Guides

Continuing Healthcare (CHC) eligibility

Reviewed by PlainNHS ·

NHS Continuing Healthcare (CHC) is a package of fully-funded care arranged and paid for by the NHS for adults assessed as having a “primary health need”. CHC covers the full cost of care, including in a nursing home or in the person's own home, with no means-test. Eligibility is decided by Integrated Care Boards (ICBs) using a national framework.

The two-step assessment process

CHC eligibility is normally assessed in two steps:

  1. Checklist — a screening tool completed by an appropriate clinician (often a nurse) to decide whether the person should proceed to full assessment. The threshold is intentionally low to minimise false negatives.
  2. Decision Support Tool (DST) — a comprehensive assessment by a multidisciplinary team (MDT) that scores 12 care domains (e.g. behaviour, cognition, breathing, drug therapies, continence) on a scale from no needs to priority needs. The MDT then makes a recommendation on whether the person's primary need is a health need.

What “primary health need” means

CHC eligibility is not driven by diagnosis, prognosis, or care setting. It is decided by the nature, intensity, complexity, and unpredictability of the person's needs. Two people with the same diagnosis can have different CHC outcomes if their actual care needs differ. The standard is set out in the National Framework for NHS Continuing Healthcare published by the Department of Health and Social Care.

If eligible

The ICB funds the full package of care, including any nursing-home placement. The person can choose where their care is delivered, subject to clinical appropriateness. CHC is reviewed at three months after the first assessment and then at least annually.

If not eligible

If the person is not assessed as eligible, the ICB must still consider whether they qualify for NHS-Funded Nursing Care (FNC) — a contribution toward the nursing element of a care-home placement — and refer to local authority social services for a means-tested social-care assessment.

How to appeal

Decisions can be appealed in two stages:

  • Local resolution — with the ICB's CHC appeals panel. The request must normally be made within 6 months of the decision.
  • Independent Review — with NHS England's Independent Review Panel (IRP). The IRP is genuinely independent and can substitute its own decision.

You can also bring a parallel complaint to the Parliamentary and Health Service Ombudsman if you believe the process itself was unfair.

Retrospective claims

If a person has paid for care that you believe should have been NHS-funded, you can apply for retrospective reimbursement. There are strict time windows; advocacy groups (e.g. Beacon CHC, Age UK) can assist.

Sources

Common questions

Where can I find the official documentation? Each numbered source link above takes you to the canonical NHS England, NHS Digital, NICE, or CQC publication. PlainNHS does not paraphrase these documents at length — we point you to them and explain the practical implication for patients.

How often does the underlying guidance change? NHS operational standards (RTT, A&E, cancer) have been stable for several years but performance against them is published monthly. NICE guidelines are revised every 2-3 years on a published schedule. CQC's inspection methodology was last updated in 2024 and the new framework is now in force for all inspections.

What if my situation differs from what is described here? Always speak to your GP, NHS 111, or PALS at the treating Trust. The guidance on this page covers the standard pathway; individual cases can vary on clinical grounds, locality of services, and patient preference.

How PlainNHS uses this guidance

When we present operational performance data on a Trust profile (e.g. “a Trust achieved 76% on the 18-week RTT standard”), we are referring to the same standard described on this page. Reading this guide gives you the context to interpret the numbers correctly. The PlainNHS methodology describes how we compute and verify the figures.

Related guides on PlainNHS

Important: This guide is general information and not medical advice. Always consult your GP, NHS 111, or a qualified healthcare professional for clinical decisions about your own care.