NHS CHC, put simply.
NHS Continuing Healthcare (CHC) Explained
NHS Continuing Healthcare is trying to answer one question:
Who is responsible for meeting these needs?
The NHS? Or the Local Authority?
We explain the CHC process clearly, simply and without jargon — informed by the professional perspectives of a registered Social Worker and a Registered Nurse.
The CHC Decision Process
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (NHS CHC) is a package of ongoing care that is arranged and fully funded by the NHS. It is available to adults in England whose primary need is a health need — meaning the NHS, rather than the Local Authority, is legally responsible for meeting those needs.
Eligibility is not based on age, diagnosis, care home placement, or a particular score on a form.
The real question
Does the person have a Primary Health Need?
If the answer is yes, the NHS is responsible for meeting those needs. If the answer is no, responsibility falls to the Local Authority.
Who can qualify for NHS Continuing Healthcare?
Not all care needs are the same. The type of need determines who is responsible.
Local Authority
Typically responsible for social care needs:
- Washing
- Dressing
- Preparing meals
- Daily living support
- Social support
NHS
Typically responsible for health care needs:
- Complex medication
- Pressure damage
- Swallowing difficulties
- Clinical monitoring
- Unstable conditions
- High health risks
In practice, many people have a mix of both. CHC determines which type of need is primary.
The Heart of CHC
How does the CHC assessment process work?
The whole NHS Continuing Healthcare process is trying to answer one question:
"Does this person have a Primary Health Need?"
There is no pass mark.
There is no score within the Decision Support Tool that automatically means someone qualifies for NHS Continuing Healthcare.
There is no legal definition.
A Primary Health Need does not have a single legal definition. Every person must be considered individually.
There is no automatic eligibility.
Even high scores within the Decision Support Tool do not automatically mean a person is eligible.
What is a Primary Health Need?
Professionals apply four key characteristics to the evidence.
Nature
What are the person's needs and how do they affect them?
Intensity
How much care is required and how often?
Complexity
How do different needs interact and make care more difficult?
Unpredictability
How likely are the person's needs to fluctuate or create significant risk?
Professionals consider all of the available evidence, apply the four key characteristics and use professional judgement to determine whether the person's needs, taken as a whole, amount to a Primary Health Need.
If Yes
NHS Responsibility
The NHS is responsible for arranging and funding care.
If No
Local Authority Responsibility
The Local Authority may have responsibility for meeting eligible social care needs.
CHC is not about a diagnosis.
It is not about a pass mark.
It is about understanding who is legally responsible for meeting the person's needs.
CHC Clarity
NHS CHC, put simply.
Explore the CHC process
Each section explains one part of the process in plain English.
What is the CHC Checklist?
The CHC Checklist is the first formal stage of the CHC assessment process. It is a screening tool — not a full assessment — used to decide whether someone should proceed to a full CHC assessment.
The Checklist is completed by a health or social care professional and looks at a person's needs across a number of care domains. If the Checklist indicates that a full assessment may be appropriate, the person should be referred for a full multidisciplinary assessment.
Important to know
A person can request a CHC Checklist if they believe they may have a Primary Health Need. If the Checklist is not completed, or if a referral for a full assessment is refused, families have the right to challenge that decision. Our CHC Journey page explains each stage of the process in detail.
What is the Decision Support Tool (DST)?
The Decision Support Tool (DST) is the structured framework used during the full CHC assessment. It looks at a person's needs across 12 care domains — including behaviour, cognition, communication, mobility, nutrition, skin, breathing, drug therapies, psychological needs, continence, altered states of consciousness, and other significant care needs.
For each domain, professionals record the level of need. But the DST is a support tool — not a scoring system. There is no pass mark, and no combination of domain levels automatically results in eligibility or ineligibility for CHC funding.
Professionals must use the DST alongside professional judgement to consider whether the person's needs, taken as a whole, amount to a Primary Health Need. The DST informs that judgement — it does not replace it.
What happens after a CHC assessment?
After the full assessment, the multidisciplinary team makes a recommendation about whether the person has a Primary Health Need. That recommendation is then considered by the Integrated Care Board (ICB), which makes the final funding decision.
If eligible
The NHS arranges and funds a care package. This is reviewed regularly to ensure it continues to meet the person's needs.
If not eligible
The person may be eligible for NHS-funded nursing care (FNC) if they are in a care home. Social care needs may be met by the Local Authority, subject to a financial assessment. Families have the right to request a review or appeal the decision.
What does NHS Continuing Healthcare pay for?
If a person is found eligible for NHS CHC funding, the NHS is responsible for arranging and funding their care in full. CHC funding is not means-tested — there is no financial assessment.
CHC can fund care at home, in a care home, or in a nursing home. The NHS arranges the care package and covers the full cost, including nursing care, personal care, and any other care needs identified in the assessment.
What can you do if CHC funding is refused?
If CHC funding is refused, or if a previous award is withdrawn, families have the right to request a review and, if necessary, to appeal the decision. Many families who appeal are successful.
The appeals process involves a Local Resolution stage with the Integrated Care Board, and if that does not resolve the matter, an Independent Review Panel. Understanding the process — and preparing properly — significantly improves the chances of a successful outcome.
Frequently asked questions about NHS Continuing Healthcare
Answers to the questions families most commonly ask about CHC eligibility, assessments and funding.
Not sure where to start?
Begin with the CHC Journey — a simple, step-by-step walkthrough of the entire process from first screening to final decision.
View the CHC Journey