NHS Continuing Healthcare — CHC for short — is one of the best-kept secrets in adult social care, and that’s not an accident. It’s a stream of NHS funding that, if you qualify, pays for the entirety of your care — in a nursing home or in your own home — regardless of your savings, assets, or income. There’s no means test. There’s no upper threshold. If you qualify, the NHS pays. And yet, year after year, families who should be eligible are not assessed, are assessed badly, or are turned down for reasons that don’t stand up to scrutiny.
Let’s start with what CHC actually is. The legal foundation is the National Health Service Act 2006 and the National Framework for NHS Continuing Healthcare. The principle is simple: if your relative’s care needs are primarily health needs rather than social care needs, then the NHS — not the local authority, not your relative — should pay for those needs. The complication is the word “primarily,” which is where every CHC dispute lives.
The assessment process is a two-stage thing. Stage one is the Checklist, which is a screening tool that any nurse, social worker, or GP can complete. It looks at twelve care domains — things like breathing, nutrition, continence, skin integrity, mobility, cognition, behaviour, communication, drug therapies, altered states of consciousness, psychological/emotional needs, and so on. Each domain is scored as High, Moderate, Low, or No needs. If the Checklist scores meet a certain threshold — broadly, two highs, five moderates, or one with a priority indicator — the case moves to a full assessment.
Stage two is the Decision Support Tool, or DST. This is a much fuller multi-disciplinary assessment, usually involving a clinical commissioning representative, a social worker, the GP, and ideally the family. It looks at the same domains but in much more depth, and it uses four key indicators to decide whether the needs are “primarily health.” Those indicators are nature, complexity, intensity, and unpredictability. If your relative’s needs are complex enough, intense enough, or unpredictable enough, they qualify for CHC.
In practice, this is where families get tripped up. CHC assessments are notoriously inconsistent across the country. Some Integrated Care Boards (formerly Clinical Commissioning Groups) are more generous than others. The same condition can result in CHC funding in one area and refusal in another. The Parliamentary and Health Service Ombudsman has repeatedly found that CHC decisions are often based on financial pressures within the local NHS, not on the framework. There is an active appeals process, and a substantial number of appeals succeed. If you’ve been turned down and you think the decision is wrong, appeal.
Who typically qualifies? People with advanced dementia and behavioural challenges. People with neurological conditions like motor neurone disease, multiple sclerosis, Parkinson’s at advanced stages, or Huntington’s disease. People recovering from severe strokes with complex rehabilitation needs. People with complex medication regimes — multiple drugs at varying times, syringe drivers, complicated wound dressings. People who are nearing the end of life from any progressive condition. People with very intense, unpredictable behaviour. People who require one-to-one care for safety reasons.
Who typically doesn’t? Frail elderly people whose care needs are mostly about everyday support — help with washing, dressing, mobility, food — even if they have significant health conditions. The system treats those needs as social, not health, even though for the family they feel deeply medical. This is the fundamental injustice in the way CHC is drawn, and it’s the reason the line gets fought about in every appeal.
There’s also something called Fast Track CHC, which is the route for people who are nearing end of life. If a clinician believes someone has a rapidly deteriorating condition that may be entering its terminal phase, they can complete a Fast Track tool and CHC funding can be in place within 48 hours. There’s no checklist, no DST — just the Fast Track form. This is one of the most useful and underused provisions in the framework, particularly for people being discharged from hospital to die at home or in a nursing home.
If your relative is being assessed for CHC, here’s what you can do to make the process work for them. First, ask for the assessment in writing. Don’t let it be informal. Second, ask for a copy of the Checklist and the DST when they’re completed. You have a right to see them. Third, contribute to the assessment yourself — you know your relative better than the multi-disciplinary team does, and your input matters. Fourth, push back on any score that you think is wrong. The assessors don’t always know the day-to-day reality, especially if your relative has good days and bad days.
Fifth, get help. Organisations like Beacon CHC and the Care to be Different community can advise. The CHC framework is dense and intimidating, and a knowledgeable advocate can make a material difference. Some advocates work on a no-win-no-fee basis if you’re appealing a refusal. Some charge a flat fee. The cost can be worth it if a successful appeal results in years of free care.
What happens if CHC is granted? The NHS will pay the full cost of your relative’s care. If they’re in a nursing home, the NHS pays the home directly, at whatever rate has been agreed. If they’re at home, the NHS will commission a package of domiciliary care. You as the family pay nothing. Your relative pays nothing — though their state pension continues, and they keep their personal allowance.
What happens if CHC is refused? You can appeal. The first step is a local resolution meeting with the Integrated Care Board. The second is an Independent Review Panel. The third is the Parliamentary and Health Service Ombudsman. Appeals can take months or even years, but if you win, the funding is backdated. Families have received six-figure refunds where they’d been wrongly self-funding for years.
What about retrospective claims? If you believe your relative should have been receiving CHC funding in the past but wasn’t, you can apply for a retrospective review. The window for these is narrow — you generally have to apply within six months of the death or the funding decision — but it’s worth knowing about. If your mum died last year and was self-funding her care while clearly meeting CHC criteria, you may be entitled to a refund of those fees.
What about FNC — Funded Nursing Care? This is a separate, smaller stream of NHS funding that applies to anyone in a nursing home (not a residential home) who has assessed nursing needs. It’s a flat weekly contribution, £235.88 in 2024/25, paid directly to the home and credited against your fees. Every nursing resident should be assessed for FNC. If your home hasn’t done this, push them to.
We see the CHC system working well, and we see it working badly. The variability is the thing. Two residents with very similar needs can end up with completely different outcomes depending on who assessed them, when, and where. We do everything we can to support the families through the process — we contribute to assessments, we challenge unfair decisions, we keep records that help. But the framework is what it is, and we’re not pretending it’s perfect.
If you’re at the start of this journey, here’s the short version. Ask for the Checklist as soon as a CHC assessment is even possible. Be present at every assessment you can. Read the Decision Support Tool carefully. Appeal anything that looks wrong. And get help if you need it.
At Aldridge Court Nursing Home in Aldridge, Walsall, we’ve supported many families through the CHC process over the years. We’ve seen people get funded, we’ve seen people get refused, and we’ve seen people win on appeal. If you want to talk about your situation in confidence, drop in any time or call 01922 455731. There’s no charge for the conversation.
It’s worth saying something about how CHC interacts with the rest of the social care system. If your relative has CHC, the rest of the means-tested system becomes largely irrelevant. The local authority is not involved. The NHS commissions the care directly. If your relative loses CHC at a future review (which can happen if their condition stabilises or improves), they’ll be reassessed for local authority funding, and the rules from before kick back in. Reviews happen at three months after the initial funding decision, then annually. They’re real assessments — CHC is not a permanent grant. Some families lose CHC and have to find alternative funding fast. We work with families through those transitions.
There’s also a quiet point about CHC and choice. In theory, CHC funding gives you choice of care home, in the same way self-funding does. In practice, the Integrated Care Board may have a list of homes they have block contracts with, and steering you towards those homes. You don’t have to accept that. If your relative qualifies for CHC and you want them at a particular home that’s not on the ICB’s preferred list, you can make the case — especially if the home meets the assessed needs and the cost is in line with what the ICB would otherwise pay. We’ve had this conversation with the ICB many times. It’s not always easy, but it’s a conversation worth having.