If you’ve ever tried to understand how care is funded in England, you’ll know it can feel like learning a foreign language.
Council assessments. Financial assessments. Personal budgets. And then, somewhere in the middle of it all, three letters that families often hear about late: CHC.
NHS Continuing Healthcare is one of the most important and most overlooked funding routes for people with significant ongoing health needs. This guide explains what it is, how the assessment works and how to prepare, in plain English.
What Is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is a package of care that is arranged and funded by the NHS for adults who have ongoing health needs that meet the eligibility criteria. It can be provided in different settings, including a person’s own home.
The key idea is something called a “primary health need”. In simple terms, this looks at whether the main reason someone needs care is related to their health, rather than being mainly social care.
Importantly, eligibility doesn’t depend on having a particular diagnosis, and it doesn’t depend on where someone lives. It depends on the person’s overall care needs and how those needs affect them.
When Should Families Think About CHC?
It’s worth asking about CHC when:
- Someone’s physical or mental health has deteriorated significantly
- The current care package no longer seems to meet their needs
- They have new or more complex needs after a hospital stay
- A person has a complex, unpredictable or intensive set of health needs at home
You don’t need to be an expert. Often the first step is simply asking a GP, hospital team, district nurse or social worker whether a CHC assessment is appropriate.
The Two Stages of the Assessment
The CHC process usually has two main stages.
Stage 1: The Checklist
The checklist is a screening tool. It helps a trained professional, such as a nurse or social worker, decide whether the person should have a full assessment.
A positive checklist doesn’t mean someone will definitely receive funding. It means the NHS should look at their needs more fully. Equally, a negative checklist doesn’t always close the door, so it’s worth asking for the reasons and for a copy of the form.
Stage 2: The Decision Support Tool (DST)
If a full assessment is needed, a multidisciplinary team, which means professionals from health and social care, completes a document called the Decision Support Tool.
The DST looks at 12 areas of care need. These cover things like breathing, nutrition, continence, skin, mobility, communication, thinking and memory, behaviour, medication and other significant needs. Each area is graded according to the level of need.
The team also considers the overall nature, complexity, intensity and unpredictability of the person’s needs, and the risks if care isn’t managed properly. They then make a recommendation about whether the person has a primary health need.
How Long Does It Take?
Guidance says a decision about eligibility should generally be made within 28 days of the integrated care board (ICB) receiving a positive checklist. In practice, timescales can vary, so it’s sensible to ask the team for dates and keep notes of who you’ve spoken to.
The ICB is the local NHS body that makes the eligibility decision. Local teams and contact routes can differ, so check your ICB’s website or ask your GP or social worker for the right contact.
What About End-of-Life Care? The Fast Track Pathway
When someone has a rapidly deteriorating condition that may be entering a terminal phase, there is a separate Fast Track Pathway. An appropriate clinician can complete a Fast Track Pathway Tool, and the usual checklist and DST process doesn’t apply.
If you’re in this situation, ask the person’s GP, specialist nurse or hospital team about Fast Track as soon as possible.
If CHC Is Approved
If someone is found eligible, the NHS arranges and funds their assessed health and associated social care needs. At home, this can include support from carers and nursing input, depending on the person’s needs.
For people receiving CHC in their own home, NHS England expects a personal health budget to be the default approach, except in exceptional circumstances. A personal health budget can give individuals and families more involvement and choice in how their care is arranged.
Eligibility is also reviewed. Needs change, and the NHS will usually review someone’s package after an initial period and then regularly after that.
If CHC Isn’t Approved
This can be disappointing, but it isn’t always the end of the road.
- Ask for the decision in writing, with a copy of the completed DST and a clear explanation of the reasons.
- Check that the information was accurate. Did the team have full information about typical bad days, not just good days?
- Ask about the review process. You can ask the ICB to review the decision. If you remain unhappy after that, you can ask NHS England to review the decision independently.
- Explore other support, such as local authority care, direct payments or private arrangements, while any review is taking place.
If you’re unsure what to do next, organisations such as Age UK, Beacon and local advocacy services provide guidance. We’d encourage families to seek independent advice if they’re considering challenging a decision.
How to Prepare for a CHC Assessment
Preparation can make a real difference. Assessors can only consider what they know, so clear, honest information matters.
1. Keep a care diary. For a week or two, note what care or support is needed, when and how often. Include difficult nights, falls, near-misses, behaviour changes, emergency calls and periods when the person needed extra help.
2. Describe the bad days, not just the good ones. Many people present at their best on assessment day. Families often downplay difficulties because they don’t want to seem negative. Explain what a typical difficult day looks like.
3. Gather the paperwork. Hospital letters, GP records, care plans, medication lists, therapy reports and recent assessments can all help.
4. Think about each care area. Use the 12 areas as a prompt. For each, ask: what support is needed, how often, what happens if it isn’t provided, and how predictable is it?
5. Attend if you can, and involve the person. Family members or representatives can attend and share information. Where possible, the person’s own views should be central.
6. Ask for copies. Ask for copies of the checklist and the DST. They’re useful if you ever need to understand or challenge the outcome.
7. Keep notes. Write down names, dates, phone calls and what was said. It makes things much easier if something is delayed or unclear.
Common Myths About CHC
“It’s only for people in care homes.” No. CHC can be provided in a person’s own home.
“You need a specific diagnosis.” No. Eligibility depends on overall care needs, not a diagnosis alone.
“If we’re refused once, that’s final.” Not necessarily. There are review routes, and needs can change over time.
“Owning a home or having savings affects it.” CHC eligibility isn’t means-tested. That’s one reason it’s so important to ask.
Where Home Care Fits In
CHC decisions are made by the NHS, not by care providers, and no provider can guarantee that someone will be eligible.
What a nurse-led home care provider can do is help families understand the process, provide factual information about the care someone currently receives (with the person’s consent), and deliver care that’s properly planned, recorded and reviewed, whether someone is waiting for a decision, receiving CHC or funded another way.
Good records can also make conversations with assessors easier, because they show what support is really needed day to day.
Final Thoughts
The CHC process can feel daunting, but you don’t need to navigate it alone, and you don’t have to wait for a crisis to ask about it.
If you’re caring for someone with significant ongoing health needs, ask the question. Prepare honestly. Keep records. And remember that a first answer isn’t always the final one.
At Kome Care, our nurse-led team provides person-centred home care across London, including support for people with complex needs. If you’re exploring care options and funding, we’re happy to talk through your situation.
Talk to our team or book a Nurse-Led Care Review.
This article is for general information and is not legal, financial or medical advice. NHS Continuing Healthcare rules, local processes and timescales can change and may vary by area. Always check current guidance with your local ICB, NHS England or an independent adviser.
