NHS Continuing Healthcare explained

What NHS Continuing Healthcare is

NHS Continuing Healthcare is free care funded by the NHS for adults aged 18 and over whose main need for care is because of their health rather than social reasons. If someone qualifies, the NHS pays for the whole package — including personal care and, where relevant, the full cost of a care home place or care in their own home. This is different from ordinary social care arranged by the local council, which is means-tested, so many people have to contribute towards or fully fund it depending on their savings. Because CHC covers everything, it can make an enormous financial difference to families. It is not about a particular diagnosis; it is about the nature and complexity of a person's ongoing needs. Anyone with significant continuing health needs can be considered, whatever their condition.

Who might qualify

Whether someone qualifies depends on their assessed needs, not on their illness alone. The system looks at what is called a primary health need — meaning the main reason they need care is health-related. Assessors consider things like the nature of the person's needs, how intense and complex they are, and how unpredictable they can be, across areas such as mobility, breathing, nutrition, skin, continence, medication, behaviour and cognition. Someone with a fast-changing, complex or risky condition is more likely to qualify than someone with stable, straightforward needs. People with advanced illness, severe disability, or complex conditions after a stroke or with dementia may be eligible, but eligibility is never assumed from the diagnosis. It is decided through a structured assessment, so it is always worth asking to be considered if needs are significant.

How the assessment works

Assessment usually happens in two stages. First, a professional such as a nurse, doctor or social worker completes a short screening tool called the Checklist to see whether a full assessment is needed; this is deliberately set to let many people through to the next stage. If the Checklist is positive, a fuller assessment follows using a Decision Support Tool, completed by a team of at least two professionals from different backgrounds. They score needs across the different areas and use this, plus their overall judgement, to recommend whether the person has a primary health need. The person and their family or representative should be involved and can contribute evidence. A local NHS panel then makes the final decision. There is also a Fast Track process for people who are rapidly deteriorating, for example with a terminal illness, so care can be put in place quickly.

If you disagree with a decision

Not everyone who applies is found eligible, and decisions can feel unfair or hard to understand, but you have the right to challenge them. If you disagree with the outcome, you can ask the NHS body (the integrated care board) that made the decision to review it, and you should be given clear reasons for the original decision in writing. If you remain unhappy after their review, you can take the matter to an independent review panel, and beyond that to the Parliamentary and Health Service Ombudsman. It is also possible to seek reimbursement if care was wrongly paid for in the past. The process can be lengthy and detailed, so keeping records, gathering evidence about the person's needs, and getting support from an advocate or a specialist advice organisation can make a real difference.

Getting help and support

The CHC process is well known for being complex, so it is worth getting support. Ask the person's care team, GP, hospital discharge team or social worker how to request an assessment — you can ask for one if you think you or a relative might qualify. Age UK, Carers UK, the Alzheimer's Society and Citizens Advice all offer free, trusted information, and some provide help through the assessment or an appeal. There are also independent advocates and specialist advisers, though be wary of firms charging high fees. Keep copies of assessments, care notes and correspondence, and take someone with you to meetings if you can. If needs change, a review can be requested, as eligibility is not fixed forever. Understanding your rights, and asking questions, helps make sure people get the funded care they are entitled to.