NHS Continuing Healthcare (CHC) Explained

When someone you love has been unwell for a long time, the question of who pays for their care can feel like the last thing you have the energy to think about. But it matters. A lot. And there is one source of NHS funding that could cover your loved one’s care costs entirely, including a care home place, that a significant number of families never find out about until it is too late.

It is called NHS Continuing Healthcare, or CHC. If your loved one qualifies, the NHS pays. Not a contribution. Not means-tested. All of it.

There is something important to say upfront, though, and it is the part most guides leave out. CHC rates are set locally by NHS bodies called Integrated Care Boards, and those rates typically reflect the cost of a standard nursing home place. Whether CHC works in practice depends significantly on where your loved one lives or is hoping to move. If you are considering a premium or specialist care home, the gap between what the NHS will fund and what the home charges is a real and important factor. Under NHS law, families cannot top up the difference privately. We cover this in detail further down, and it is worth reading before anything else if it applies to your situation.

With that context set, this guide walks you through what CHC is, who it is for, how the assessment works, and what to do if you are turned down.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of care arranged and paid for entirely by the NHS. It is available to adults in England who have significant, ongoing health needs arising from disability, accident or illness.

If your loved one qualifies:

• If they are cared for at home, the NHS pays for the care and support they need, including personal care such as help with washing and dressing.
• If they are in a care home, the NHS pays the fees in full, including accommodation.

The critical thing to understand is that CHC is not means-tested. It has nothing to do with savings, property or income. If your loved one’s needs meet the threshold, the NHS pays, regardless of what they own.

In practice, CHC is most commonly used in traditional nursing homes, where the fees typically align more closely with ICB funding rates. It is less common in premium or specialist settings, though it does happen. The section on CHC and premium care homes below explains why, and what the implications are for families in that position.

CHC can be provided at home, in a care home, or in a hospice.

Who Does CHC Cover?

To qualify, your loved one must have ongoing health needs significant enough that the main purpose of their care is to manage or prevent those needs, going beyond what a local authority social care package would normally cover.

Here is the part that catches many families off guard: eligibility is not decided by diagnosis. Two people with the same condition, dementia for example, can have very different levels of need. What matters is how complex, intense and unpredictable those needs are, not the label attached to them.

CHC applies in England only. Scotland ended the scheme in 2015. Northern Ireland has a similar but separate arrangement.

Assessments are carried out by your local Integrated Care Board (ICB), the NHS body that commissions health services in your area.

Signs That Someone Might Qualify

There is no checklist of conditions. But the NHS requires health and care staff to consider CHC in certain situations. These include:

• After a hospital stay, if your loved one’s condition is unlikely to improve and they have significant ongoing health needs.
• When a professional is recommending a move to a nursing home.
• During a care needs review, if things have changed significantly.
• If their current level of care no longer seems to be meeting their needs.
• If their condition is deteriorating rapidly and they may be approaching the end of their life.

You do not have to wait to be told. You can ask a GP, district nurse, social worker or care home nurse to start the process. You can also go directly to your ICB.

How Does the CHC Assessment Work?

There are two stages, with a faster route for people who are very unwell.

Stage 1: The Checklist

A nurse, doctor or social worker completes an initial screening tool that looks across 11 areas of need. Think of it as a filter, not a decision. It is designed to be inclusive: if there is any reasonable chance your loved one might qualify, they should be referred for the full assessment.

You are entitled to be told that the checklist is happening, and to receive a copy afterwards. If nobody has offered one and you think your loved one might qualify, you can ask for it to be done.

Download a blank copy of the CHC checklist from GOV.UK

Stage 2: The Full Assessment

If the checklist suggests your loved one might be eligible, a multidisciplinary team of at least two professionals already involved in their care carries out a deeper assessment. They look at how your loved one’s needs affect every part of their daily life: their breathing, nutrition, skin integrity, mobility, continence, communication, cognition, behaviour, emotional wellbeing, and how their medication and clinical needs are managed.

Each area is given a weighting that reflects how serious the need is. To qualify, a person generally needs at least one need at Priority level, or multiple needs at a Severe level. What matters most is the overall picture: how complex, intense and unpredictable their needs are as a whole.

You and your family should be involved throughout. Your views must be taken into account, and you are entitled to a copy of the final decision with a clear explanation of the reasoning behind it. The team uses a standardised Decision Support Tool to structure their recommendation, which then goes to the ICB for a final decision.

That decision should be made within 28 days of the completed checklist.

The Fast-Track Pathway

If your loved one is in the final stages of a terminal illness and their condition is deteriorating rapidly, they should not have to wait for the standard two-stage process. The fast-track pathway is designed to get a care package in place within 48 hours. Any clinician involved in their care can trigger it.

What Happens If Your Loved One Is Eligible?

Once the ICB confirms eligibility, you work together to agree a care package. Your loved one should be at the centre of that conversation, and you as a family member can be part of it too. The options typically include:

• A care package at home, fully funded and arranged by the NHS.
• A place in a care home, with the NHS covering the full fee including accommodation.
• A personal health budget, which gives more flexibility over how the funding is used. Note: a personal health budget cannot be used to pay care home fees directly.

What Happens to Benefits?

If NHS continuing healthcare is delivered at home, Attendance Allowance, Disability Living Allowance and Personal Independence Payment continue as normal.

If the NHS is covering a care home place, the care component of Disability Living Allowance, the daily living component of PIP, and Attendance Allowance will normally stop after 28 days. The state pension is not affected. It is worth building this into your financial planning from the start.

CHC Is Reviewed Regularly

CHC is not a permanent guarantee. It should be reviewed within three months of the initial decision, and at least annually after that. If your loved one’s needs change significantly, a full reassessment may take place. If funding is reduced or withdrawn, you have the right to challenge that decision.

If There Was a Delay

If the ICB takes longer than 28 days to reach a decision without good reason, and your loved one is found to be eligible, you should be refunded care costs from the 29th day up to the date of the decision. Keep records of everything paid during the wait.

CHC and Premium Care Homes: What Families Need to Know

This is the section most CHC guides do not cover clearly enough. If your loved one is in, or hoping to move to, a premium care home, it is the most important part of this article to read.

Each ICB sets its own rate for what it will pay toward a care home place under CHC. Those rates are typically based on the cost of a standard nursing home in the local area. Premium and specialist care homes, which often provide higher staffing levels, purpose-built environments and a broader range of therapeutic and lifestyle provision, generally charge above those rates.

Under NHS law, families cannot top up the difference. This is not the same as local authority social care funding, where a third party, a family member for example, can legally pay a top-up to bridge the gap between the council’s rate and the fees of a preferred home. That option does not exist under CHC.

CHC is most commonly used in traditional nursing homes, where fees are more likely to align with what an ICB will fund. It does occasionally work in premium settings. Where it does, it tends to involve a strong clinical case, established relationships between the resident and their care team, and an ICB that accepts those factors as sufficient grounds to fund the placement at the home’s rate. But this is the exception, not the rule.

What the ICB Has to Consider

If your loved one becomes CHC-eligible while already living in a premium care home, the ICB will review whether that placement can be funded at its standard rate. It is required to consider genuine clinical and needs-based reasons why your loved one should remain where they are. The Age UK CHC factsheet notes relevant factors: frailty, established relationships with staff, the risk that a move could cause serious harm to health and wellbeing, or a clear link between the environment and the management of the person’s needs. These are legitimate grounds and worth setting out carefully in writing.

But preference alone is not sufficient. If the ICB concludes that a lower-cost placement could meet your loved one’s assessed needs, it is under no obligation to fund a more expensive one.

What About Optional Extras?

There is a distinction worth knowing. Your loved one can pay privately for services that sit genuinely outside their assessed care needs: an optional hairdressing appointment, a private outing, a particular activity. The CMA’s consumer law guidance for care homes is explicit that these must be entirely voluntary and clearly separate from the agreed care package.

What is not permissible is any arrangement, formal or informal, where a family is asked to contribute privately toward the core care the ICB has agreed to fund. A care home that does this is likely acting unlawfully.

If You Were Already Self-Funding

If your loved one has been self-funding their care in a premium home and is then assessed as CHC-eligible, the transition needs careful planning. The ICB takes over funding responsibility from the point of eligibility, but the rate it pays may be lower than the fees being charged. You cannot top up the difference. Talking to both the ICB and the care home early, before a decision is finalised, gives you the best chance of understanding your options and managing the change well.

What If the Application Is Turned Down?

A refusal is not the end of the road. Many families who are initially turned down go on to win their case on appeal. And you do not need to pay a solicitor or a claims management company to do it.

The Health Service Ombudsman has been clear on this point: it rarely finds cases where professional legal representation was necessary, and it will not typically ask the NHS to reimburse those costs even if the appeal succeeds. Save your money. The free support available is genuinely good.

The appeals process has four stages:

• Step 1: Talk to the assessor. Ask for a Local Resolution Meeting with the original assessment team. You can raise concerns, provide new information, and ask them to reconsider. A lot of cases are resolved here, without going any further.
• Step 2: Request a formal review. If you are still not satisfied, ask for a Local Review Panel. This involves professionals who were not part of the original decision.
• Step 3: Appeal to NHS England. An Independent Review Panel examines the case afresh. Their recommendation is usually accepted by the ICB. If the original decision is overturned, funding is backdated to the date of that decision.
• Step 4: The Ombudsman. If you have been through all three stages and are still unhappy, you can take your complaint to the Parliamentary and Health Service Ombudsman. This is free and can be done online.

You need to submit your appeal within six months of the decision letter. Start the clock from the date on that letter, not the date you received it.

If CHC is not awarded, ask to be referred to your local authority for a means-tested care funding assessment. Your loved one may also qualify for NHS-Funded Nursing Care, a separate NHS contribution toward registered nursing costs in a care home, which is assessed as part of the same process.

CHC and NHS-Funded Nursing Care: What Is the Difference?

These two are often confused. The short version: CHC covers everything, NHS-Funded Nursing Care covers only the nursing element. Here is how they compare:

If your loved one does not qualify for CHC but is in a nursing home, NHS-Funded Nursing Care is assessed as part of the same process. You do not normally need to apply separately.

Where to Get Free Help

The CHC process has a lot of moving parts. But you do not have to navigate it alone, and you do not have to pay anyone to guide you through it.

There is a free advice service called Beacon, funded by NHS England and backed by Age UK, Parkinson’s UK and other major charities. Through Beacon, you can access up to 90 minutes of one-to-one advice from a trained CHC specialist, at no cost.

Beacon also offers a paid service, but you do not need it. Most families find the free advice more than enough to understand where they stand and what to do next.

Beacon: beaconchc.co.uk | 0345 548 0300

Age UK Advice Line: ageuk.org.uk | 0800 678 1602 (free, 8am to 7pm, 365 days a year)

Find your local ICB: nhs.uk/nhs-services/find-your-local-integrated-care-board

Frequently Asked Questions

What is NHS Continuing Healthcare in simple terms?

It is a free care package, funded entirely by the NHS, for adults with significant ongoing health needs. It is not means-tested, so it has nothing to do with savings or assets. If someone qualifies, the NHS pays their full care costs, whether they are at home or in a care home.

Who is eligible for CHC?

Any adult in England whose care needs are primarily health-based may be eligible. Eligibility is not about diagnosis. Someone with dementia, Parkinson’s, a neurological condition or any other complex health need could qualify if the nature and intensity of their needs meet the threshold.

How do I start the CHC process?

Ask a GP, district nurse, social worker or care home nurse to complete a CHC checklist. You can also contact your local Integrated Care Board directly. You do not need anyone’s permission to ask.

What is a “primary health need”?

It means the main purpose of the person’s care is to manage or prevent health needs that go beyond what standard social care can provide. There is no single legal definition. It is assessed case by case, looking at the complexity, intensity and unpredictability of needs.

Can CHC be refused for someone with dementia?

Yes. Dementia alone does not guarantee eligibility. What matters is the level and nature of the needs that result from the condition. That said, many people with moderate to advanced dementia do qualify, particularly where their needs are unpredictable, intense, or carry a risk if not met promptly.

Does CHC affect Attendance Allowance?

If NHS continuing healthcare is delivered at home, Attendance Allowance continues as normal. If the NHS is funding a care home place, Attendance Allowance will normally stop after 28 days. The state pension is unaffected. It is worth factoring this into your planning.

Can I top up CHC funding to stay in a premium care home?

No. Under NHS law, top-ups are not permitted. This is different from local authority social care funding, where third-party top-ups are allowed. If the ICB’s rate is lower than the care home’s fees, the family cannot bridge the gap privately. CHC most commonly works in traditional nursing homes, where fees are more likely to align with ICB rates. It does occasionally work in premium settings, but it requires strong clinical justification and is not the norm.

Can I appeal if CHC is refused?

Yes, and many families succeed on appeal. The process runs through four stages: a conversation with the original assessment team, a formal Local Review Panel, an Independent Review Panel through NHS England, and finally the Parliamentary and Health Service Ombudsman. You do not need legal representation. Free advice through Beacon is enough for most families.

What is the difference between CHC and NHS-Funded Nursing Care?

NHS continuing healthcare covers all care costs in full. NHS-Funded Nursing Care is a lower-level, flat-rate NHS contribution toward registered nursing costs for people in nursing homes who do not qualify for CHC. Both are non means-tested and assessed through the same process.

Sources

• NHS: NHS Continuing Healthcare
• NHS England: NHS Continuing Healthcare
• Age UK Factsheet 20: NHS Continuing Healthcare and NHS-Funded Nursing Care (July 2025)
• MoneySavingExpert: NHS Continuing Healthcare (updated May 2025)
• UK: Decision Support Tool for NHS CHC (PDF)
• UK: National Framework for NHS CHC and NHS-Funded Nursing Care
• Competition and Markets Authority: Care Homes Consumer Law Advice (2021)
• Beacon: Free CHC Information and Advice Service
• NHS England: CHC Explainer Video