NHS Continuing Healthcare (CHC) is a fully-funded package of health and social care — not means-tested — for adults with significant ongoing health needs. Most families never hear of it. Many who do are turned down at first. Most who appeal with proper evidence win. This is the calm, plain-English guide.
Most people only discover CHC after they’ve been paying care home fees for months or years. A typical UK care home costs £50,000–£100,000 per year. CHC pays for all of it — if the person’s health needs meet the test.
The test is not about diagnosis. It’s about the nature, intensity, complexity and unpredictability of someone’s health needs across 12 care domains. Dementia, stroke, Parkinson’s, MS, motor neurone disease, end-stage cancer, severe behavioural needs — all common qualifying conditions when the needs are significant enough.
A fully-funded NHS care package — arranged and paid for by the NHS — for adults aged 18+ whose primary need for care arises from their health rather than social or personal-care needs. Free at point of use, not means-tested. Works in your own home, a care home, or a nursing home.
Eligibility doesn’t depend on a diagnosis. The assessment focuses on four characteristics of someone’s needs:
The legal phrase is “primary health need”. Where the health element of someone’s needs dominates the social-care element, CHC should apply. The National Framework (2018, revised) sets it all out.
This is a private, non-official self-assessment. For each domain, pick the level that best describes the person’s current need. The score is a rough indicator — only an NHS Multi-Disciplinary Team (MDT) using the Decision Support Tool can make the real decision. Nothing is saved. Nothing leaves your device.
This quick-check is for orientation only. CHC is decided by an NHS MDT using the official Decision Support Tool with detailed descriptors. A “not indicated” result here does not mean someone is ineligible — particularly if needs are complex, unpredictable, or rapidly changing. When in doubt, request a Checklist (Stage 1) anyway. The threshold is intentionally low.
The same path applies whether you’re asking proactively or being assessed during a hospital discharge. Get every decision and meeting note in writing.
You don’t need a referral. Ask the GP, district nurse, hospital discharge team, social worker, care home manager, or your local Integrated Care Board (ICB) directly. Use the letter generator below if it helps. Put the request in writing so there’s a paper trail.
A nurse, doctor or social worker completes the official CHC Checklist — typically 30 minutes. It scores needs across 11 domains at a simpler level (A/B/C). The threshold to proceed is intentionally low: two or more Cs, or one A + four Bs, or one A with one or more Bs, all trigger a full assessment.
You should be told a Checklist is happening, be invited to contribute, and receive a written copy of the outcome. If the Checklist is negative and you disagree, you can request a review.
If the Checklist is positive, a Multi-Disciplinary Team (MDT) — usually two or more professionals from different backgrounds — complete the Decision Support Tool (DST). They score each of the 12 care domains at a more detailed level (N / L / M / H / S / P) and make an eligibility recommendation.
You and your family have a right to be involved. Submit evidence (care diaries, GP letters, incident logs). Take an advocate. Ask to see the draft DST before it’s submitted.
The ICB ratifies the MDT recommendation. Eligible → the NHS arranges and funds care (home care, nursing home, or a Personal Health Budget). Reviews happen at 3 months, then annually. Reviews can remove funding if needs are deemed “stable” — for progressive conditions, challenge this with fresh evidence.
A clinician (usually a GP, consultant or palliative-care nurse) completes the Fast-Track Pathway Tool. Care must then start within 48 hours and continue while the assessment process catches up. Don’t accept being told Fast-Track “isn’t available” if a clinician believes the criteria are met — the National Framework is clear.
If you’ve been refused a Checklist (or just never offered one), this drafts a formal written request to the ICB. Free. No login. The text stays in your browser.
Strong evidence is what swings difficult assessments. Most family members underestimate how much of a difference a 4-week care diary makes. Here’s exactly what to gather.
For at least 28 days, log each significant care event with: date / time, what happened, who responded, how long it took, the outcome, the risk. Specifics beat generalities.
Weak entry: “Mum needs help with washing.”
Strong entry: “14 Apr, 08:20 — Mum refused personal care, became distressed and shouted, attempted to hit carer twice. Required two carers for 28 minutes to de-escalate using established care plan. Followed by 40 minutes of confusion and tearfulness. This is the 4th similar incident this week.”
Use the same approach for falls (with frequency), choking incidents, episodes of disorientation, wandering, incontinence frequency, skin breakdown, medication-related incidents, mood changes.
You have a legal right under UK GDPR and the Data Protection Act 2018 to a free copy of medical records held by a GP, hospital, NHS trust or care home. Responses must come within one month. This drafts a compliant SAR.
If the records contain information about third parties (other patients, family members) you don’t have authority to share, redact it before submitting evidence. A black-highlight in Word is not secure — the text underneath is still selectable. Use proper redaction.
Always work on a copy and verify after saving: re-open the redacted file and try to select text in the redacted area — it should be impossible.
These are the headings used in the official Decision Support Tool. Each has its own descriptors at every level. The detail matters — arguing for a higher level on one domain has often turned an “ineligible” decision around.
Oxygen, suctioning, tracheostomy, severe breathlessness, recurrent respiratory infections, BiPAP/CPAP at night. Priority level: someone unable to breathe independently without intervention.
Swallowing difficulties (dysphagia), choking risk, PEG / NG tube feeding, MUST scores, significant weight loss, modified diets, prolonged supervision at every meal.
Catheter management, recurrent UTIs, stoma care, double incontinence with skin breakdown risk, frequent accidents requiring full changes.
Pressure ulcers (grade), wounds, dressing regimes, frequent repositioning, skin tears, fungal infections, lymphoedema.
Transfers (one carer vs two), hoist use, falls frequency and severity, contractures, pain on movement, equipment needs.
Aphasia, severe dysarthria, sensory impairments affecting communication, ability to express pain or distress, alternative methods (PECS, Makaton, written boards).
Severe anxiety requiring intervention, depression with risk, emotional lability disrupting care, trauma-related distress, refusing essential care due to mental state.
Memory loss with safety risks, disorientation in time/place/person, capacity to make decisions, executive dysfunction affecting daily life, wandering, vulnerability.
Aggression (verbal/physical), disinhibition, withdrawal affecting care, self-harm, behaviours requiring 1:1 supervision, frequency and severity of incidents.
Complex medication regimes, syringe drivers, controlled drugs, side-effect management, fluctuating symptom control (especially in advanced cancer, Parkinson’s, end-stage organ disease).
Seizures (frequency, type, response time required), fluctuating consciousness, hypoglycaemic episodes requiring rescue medication, transient ischaemic attacks.
The catch-all. Anything that materially affects health-care needs but doesn’t fit the other 11 boxes. Use this for unusual presentations, rare conditions, or interactions between needs.
You have 6 months from the date of the decision letter to start an appeal. Success rates rise dramatically with proper evidence at each stage. Many appeals succeed at the very first stage.
Write to the ICB’s CHC team requesting a Local Resolution review. Most ICBs run a two-part process: an informal dispute meeting first, then a Local Review Panel if needed. The panel is independent of the original assessors and reviews the DST against the National Framework.
Decisions usually arrive within 4–6 weeks. Many cases overturn here.
If the Local Resolution upholds the original decision, request an Independent Review Panel (IRP) via NHS England. The panel includes a lay Chair plus health and social care professionals with no connection to the local ICB. You submit written evidence and are usually invited to attend.
The IRP makes a recommendation to the ICB. Recommendations are almost always followed.
If you remain dissatisfied after the IRP, complain to the Parliamentary and Health Service Ombudsman (PHSO). The PHSO doesn’t re-decide eligibility — it investigates whether the process was handled fairly and reasonably. Findings of maladministration can lead to funding being awarded retrospectively.
Drafts a formal Local Resolution request to the ICB. Identifies the decision you’re challenging, summarises why the assessment underestimated needs, and lists the evidence you’re submitting.
If your relative was self-funding care (often a care home), and you believe they should have been eligible for CHC at the time, you can apply for a retrospective review. If upheld, the NHS refunds the care fees paid privately for the eligible period.
What you’ll need:
Retrospective claims often go back several years. They can also be brought by family members after the person has died — refunds go to the estate.
Free regulated help is available from Beacon CHC (charity specialising in CHC), Age UK and Citizens Advice. For complex retrospective claims, a CHC-specialist solicitor may take the case on a no-win-no-fee basis.
The principles are similar, the systems differ.
CHC is hard. You don’t have to do it alone. These services are free, confidential, and have helped tens of thousands of families.
Sources: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (DHSC); NHS — NHS Continuing Healthcare guide; NHS England CHC operational framework; PHSO case studies; Beacon Free CHC Guide; UK GDPR / Data Protection Act 2018. Last reviewed 29 May 2026.
Sorted is not a law firm or regulated welfare-rights adviser. The Quick-Check is for orientation only — CHC is decided by an NHS MDT using the official Decision Support Tool. For binding advice on a specific case, contact Beacon CHC, Age UK, Citizens Advice, or a CHC-specialist solicitor.
CHC may unlock Attendance Allowance + Carer's Allowance for family + Council Tax disregards + Disabled Facilities Grant. Free. Sourced to NHS England + National Framework for CHC.
Sourced to NHS England · National Framework for CHC · Care Act 2014 · Age UK 0800 678 1602