The free NHS care that thousands of UK families miss.
Last reviewed June 2026 - check GOV.UK for the latest figures · Source NHS England + National Framework for CHC + Care Act 2014NHS 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.
What CHC actually is.
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.
The four key tests
Eligibility doesn’t depend on a diagnosis. The assessment focuses on four characteristics of someone’s needs:
- Nature — the type and overall effect of needs (e.g. specialist nursing, complex symptom management).
- Intensity — how often and for how long care is needed.
- Complexity — how skilled the care must be (multiple conditions, interactions, expert input).
- Unpredictability — how often the needs change suddenly, requiring quick intervention.
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.
Quick-check across the 12 care domains.
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. Private by design · never sold.
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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 CHC process — five stages.
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 should normally be in place within 48 hours (NHS England framework) 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 they’re in hospital — read before discharge.
Watch for these traps
- “Discharge to Assess” pressure. Hospitals often discharge first, then assess later. The interim care must be funded by the NHS while CHC eligibility is being decided. If the hospital tells you to self-fund a care home in the meantime, push back — this is a common error.
- Being asked to sign a self-funding agreement before any assessment. Don’t. Request a CHC Checklist first.
- Assessments rushed in hospital. The National Framework says CHC assessments are best done in the person’s normal environment, when they’ve stabilised. A hospital snapshot doesn’t reflect long-term needs.
- “Section 2” / “Section 5” notices. These are NHS discharge notices, not CHC decisions. Don’t confuse them.
- “They’re medically fit for discharge” doesn’t mean “social care is responsible from now on”. CHC is decided on health-need profile, not on medical stability.
Letter 1 — Request a CHC Checklist.
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.
Build the evidence pack.
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.
Records to request now
- Full GP records — use the medical records SAR letter further down this page.
- Hospital discharge summaries — one for every admission in the last 2 years.
- Specialist letters — neurology, tissue viability, palliative care, mental health, dietetics, speech & language therapy.
- Care records — daily notes, medication charts, incident reports, falls log, risk assessments from any care home or domiciliary care provider.
- Social care assessments — previous Care Act assessments from the council.
- OT / Physio reports — mobility, equipment needs, transfer techniques.
The 4-week care diary — the single strongest piece of evidence
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.
How professionals describe needs — vs how to describe them
- Replace “care given as per plan” with what the plan required and what would happen if it weren’t followed.
- Replace “managing well” with what the management consists of and the consequences of withdrawing it.
- Replace “stable” with how stability is being achieved (intensive support, skilled monitoring, complex medication regime).
- Always describe needs at their worst regular occurrence, not their best.
- Show how needs interact across domains (cognition affecting mobility, behaviour affecting nutrition, etc.).
Letter 2 — Request medical records (Subject Access Request).
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.
Before you submit records — redact safely.
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.
Safe free tools (UK-friendly)
- PDFgear (Windows / Mac) — free, works locally on your computer, true redaction. Open the PDF → Protect → Redact → drag over the text → save as a new file. The redaction becomes permanent on save.
- iLovePDF (online) — free; processes online so only use it for documents you’re comfortable being uploaded.
- LibreOffice Draw (Windows / Mac / Linux) — open the PDF, draw a black rectangle over the text, export as PDF. The text is permanently flattened.
- Adobe Acrobat Pro — paid, professional-grade 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.
The 12 care domains — in plain English.
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.
1. Breathing
Oxygen, suctioning, tracheostomy, severe breathlessness, recurrent respiratory infections, BiPAP/CPAP at night. Priority level: someone unable to breathe independently without intervention.
2. Nutrition — food and drink
Swallowing difficulties (dysphagia), choking risk, PEG / NG tube feeding, MUST scores, significant weight loss, modified diets, prolonged supervision at every meal.
3. Continence
Catheter management, recurrent UTIs, stoma care, double incontinence with skin breakdown risk, frequent accidents requiring full changes.
4. Skin (including tissue viability)
Pressure ulcers (grade), wounds, dressing regimes, frequent repositioning, skin tears, fungal infections, lymphoedema.
5. Mobility
Transfers (one carer vs two), hoist use, falls frequency and severity, contractures, pain on movement, equipment needs.
6. Communication
Aphasia, severe dysarthria, sensory impairments affecting communication, ability to express pain or distress, alternative methods (PECS, Makaton, written boards).
7. Psychological & emotional needs
Severe anxiety requiring intervention, depression with risk, emotional lability disrupting care, trauma-related distress, refusing essential care due to mental state.
8. Cognition
Memory loss with safety risks, disorientation in time/place/person, capacity to make decisions, executive dysfunction affecting daily life, wandering, vulnerability.
9. Behaviour
Aggression (verbal/physical), disinhibition, withdrawal affecting care, self-harm, behaviours requiring 1:1 supervision, frequency and severity of incidents.
10. Drug therapies and medication: symptom control
Complex medication regimes, syringe drivers, controlled drugs, side-effect management, fluctuating symptom control (especially in advanced cancer, Parkinson’s, end-stage organ disease).
11. Altered states of consciousness
Seizures (frequency, type, response time required), fluctuating consciousness, hypoglycaemic episodes requiring rescue medication, transient ischaemic attacks.
12. Other significant care needs
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.
If the decision is “not eligible” — the 3-stage appeal.
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.
- Submit new evidence (care diary, GP letter, specialist statements, incident logs).
- Attend the meeting if possible — in person or remotely.
- Reference specific National Framework paragraphs.
- Identify where each domain should have scored higher and why.
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.
Letter 3 — Local Resolution appeal letter.
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.
Retrospective claims — past care fees.
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:
- Proof of fees paid (invoices, bank statements, care home records).
- Evidence of the person’s health needs at the time.
- The original decision letter, if there was one.
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.
How it works across the UK.
The principles are similar, the systems differ.
Free, regulated human help.
CHC is hard. You don’t have to do it alone. These services are free, confidential, and have helped tens of thousands of families.
Common pitfalls — and how to avoid them.
- Underplaying needs at assessments. Describe the worst regular day, not the best.
- Accepting “they don’t qualify because their needs are well-managed”. The National Framework specifically rejects this argument — the question is what would happen without the management.
- Missing the 6-month appeal deadline. Start the appeal immediately — you can always add evidence later.
- Submitting evidence with private third-party information unredacted. Use proper redaction (see above).
- Not attending the MDT or panel meetings. Always attend, in person or remotely.
- Letting reviews remove funding from progressive conditions without challenge. Dementia, MND, Parkinson’s rarely “stabilise” in any meaningful sense — argue this.
- Believing assessors who say the criteria have “tightened”. The Framework hasn’t fundamentally changed since 2018. Local variation in application has, and it’s appealable.
Sources: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (DHSC); NHS — NHS Continuing Healthcare guide; NHS England — NHS Continuing Healthcare; 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.