emotional needs
• cognition
• behaviour
• drug therapies and medication
• altered states of consciousness
• other significant care needs

Each domain is scored from "no needs" up to "priority". The team is not just adding up the scores. It weighs four key characteristics of your needs: their nature, intensity, complexity and unpredictability. A single "priority" score, or two or more "severe" scores, usually points toward eligibility, but the overall picture is what counts.

The MDT then recommends a decision to the Integrated Care Board (ICB), the local NHS body that makes the final call and holds the budget. England has 36 ICBs following the April 2026 mergers.

An honest tension. The ICB both decides eligibility and pays the bill if you qualify. That does not make the process unfair, but it does mean good evidence matters. Vague notes like "needs help washing" are weaker than specific records such as "two-person assist for transfers, with distress and resistance during personal care". Ask the care provider to keep detailed, dated records ahead of any assessment.

The Fast Track for end-of-life care

If someone has a rapidly deteriorating condition and may be entering the final weeks of life, the Checklist and DST are skipped. A clinician completes a Fast Track tool, and the ICB should put funding in place within days, not weeks. If a doctor or nurse mentions a Fast Track, that funding should follow quickly.

CHC is not the same as Funded Nursing Care

These two are easily confused. If you do not qualify for full CHC but you live in a nursing home and need care from a registered nurse, the NHS pays a flat weekly contribution called NHS-funded Nursing Care (FNC) toward the nursing element. From April 2026 the standard FNC rate in England is £267.68 a week (a higher band of £368.24 applies to a small group who were on it before October 2007).

FNC is helpful, but it is far less than full CHC, which covers everything. Always test for CHC first.

If you are turned down

A refusal is not the end of the road. You have the right to:

1. Ask the ICB for a local review, setting out which domain scores you disagree with and why, backed by evidence.
2. Request an independent review from NHS England if the local review does not resolve it.

Gather medical records, care logs and any specialist letters. The clearer the clinical picture, the stronger the case.

The rest of the UK

CHC is an England term, but the principle of NHS-funded care for primarily health-driven needs exists across the UK under different names and processes. Scotland funds Hospital Based Complex Clinical Care and free personal and nursing care; Wales and Northern Ireland operate their own continuing healthcare arrangements. If you are outside England, ask your health board about the local equivalent.

What to do next

1. Ask for a CHC Checklist. You can request one through the person's GP, hospital discharge team, social worker or community nurse. You do not have to wait to be offered it.
2. Prepare the evidence. Collect care records, hospital letters and medication details before the assessment.
3. Be present. You, or a chosen representative or advocate, have the right to take part in the assessment. Ask for the meeting date in advance.
4. Keep copies. You are entitled to a copy of the completed DST and the decision letter, which should arrive within 28 days.

Check the record before you choose. Whether care is NHS-funded or self-funded, the home still has to be right. Homesplace shows the official regulator's record for every care home and home care agency in Britain, with every fact dated and sourced, so you can choose on the evidence.

Sources

• House of Commons Library: NHS continuing healthcare in England.
• GOV.UK: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
• NHS: NHS continuing healthcare.
• Age UK Factsheet 20: NHS continuing healthcare and NHS-funded nursing care (FNC rates from April 2026).

Homesplace is an independent service and is not affiliated with the NHS, the Care Quality Commission, or any government department. This guide is general information, not medical, financial or legal advice. Figures are correct as of June 2026 and are reviewed regularly.