NHS Continuing Healthcare — almost always shortened to CHC — is a package of care funded entirely by the NHS for adults whose primary need is a health need. Where someone qualifies, the NHS pays the full cost, with no means test, and that includes care delivered in their own home.
It is also the single most underclaimed thing in the care system. Families spend savings for years on care that would have been funded, because nobody told them to ask.
The thing that decides it
CHC does not depend on a diagnosis. Having a serious condition does not qualify you; managing well with a serious condition may not, and struggling badly with a less dramatic one may.
What is assessed is whether the person has a primary health need, judged across four dimensions:
- Nature — what kind of needs they are, and what effect they have
- Intensity — how severe, and how much support they require
- Complexity — how the needs interact and how skilled the response has to be
- Unpredictability — how much they fluctuate, and what the risk is if they are not met promptly
Unpredictability is the one families most often under-describe. "He's fine most days" is true and unhelpful; what the assessment needs to hear is what happens on the days he is not, how often that is, and how quickly it escalates.
How the process runs
### 1. The Checklist
A short screening tool. Any health or social care professional involved can complete one — a nurse, GP, social worker, discharge coordinator, care home manager. You can ask for one, and you should not be told it is not worth it.
The Checklist is deliberately generous: it is designed to let people through to the fuller assessment rather than filter them out. Being screened in does not mean qualifying.
### 2. The Decision Support Tool
If the Checklist is passed, a multidisciplinary team carries out a full assessment using the Decision Support Tool, which scores needs across twelve care domains — behaviour, cognition, communication, mobility, nutrition, continence, skin, breathing, medication, altered states of consciousness, and others.
The person and their family should be invited and involved. Ask when it is happening. Do not let it happen without you.
### 3. The recommendation
The team recommends eligibility or not, and the integrated care board makes the decision. Where the answer is no, they should explain why against the domains.
Preparing properly, because it matters
The assessment records what is said on the day, and families routinely undersell what they are dealing with because they have normalised it.
Before it happens, write down over a fortnight: what actually happens on a bad day, how often bad days occur, how many times a night somebody is up, what tasks require two people, what goes wrong when a need is not met quickly, how long each thing takes.
Bring that document. Ask that it goes in the record.
Describe the worst realistic day, not the average one. The framework is explicitly interested in unpredictability and risk, and an assessment that only hears about good days will score them.
Fast track
Where someone has a rapidly deteriorating condition and may be entering a terminal phase, there is a Fast Track pathway. A clinician completes it, and it should produce funded care within days rather than weeks. It exists specifically so that people can get home to die without waiting on a panel.
If palliative care at home is being discussed and CHC has not been mentioned, ask about Fast Track directly.
If the answer is no
Appeal. There is a formal route to ask the integrated care board to review, and a further route to NHS England beyond that. A meaningful proportion of decisions change.
Ask for the completed Decision Support Tool and read the scoring against each domain. Appeals succeed most often where the evidence about intensity or unpredictability was thin, which is exactly what preparation prevents.
Beacon offers free independent advice on CHC and is worth contacting before appealing.
Related funding worth knowing
NHS-funded nursing care is a separate, smaller contribution towards nursing care in a nursing home, not the same thing.
Joint packages exist where needs are partly health and partly social care, with the NHS and council each funding a portion.
And the routes that apply regardless — council funding, Attendance Allowance, PIP — are set out in who pays for home care.
Where we fit
A good deal of the complex and clinical care we deliver is CHC-funded — tracheostomy, PEG feeding, spinal injury, acquired brain injury, packages that let somebody leave hospital when the clinical need has not gone away.
We can tell you whether what you are describing sounds like the kind of package CHC typically covers. For the assessment itself, take advice from somebody with nothing to sell.
