What is NHS Continuing Healthcare (CHC)?

NHS Continuing Healthcare (CHC) funding is a package of care that is fully funded by the NHS for adults in England who have significant ongoing healthcare needs due to disability, accident, or illness. 

If you qualify for NHS CHC, the NHS pays for all your care costs – whether you receive care:

• In a Care Home (including accommodation, food, and nursing costs), or
• In your own home (covering care workers, nurses, and some equipment).

Who is eligible for NHS Continuing Healthcare?

Eligibility is based on your health needs, not on your diagnosis or where you live. 

To qualify, your “primary need” must be a health need – that is, your care is required because of health issues, not social or personal care reasons. 

The NHS look at areas like

• Mobility and physical ability
• Breathing and nutrition
• Continence and medication needs.
• Cognition, behaviour, and mental health
• Communication and emotional support needs.

 How do I apply for NHS Continuing Healthcare?

You (or someone acting on your behalf) can ask for an assessment at any time if you believe you may have significant health care needs.

You can request this through:

• Your GP, hospital discharge team or community nurse.
• Your local NHS Integrated care Board (ICB). The ICB is responsible for arranging CHC assessments and funding in your area.

What happens during a CHC assessment?

There is a two-stage assessment process:

1. Checklist Assessment – a preliminary screening (often done in hospital or by a community nurse) to see if a full assessment is needed. 
2. Full assessment – a multidisciplinary team (MDT) evaluate your needs using a Decision Support Tool (DST) across twelve domains of care.

The Checklist Assessment – a brief assessment to see if you should go on to a full assessment.

• Usually completed by a nurse, doctor , or a social worker.
• It looks at 12”care domains” (e.g. mobility, nutrition, cognition, behaviour)
• If you ‘trigger’ enough areas, you will move to the next stage.

Tip: You can have a relative or advocate present during this assessment. Always ask for a copy of the completed checklist

The Full Assessment - Decision Support Tool (DST)

If your checklist indicates you may be eligible, a multidisciplinary team (MDT) will conduct a full CHC assessment using the Decision Support Tool

The MDT usually includes:

• A nurse, doctor, or other health professionals
• A social worker (If relevant)

They assess the nature, intensity, complexity, and unpredictability of your needs across twelve domains (like breathing, mobility, medication, cognition, etc.).

After discussion, the make a recommendation to the ICB.

The ICB Decision

The final decision on eligibility is made by the NHS Integrated Care Board (ICB), having reviewed the MDT’s recommendation and decides whether you are eligible for CHC.

• You should receive the decision in writing, along with the rationale.
• If approved, a care plan is created and fully funded by the NHS.
• If not approved, you might still qualify for NHS Funded Nursing Care (FNC) if you reside in a Nursing Home.

We can help you with each step of this process, offering guidance and advice from the very first checklist straight through to your successful application or appeal.

What is the difference between NHS Continuing Healthcare and social care funding?

The main difference between NHS Continuing Healthcare (CHC) and social care funding is who pays and why the care is needed.

In short, CHC is fully funded by the NHS and is free, regardless of income or savings. Social care is means-tested, so you may have to pay some or all of the costs depending on your finances.

CHC covers healthcare needs that are significant, complex or unpredictable – this is considered a primary health need. Social care covers daily living support, such as washing, dressing, meals, and general supervision.

CHC can fund care at home or in a care/nursing home, with 100% of fees paid. Social care can also be provided at home or in residential care, but costs may be shared.

CHC is decided by the NHS using 12 domains and the 4 key criteria (nature, intensity, complexity, unpredictability). Social care is assessed by the Local Authority based on needs and financial assessment.

What if my application for CHC is refused?

You have the right to appeal if:

• The checklist did not lead to a full assessment, but you believe it should have.
• The full assessment resulted in a refusal, but you disagree with the outcome. 

Appeals are initially made by way of resolution hearing with the ICB who made the final decision on eligibility. It can also be reviewed by NHS England through an Independent Review Panel (IRP).

Can I challenge a past CHC decision?

You have 6 months to challenge a full assessment decision, from the date of the final decision letter created by the ICB. 

How long does the CHC process take?

The NHS Continuing Healthcare (CHC) process can vary in length, but here is what is typical in England:

In Reality

While the 28-day target is the official standard, in practice it often takes 6–12 weeks, especially if reports or evidence are delayed. Hospital discharges can speed it up (as CHC is sometimes used to avoid “bed blocking”). If the process exceeds 28 days, and you are waiting in a care setting, the NHS may cover your care temporarily until a decision is made.

After the Decision

If approved, your care package is arranged quite quickly (often within 1–2 weeks). If not approved, you can request a review or appeal, that process can take several months.

Can someone receive CHC funding at home?

CHC at Home (Domiciliary Care)

If you are eligible for CHC, the NHS will pay for a care package tailored to your health needs, which might include:

• Qualified nurses or carers visiting you regularly.
• Help with medication, feeding, or personal care.
• Specialist equipment (e.g., hoists, pressure-relief mattresses)
• Sometimes home adaptations if needed for safe care delivery.

Who Pays

The NHS covers all costs, including carers, nursing input, and certain equipment. If successful in securing funding you do not pay anything, regardless of your income, savings, or property ownership.

How It is Arranged

Your Integrated Care Board (ICB) will:

• Work with you (and your family) to create a care plan that meets your assessed needs.
• Either commission care providers directly, or
• Offer you a personal health budget (PHB) so you can arrange your own care team (with NHS oversight).

Care at Home vs Care Home

The NHS will consider what is safe and appropriate for your needs. If your care is extremely complex or intensive, the NHS might decide that a care home setting is more suitable, but they should always consider your preference to stay at home first.

What is a “Fast Track” CHC application?

The NHS CHC  fast track process applies if a person:

• Has a rapidly deteriorating condition , which may be terminal or
• Needs urgent end-of-life care to ensure comfort and dignity.

The aim is to put care in place within 48 hours. It is authorised by a clinician( such as a doctor, hospital consultant or a nurse) who is familiar with the patient’s needs. 

How can you help with the CHC application process?

Emerald Law can provide expert advice covering the whole spectrum of the Continuing Healthcare process and social care:- 

• Have you been told that you are responsible for covering the cost of your care?
• Do you require assistance in understanding the appropriate steps to take?
• Are unsure about how NHS Continuing Healthcare works?
• Are you finding NHS Continuing Care difficult to understand?
• Do you need some help making sense of NHS Continuing Healthcare?
• Are you looking for someone to talk through things one to one, or need some dedicated help to understand the CHC application process properly and guide you through it?

Here at Emerald Law we can provide personalised guidance and support whilst you negotiate the NHS CHC process. 

What support do you offer for appeals?

If the NHS determines that your relative is not eligible for NHS Continuing Healthcare, you can appeal this decision. You may want to consider getting professional legal advice to have the best chance of success.

Emerald Law will help you to reinforce all the evidence you gathered in respect of the original application and review that against each part of the Decision support Tool and identify each point of disagreement. We will then draft a letter of disagreement which will be served upon the ICB, this forming the basis of your appeal. 

At any hearing we will be there to advocate on your behalf and provide vital support to you,  in what can feel like a very intimidated environment. 

If the ICB Local Resolution Panel find against you following the appeal hearing, we will be able to advise you on the merits of a further appeal to NHS England and provide the same or similar support for the second appeal process to an Independent Review panel (IRP). 

Can you help recover care fees that were wrongly paid?

In relation to previously unassessed periods of care (PUPoCs), you can request your local NHS Integrated Care Board (ICB) to conduct a retrospective review of healthcare needs to ascertain whether your relative would have been eligible for NHS Continuing Healthcare Funding had they been assessed at the time. The PUPOC review can go as far back as 1st April 2012. If successful, you will be entitled to reimbursement of the care fees paid during the period of eligibility awarded, plus interest.

However, Emerald Law will examine each case of this type on its merits to establish if there is sufficient prospects to take on these instructions. 

Why choose professional help for NHS CHC cases?

Emerald Law will be able to help you to express your views, we understands your rights and support you in dealing with the NHS or care system. We do not make decisions for you, but  ensure your voice is heard.

Explaining the process

• Helps you understand the CHC assessment, decision, and appeal procedures.
• Clarifies terminology like “primary health need,” “Decision Support Tool (DST),” or “Integrated Care Board (ICB).”

Gathering and presenting evidence

• Assists in collecting medical records, care reports, and supporting documents.
• Helps present your case clearly and accurately to the ICB or Independent Review Panel (IRP).

  Supporting communication

• Attends meetings or appeal hearings with you.
• Ensures you can ask questions and respond effectively.
• Helps write letters or appeals in a clear, professional way.

  Ensuring your rights are protected.

• Checks that the NHS follows proper procedures and timelines.
• Makes sure your personal preferences, needs, and circumstances are considered.