NHS Continuing Healthcare: who qualifies and how to apply

CHC is a complete package of care arranged and funded by the NHS for adults whose main need for care comes from their health. It can be provided in a care home, where it covers the full fee including accommodation, or in your parent’s own home, where it covers their care and support.

It is not a benefit you claim, and it is not linked to any single diagnosis. It is also not the same as NHS-funded nursing care, which is a much smaller weekly contribution paid to nursing homes. CHC covers everything; you cannot receive both at the same time.

Eligibility rests on whether your parent has what the rules call a “primary health need”. In plain terms: is the main reason they need care their health, rather than the ordinary support with daily living (washing, dressing, meals) that social care provides?

Assessors look at the overall picture of needs through four lenses: their nature (what they are like and what care they demand), their intensity (how severe and constant they are), their complexity (how needs interact and how much skill they require), and their unpredictability (how hard they are to anticipate and the risks if they are not met promptly).

This is why diagnosis alone never settles it. Two people with the same condition can have very different needs. Someone with advanced dementia who is settled and well supported may not qualify, while someone whose condition causes unpredictable, high-risk behaviour might. If dementia is part of your situation, our guide to dementia care homes is worth reading alongside this one.

The process in England starts with a screening tool called the checklist. A nurse, GP, social worker or other professional completes it, in hospital before discharge, at home, or in a care home. Anyone can ask for one: speak to your parent’s GP, social worker, or the hospital discharge team, and be direct about it. Say you would like your parent screened for NHS Continuing Healthcare.

The checklist threshold is deliberately set low, so passing it does not mean your parent will qualify. It simply triggers the full assessment. If the checklist is negative, you should be told in writing, with the reasons, and you can ask again if their needs change.

The full assessment is carried out by a multidisciplinary team using a document called the Decision Support Tool (DST). The team looks at your parent’s needs across a set of care domains, including behaviour, cognition, communication, mobility, nutrition, continence, skin integrity, breathing, medication and altered states of consciousness, and records a level of need in each.

The team then recommends whether your parent has a primary health need, and the local integrated care board (ICB) makes the decision. In England, the national framework expects the whole process, from checklist to decision, to take no more than 28 days in most cases, though delays are common in practice.

You and your parent are entitled to be involved. Attend the assessment if you possibly can, bring a diary of needs and incidents, and describe the worst days honestly, not the best ones. Assessments that only capture a good day are a common reason families feel the outcome was unfair.

If your parent has a rapidly deteriorating condition and may be entering the final phase of life, the fast track route bypasses the checklist and the DST. A doctor or nurse completes a fast track tool, and funding should be put in place urgently, within days rather than weeks.

If you are in this situation and nobody has mentioned fast track, raise it yourself with the GP, hospital team or hospice. It exists precisely so that families are not dragged through a long process at the worst possible time.

A refusal is not the end of the road. First, ask for the decision and the completed DST in writing, and check whether the assessment reflected your parent’s real needs. Then you can ask the ICB to review the decision (local resolution). If you are still unhappy, you can ask for an independent review, and after that you can go to the Parliamentary and Health Service Ombudsman.

Time limits apply to requesting a review, usually six months from the decision, so do not sit on a refusal; check the deadline in the decision letter. In some circumstances families can also claim retrospectively for periods when a relative should have been funded but was not.

While you challenge a decision, the normal funding rules apply, so read our guide to who pays for care to understand what your parent pays in the meantime. If they are in a nursing home and CHC has been refused, check they are at least receiving NHS-funded nursing care.

CHC attracts more myths than almost any other part of the care system. The ones we hear most often:

• “A dementia diagnosis qualifies automatically.” It does not. Eligibility is about the nature and intensity of needs, not the diagnosis.
• “You cannot get it if you have savings.” Wrong. CHC is not means tested at all.
• “It is only for people in hospital.” No. It can fund care in a care home or in your parent’s own home.
• “Being in a nursing home means they already get it.” No. Most nursing home residents receive the smaller NHS-funded nursing care payment, not CHC.
• “Once awarded, it lasts forever.” CHC is reviewed, typically after three months and then at least annually, and it can be withdrawn if needs change.

This guide describes the English system. Scotland no longer uses CHC; its equivalent is Hospital Based Complex Clinical Care, which has different rules, and Scotland separately provides free personal care for those assessed as needing it. Wales and Northern Ireland each have their own continuing healthcare frameworks, similar in spirit to England’s but with different processes. Ask the local health board (Wales) or health and social care trust (Northern Ireland).

Wherever your parent lives, the underlying question is the same: are their needs primarily health needs? If the answer might be yes, push for an assessment. And if you are choosing a home for someone with significant health needs, you can browse nursing homes to see what is available locally.