What Is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS for adults who have a primary health need.
This means the NHS, not the local authority or the individual, is responsible for meeting their ongoing care needs, and the care is free.

CHC can fund care in:

• A care home

• A nursing home

• The person’s own home

It can cover all assessed health and social care needs, including:
nursing care, personal care, mobility support, medication, equipment, and specialist interventions.

Who Is Eligible for CHC?

Eligibility does not depend on:

• Age

• Diagnosis

• Savings or income

• Where the person lives

Instead, it depends on the nature of the person’s needs not the condition itself.

The NHS uses four tests, known as Key Indicators, to determine if someone has a primary health need:

1. Nature

This describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.

NHS Wales (2022) National Framework for Implementation of Continuing NHS Healthcare in Wales (Revised Edition). Cardiff: Welsh Government.

2. Intensity

This relates both to the extent (‘quantity’) and severity (‘degree’) of the needs and to the support required to meet them, including the need for sustained/ongoing care (‘continuity’).

NHS Wales (2022) National Framework for Implementation of Continuing NHS Healthcare in Wales (Revised Edition). Cardiff: Welsh Government.

3. Complexity

This is concerned with how the needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/ or manage the care. This may arise with a single condition, or it could include the presence of multiple conditions or the interaction between two or more conditions. It may also include situations where an individual’s response to their own condition has an impact on their overall needs, such as where a physical health need results in the individual developing a mental health need.

NHS Wales (2022) National Framework for Implementation of Continuing NHS Healthcare in Wales (Revised Edition). Cardiff: Welsh Government.

4. Unpredictability

This describes the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the individual’s health if adequate and timely care is not provided. Someone with an unpredictable healthcare need is likely to have either a fluctuating, unstable or rapidly deteriorating condition.

NHS Wales (2022) National Framework for Implementation of Continuing NHS Healthcare in Wales (Revised Edition). Cardiff: Welsh Government.

If the overall picture across these indicators shows that the person’s needs are beyond what local authority social care can legally provide, they should qualify for CHC.

What Happens in a CHC Assessment?

Step 1: The Checklist

A short screening tool used by a nurse, doctor, or social care professional.

• If the checklist meets the threshold, the person moves to a full assessment. This does not mean an individual is eligible for funding. The threshold is set intentionally low to ensure everyone who potentially requires NHS CHC funding.

Step 2: The DST (Decision Support Tool)

A multidisciplinary team (MDT) assesses 12 areas of need, called domains, including:

• Breathing

• Nutrition

• Continence

• Skin Integrity

• Mobility

• Communication

• Psychological & Emotional Needs

• Cognition

• Behaviour

• Drug Therapies and Medication

• Altered States of Consciousness

Each domain is given a level of need (No Needs → Priority).

The MDT then considers the Key Indicators to make a recommendation.

Step 3: The ICB Decision

The Integrated Care Board reviews the MDT’s recommendation and makes the final decision about eligibility.

If CHC Is Approved

Care becomes fully funded, and:

• A care plan is created

• Funding is reviewed after 3 months, then yearly

• Families can choose suitable providers or opt for care at home

There is no means-testing or personal contributions.

If CHC Is Refused

Families can:

• Request a local resolution meeting

• Submit a formal appeal

• Escalate to an Independent Review Panel (IRP) if needed

It’s important to ask for the full DST and MDT notes, and to challenge inaccuracies or missing evidence.

What About Retrospective CHC?

If someone should have received CHC in the past but didn’t, families can request a retrospective review.
If found eligible, they may receive reimbursement for that period of care, usually up to a maximum of twelve months.

Common Myths About CHC

❌ “You need to have dementia or be at end of life.”
✔ Eligibility is based solely on needs.

❌ “You must be bedbound.”
✔ Many mobile individuals still qualify.

❌ “It depends on your savings or income.”
✔ CHC is not means-tested.

Final Thoughts

NHS Continuing Healthcare can remove a huge financial and emotional burden from families and the process can feel overwhelming. Understanding the criteria, the assessment stages, and your rights makes all the difference.

Need Support With CHC?

If you’re unsure where to start, need help understanding a decision, or want guidance on a retrospective review, I can support you.

Get in touch today for clear, expert advice on navigating the CHC process.