How to Apply for NHS Continuing Healthcare

What Is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of ongoing care arranged and fully funded by the NHS for adults who have a "primary health need" — meaning their primary care need is health-related rather than social.

Unlike council-funded care, CHC is not means-tested. A person with £1 million in savings qualifies the same as someone with no savings if their clinical needs meet the criteria.

CHC can fund care in:

• Your own home (via a home care package or personal health budget)
• A care home (including nursing home fees — 100%)
• Other care settings

Step 1 — Trigger the Assessment

The assessment process should be triggered when there are concerns about someone's complex health needs. You can request an assessment:

• From the hospital discharge team — before someone goes home from hospital
• From the GP or community nurse
• By contacting your local Integrated Care Board (ICB) — the NHS body responsible for CHC in your area
• By writing directly to the ICB and requesting a CHC assessment

Step 2 — Checklist Assessment

The first stage is a CHC Checklist — a brief screening tool to determine whether a full assessment is warranted. It is completed by a nurse or social worker and covers 12 care domains.

If the checklist suggests the person may be eligible, the full assessment proceeds. If it is negative and you disagree, you can challenge this — the checklist is not the final decision.

Common reasons families are refused at the checklist stage:

• The assessor did not have complete information about the person's needs
• The person was assessed on a good day
• Complex or fluctuating needs were not fully captured

If the checklist is completed in hospital, insist on having a copy. If you disagree with the outcome, put your objection in writing to the ICB immediately.

Step 3 — Decision Support Tool (DST)

If the checklist indicates potential eligibility, a full assessment is conducted using the Decision Support Tool (DST). This is completed by a Multidisciplinary Team (MDT) — usually a nurse and social worker, with input from other professionals who know the person.

The DST scores the person across 12 care domains:

Each domain is rated: No Need, Low, Moderate, High, Severe, or Priority (for some domains). A "Priority" level in any domain usually indicates eligibility. Two or more "Severe" ratings, or five or more "High" ratings, also generally indicate eligibility.

Your Role in the DST Assessment

You have the right to attend the MDT meeting and contribute. This is important — you know the person best. Before the meeting:

• Write a detailed statement covering the person's needs in each domain
• Include accounts of the person's worst or most complex days — not just typical days
• Describe unpredictable or fluctuating needs — these are significant
• Bring any supporting evidence: medical letters, care logs, notes
• Describe how needs interact — e.g., cognitive impairment affecting ability to manage medication safety

Step 4 — The Decision

The ICB (Integrated Care Board) makes the final decision. They must write to you with the outcome and reasons. If CHC is awarded:

• The ICB arranges and funds the care package
• You can request a Personal Health Budget to have more control over how care is delivered
• CHC is reviewed at least annually
• You can choose Ekvarta as your provider if you receive a Personal Health Budget

Challenging a Refusal

CHC refusals are common and are frequently successfully challenged. If you disagree with the decision:

1. 1

   Request a Review

   Ask the ICB to review the decision. Put your grounds for disagreement in writing. Submit new or additional evidence. The ICB must review and respond.

2. 2

   NHS England Independent Review

   If the ICB review is unsatisfactory, request an independent review by NHS England. This is a more formal process.

3. 3

   Parliamentary and Health Service Ombudsman

   For serious maladministration in the process, complain to the PHSO: 0345 015 4033.

The CHC Legal Advice Line provides free guidance: 0808 802 6925 (Beacon, Mon–Wed 9am–1pm)

Fast-Track CHC (Terminal Illness)

If a person has a rapidly deteriorating condition or is approaching the end of life, a fast-track process should be used. A clinician (usually a GP or hospital consultant) completes a Fast-Track Tool stating that CHC is needed urgently. The ICB must put care in place within 48 hours of receiving the fast-track.

If a clinician will not complete the fast-track, you can contact the ICB directly and explain the urgency. Do not wait for formal processes if a person's situation is deteriorating rapidly.