NHS Continuing Healthcare – your complete guide

NHS Continuing Healthcare covers every penny of your care costs. It’s available for anyone with long-term health needs. But many people don’t apply because they simply don’t realise it exists or assume they’re ineligible. However, you should never be put off.

What is the NHS Continuing Healthcare (CHC)?

NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS. If your loved one has a primary health need, the NHS pays for 100% of their care costs, including personal care, nursing, and even accommodation (like care home fees).

Unlike local authority funding, CHC is not means-tested. Your loved one's savings and property are not looked at and eligibility is based solely on their health needs.

Who can get Continuing Healthcare?

Eligibility is not based on a specific diagnosis (like dementia or Parkinson's), but on the nature, intensity, complexity, and unpredictability of your loved one's needs.

What's the difference between a primary health need and a social care need?

• Primary health need: Care required to manage a complex medical condition, unstable symptoms, or a need for specialised clinical intervention.
• Social care need: Help with activities of daily living like dressing, bathing, or laundry. This is usually managed by the local council and is means-tested.

Does dementia qualify for CHC?

A diagnosis alone does not guarantee funding. However, if symptoms include severe confusion, hallucinations, or behaviours that put the person at risk, they are much more likely to be eligible. Always apply if you are unsure.

The 2-step application process

The application process is governed by the National Framework for NHS Continuing Healthcare.

Stage 1: The CHC checklist (initial screening)

The CHC checklist is a quick screening tool used by a nurse or social worker. It looks at 11 "care domains", an area of health and wellbeing where your loved one may need support. There are four priority domains: ‘Behaviour’, ‘Breathing’, ‘Medication’, and ‘Altered State of Consciousness’. Scores in these areas count more than in others.

• The Goal: To see if your loved one's needs are high enough to require a full assessment.
• The Threshold: Deliberately low. Most people with significant needs should pass this stage.

Stage 2: The full assessment and decision support tool

If your loved one passes the checklist, a multi-disciplinary team, usually a nurse and a social worker, will complete a detailed document called the Decision support tool.

• They score your needs from "No needs" to "Priority."
• Eligibility rule of thumb: Your loved one generally needs one "Priority" need or two "Severe" needs to qualify.

What is fast track funding?

If your loved one's health is rapidly deteriorating and they may be entering a terminal phase, a clinician can use the Fast track pathway. This bypasses the standard 28-day waiting period, and funding is usually approved within 48 hours.

What is a Personal Health Budget?

Since April 2019, a Personal Health Budget (PHB) has been the default option for anyone receiving NHS Continuing Healthcare in England.

A PHB isn't extra money; it is a way of putting a clear monetary value on your loved one's care entitlement. This gives you transparency and, more importantly, a choice in how their care is delivered. If they are eligible for CHC and wish to stay in their own home with live-in care, a Personal Health Budget is the primary tool to make that possible.

How is a PHB administered?

Once your loved one's budget is agreed upon, you have three main options for how the funds are managed:

• Direct Payments: The NHS gives the funds directly to you or your loved one. You then have the freedom to choose and manage your own care providers, such as hiring a live-in care service like Elder.
• Notional Budgets: The NHS retains the money, but they choose and pay the care providers for you based on your preferences.
• Third-Party Arrangement: An independent organisation (such as a trust or a specialised broker) manages the money and the care arrangements on your behalf, following your agreed care plan.

CHC vs NHS-Funded Nursing Care (FNC)

If the assessment finds your loved one isn't eligible for full CHC, they may still qualify for FNC. This is a flat-rate contribution paid directly to a nursing home to cover the costs of a registered nurse.

• Standard rate: £254.06 per week
• Higher rate: £349.50 per week.

CHC impact on other benefits

Receiving CHC funding changes which benefits your loved one can claim:

How to appeal a negative decision

If your loved one is turned down, you have six months to request a local appeal.

1. Request the DST/checklist: Read the notes to see where the assessors disagreed with your view.
2. Gather evidence: Use GP records, care logs, and specialist reports to prove the "intensity" or "unpredictability" of the need.
3. Local resolution: Meet with the Integrated Care Board (ICB) to discuss the dispute.
4. Independent review: If still unsuccessful, you can request an Independent Review Panel from NHS England.

Tips for a successful application

• Keep a care diary: Document "incidents", e.g. falls, bouts of aggression, or breathing difficulties. This provides the "evidence" assessors need.
• Be [resent: Never allow an assessment to happen without a family member or advocate there to speak for the patient.
• Focus on the "why": Don't just say "they need help eating." Say "they have a high risk of choking (complexity) and require one-to-one supervision for every meal (intensity)."

NHS funding across the UK

While the principle of "free care for health needs" is universal, the application process and terminology differ by nation.

Wales: The primary health need

In Wales, CHC works similarly to England but is governed by the Welsh Government’s National Framework.

• Assessment: Uses the same "Checklist" and "Decision Support Tool" (DST) structure.
• Key difference: In Wales, there is often a stronger emphasis on the "joint" nature of care. If your loved one does not qualify for full CHC, they may receive a "joint package" where the NHS and the Local Authority split the costs.
• Nursing Care (FNC): If your loved one is in a care home but does not qualify for full CHC, the flat-rate NHS contribution is currently £201.74 per week.

Scotland: Hospital Based Complex Clinical Care (HBCCC)

Scotland abolished the traditional "Continuing Healthcare" model in 2015. It was replaced by Hospital Based Complex Clinical Care.

It boils down to one question: "Can your care needs be properly met in any setting other than a hospital?" If yes, your loved one is discharged. They do not get "CHC funding" at home or in a care home. Instead, they transition to social care.

In Scotland, personal care is free for everyone aged 65+ (and many under 65) regardless of income. While you might pay for "bed and board" in a care home, the actual "care" part is funded by the state.

If your loved one's needs are so complex they must be met in a hospital, the NHS funds 100% of their stay.

England: The 28-day rule

England remains the most rigid regarding the 28-day timeline for assessments.

• ICBs: Care is managed by Integrated Care Boards (formerly CCGs).
• Personal Health Budgets: England is currently the leader in offering Direct Payments for CHC, giving you the most flexibility to hire your own home-care team.

Need help arranging care after a CHC assessment? Speak to our care experts today to see how a Personal Health Budget can be used for live-in care.

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