NHS Continuing Healthcare for Adults

NHS Continuing Healthcare (CHC) is a package of care arranged and fully funded by the NHS for adults who have a primary health need — that is, where their overall care needs are primarily due to their health condition rather than social care needs.

CHC can fund:

• Care in a nursing home or residential care home
• Care at home, including personal care, nursing visits, and specialist therapies
• Any combination of the above

Crucially, CHC is free of charge to the recipient, unlike local authority funded social care which is means-tested. Families who are already paying for care should request a CHC assessment if they believe a loved one may qualify — NHS eligibility does not depend on your savings or income.

The CHC assessment process has two stages:

1. CHC Checklist: A brief screening tool completed by a nurse or other health/social care professional. It looks at 12 domains of need. If the checklist indicates the person may qualify, a full assessment is triggered. If it does not, CHC is not pursued further — but you can request a review of this decision.
2. Full Assessment using the Decision Support Tool (DST): A more detailed assessment carried out by a multidisciplinary team (MDT). The DST looks at the same 12 domains in depth (behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other needs). Each domain is rated as Priority, Severe, High, Moderate, Low, or No needs.

The MDT then makes a recommendation to the Integrated Care Board (ICB), which makes the final eligibility decision. The whole process should ideally be completed within 28 days of the checklist.

The central eligibility question is whether your primary need is a health need. This is not simply about the number or type of conditions — it is a holistic judgement based on the nature, complexity, intensity, and unpredictability of your needs.

A person with one or more Priority needs or two or more Severe needs in the Decision Support Tool is likely to be eligible for CHC. However, the MDT must consider the whole picture and cannot apply a purely mechanical approach.

Common reasons for CHC eligibility include: complex neurological conditions (e.g., advanced MS, acquired brain injury), end-of-life care with high medical need, severe dementia with complex behavioural needs, and conditions requiring frequent nursing interventions.

If CHC eligibility is refused and you believe this is wrong, you have the right to appeal:

1. Local review by the ICB: Request a local resolution meeting with the ICB within three months of the decision. Bring the DST and any supporting evidence (GP letters, specialist reports, care home records).
2. Independent Review Panel: If the local review does not resolve the issue, you can request an Independent Review Panel (IRP) via NHS England.
3. Parliamentary and Health Service Ombudsman: If you remain unsatisfied, the PHSO can investigate procedural failures in the CHC process.
4. Legal challenge: In some cases, judicial review may be an option if the ICB has acted unlawfully.

The CHC Alliance (chcalliance.org) provides free guidance and support for people navigating CHC assessments and appeals.

The CHC process involves significant legal rights and several layers of oversight that families can use when navigating disputes.

NHS Constitution Rights in CHC

The NHS Constitution applies throughout the CHC process. You have the right to:

• Be treated with dignity and respect, and to have your wishes considered, throughout the assessment
• Be given information in a way you can understand, including through an interpreter or communication support if needed
• Have a family member, carer, or advocate present at any assessment meeting
• Complain about the process and receive a written response under the NHS Complaints Regulations 2009
• Have the assessment carried out within the NHS National Framework for Continuing Healthcare timescales — typically 28 days from checklist to full DST decision

Independent Advocacy in CHC

If the person being assessed lacks mental capacity to engage with the CHC process, they may be entitled to an Independent Mental Capacity Advocate (IMCA) under the Mental Capacity Act 2005, or a statutory advocate under the Care Act 2014. These advocates are independent of the NHS and local authority, and their role is to represent the person's interests in the assessment.

Even where the person has capacity, free NHS Complaints Advocacy (provided by organisations such as POhWER and VoiceAbility) can support families who are challenging a CHC refusal through the local review or IRP process. Advocates can help organise evidence, attend meetings, and assist in preparing written submissions.

ICS Commissioning Oversight

Integrated Care Boards (ICBs) commission CHC as part of their responsibilities within the wider Integrated Care System. NHS England oversees ICBs and sets national standards for CHC through the National Framework for Continuing Healthcare (last updated 2022). If an ICB is persistently failing to meet framework standards — for example, by using an inadequate checklist, failing to involve patients in assessments, or delaying decisions — concerns can be escalated to NHS England's regional offices.

For families who have exhausted local resolution and the IRP route, the PHSO can investigate procedural failures — including cases where the ICB failed to offer an assessment at all, used an incorrect version of the DST, or did not apply the National Framework correctly. The PHSO can also investigate retrospective CHC claims that were improperly refused.