NHS Continuing Healthcare (CHC)

What Is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a package of ongoing care that is arranged and fully funded by an Integrated Care Board (ICB) — the NHS body responsible for commissioning care in your area. It applies to adults who have a primary health need.

Unlike care funded by the local council, CHC has no financial means test. The person's savings, property or income are irrelevant. If you qualify on health grounds, the NHS pays everything.

CHC can fund care provided in your own home, in a care home, or in a nursing home.

Who Qualifies?

To qualify for CHC, you must have a primary health need — meaning your overall care needs are primarily driven by a health condition, rather than social or personal care needs alone.

There is no single diagnosis that automatically qualifies you. The assessment looks at the nature, complexity, intensity and unpredictability of your needs across 12 domains.

Conditions that frequently lead to CHC funding include:

• Advanced dementia with significant behaviour or physical care needs
• Advanced progressive neurological conditions (MND, MS, Parkinson's)
• Acquired brain injury with complex care needs
• Advanced cancer with palliative care needs
• Severe COPD with frequent crises
• Complex wound care or clinical nursing needs
• Epilepsy with frequent uncontrolled seizures
• Significant learning disabilities with complex health needs

This list is not exhaustive. The decision is always based on the individual assessment, not diagnosis alone.

The Assessment Process

1. 1

   CHC Checklist

   A brief initial screening tool. Completed by a health or social care professional. If the result indicates possible CHC eligibility, a full assessment is arranged.

2. 2

   Multidisciplinary Team (MDT) Assessment

   A more detailed assessment using the Decision Support Tool (DST), completed by two or more health and social care professionals who know the person. You or your representative should be involved.

3. 3

   ICB Decision

   The Integrated Care Board reviews the MDT's recommendation and makes the funding decision. This should happen within 28 days of the MDT assessment.

4. 4

   Care Planning

   If approved, the ICB commissions a care package that meets your assessed health needs. You may have the option of a personal health budget.

The CHC Checklist

The CHC checklist is a 12-domain screening tool used to determine whether a full assessment is needed. The 12 domains are:

For the checklist to indicate CHC eligibility, the person must have either: two or more "A" (high) scores, or five or more "B" (moderate) scores, or one "priority" domain score (representing a severe need).

The Decision Support Tool (DST)

If the checklist indicates possible eligibility, a full assessment using the Decision Support Tool is carried out. Each of the 12 domains is scored as: No needs / Low / Moderate / High / Severe / Priority.

One "priority" rating in any domain (or two "severe" ratings) should normally lead to a recommendation of CHC eligibility. The MDT looks at the overall picture — the nature, complexity, intensity and unpredictability of needs — not just the individual scores.

How to Apply

You cannot self-refer for CHC — a request must come from a health or social care professional:

• Ask your GP to request a CHC checklist screening
• Ask a hospital consultant or ward staff — particularly at the point of hospital discharge
• Ask your district nurse or community nursing team
• Ask your social worker if you already have one

If a professional declines to refer despite clear complex health needs, you can contact your ICB directly and request a screening. Citizen's Advice or a welfare rights service can help.

You are also entitled to be involved in the assessment process, to see the completed DST, and to have a representative (family member, advocate) present.

If You're Refused

CHC is frequently refused — and frequently overturned on review. If you believe the decision was wrong:

1. Request a copy of the DST and written reasons for the decision
2. Local Review — request an internal review by the ICB. Must be requested within 6 months of the decision.
3. NHS Resolution (formerly the Independent Review Panel) — an independent review if local review doesn't resolve the matter
4. Parliamentary and Health Service Ombudsman — if all internal processes are exhausted

Consider seeking help from a CHC specialist or solicitor who operates on a no-win no-fee basis — many families have successfully recovered substantial backdated funding.

Fast-Track CHC

Where a person has a rapidly deteriorating condition that may be entering a terminal phase, a clinician can complete a Fast-Track CHC request. This should result in a care package being put in place within 48 hours, without a full DST assessment.

Fast-track applies to end-of-life situations. If you are caring for someone who is terminally ill and needs urgent care, ask the GP or palliative care team about fast-track CHC immediately.