Full eligibility criteria, assessment process, funding options, and how to appeal a CHC decision. Everything you need to know about NHS-funded care for complex health needs.
~60,000
People receive CHC at any one time in England
12 domains
Assessed during the full CHC assessment
28 days
Timeline for completing the DST assessment
Free
CHC is completely free and not means-tested
NHS Continuing Healthcare (CHC) is a package of ongoing care fully funded by the NHS for people with complex, ongoing healthcare needs. It is completely free and not means-tested, meaning your care is funded regardless of your savings, property, or income.
Unlike local authority-funded social care, which depends on a financial assessment, CHC funding is based purely on the nature and intensity of your healthcare needs. It is governed by the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care, revised in October 2018 and updated in 2022.
There is no specific condition that automatically qualifies you for NHS CHC. Instead, eligibility is based on the 'primary health need test': your main care need must be a health need rather than a social care need.
To qualify for CHC, you must have a primary health need. This means your main care requirement is linked to a medical condition or healthcare problem, rather than to general aging or disability (which would be social care).
Your primary health need is assessed by looking at four key characteristics:
The following conditions often result in CHC eligibility, although it depends on the severity and complexity of your individual case:
It is important to note that you do not need to be in a hospital or care home to qualify for CHC. Many people receive CHC-funded care in their own homes.
Step-By-Step Guide
The CHC assessment is a detailed multi-step process designed to thoroughly evaluate whether you have a primary health need. It typically involves several healthcare professionals and takes between 4 and 8 weeks from initial screening to final decision.
The first stage is a simple screening questionnaire, usually completed by a GP, healthcare professional, or care coordinator. The screening checklist asks about 11 key care domains to determine whether there is any possibility of CHC eligibility.
If the screening suggests possible eligibility, you move forward to the full assessment. If screening indicates unlikely eligibility, you can request a full assessment anyway, or ask for the decision to be reviewed.
Timeline: Screening checklist should be completed within 28 days of referral.
If the checklist indicates possible eligibility, a detailed multi-disciplinary team assessment follows. This typically involves a doctor, nurse specialist, and sometimes an occupational therapist or other healthcare professionals familiar with your condition.
The DST assesses 12 care domains (see section 4 below), scoring each as Priority, Severe, High, Moderate, Low, or No Needs. If you have any Primary or Severe needs in one or more domains, you are likely to qualify for CHC.
Timeline: The DST should be completed within 28 days of screening.
After the DST assessment, the local Integrated Care Board (ICB, previously the Clinical Commissioning Group or CCG) makes the final eligibility decision. They consider the clinical evidence and determine whether you meet the criteria for CHC funding.
You will receive a written decision explaining whether you qualify for CHC. If you do not qualify, the decision letter must explain why and inform you of your right to appeal.
If you are eligible for CHC, the NHS develops a personalised care plan with you and your family. This outlines what care and support you will receive, who will provide it, and where it will be delivered. The care can start immediately, or you can request a choice of providers through a Personal Health Budget.
The 12 care domains assessed during the DST evaluation cover all aspects of a person's health and care needs. Each domain is scored according to the level of need.
| Care Domain | What It Assesses |
|---|---|
| Breathing | Support for respiratory function; oxygen, ventilation, tracheostomy care, suctioning |
| Nutrition | Eating, drinking, swallowing; PEG feeding, tube feeding, specialist diets |
| Continence | Bladder and bowel control; catheter care, incontinence pads, toileting support |
| Skin Integrity | Pressure ulcer risk; wound care, burns, skin conditions requiring specialist nursing |
| Mobility | Movement, positioning, transfers; falls risk, specialist mobility equipment |
| Communication | Speech, hearing, swallowing; speech therapy, hearing aids, non-verbal communication |
| Psychological/Emotional | Mental health needs; anxiety, depression, behavioural distress requiring support |
| Cognition | Memory, understanding, reasoning; dementia, acquired brain injury, confusion management |
| Communication | Speech, hearing, swallowing; speech therapy, hearing aids, non-verbal communication |
| Behaviour | Challenging behaviour; aggression, wandering, behaviours that may harm self or others |
| Drug Therapies/Medication | Complex medication regimens; chemotherapy, immunosuppressants, specialist administration |
| Altered States of Consciousness | Coma, minimal consciousness, persistent vegetative state management |
| Other Significant Care Needs | Any other healthcare needs not covered by the 11 domains above |
Each domain is scored according to the level of need:
If you score Priority or Severe in any domain, you will typically qualify for full CHC. High scores in multiple domains may also result in CHC eligibility. The decision considers the overall picture, not just individual domain scores.
For people with rapidly deteriorating conditions or approaching end of life, the NHS offers a fast-track CHC assessment. This is a specialist pathway that bypasses the normal checklist and DST stages and provides immediate CHC funding while the full assessment is arranged at a later date.
Fast-track is available for people with:
An appropriate clinician (doctor, nurse, or healthcare professional) can recommend fast-track assessment. The process must be completed and a decision made within 48 hours.
NHS CHC is comprehensive funding that covers all health and personal care costs needed as part of your care package. Here is what is included:
Your primary health need is assessed by looking at four key characteristics:
CHC does not cover:
Once you are assessed as eligible, the NHS creates a personal care plan outlining your care needs. The NHS then either:
You have no say in how much you pay; the NHS funds your care in full, as it is your healthcare need they are meeting.
It is important to understand that NHS-Funded Nursing Care (FNC) is different from full NHS Continuing Healthcare. FNC is a flat-rate contribution from the NHS towards the nursing element of care in a nursing home, available to people who do not qualify for full CHC but have nursing needs.
CHC covers all health and personal care costs anywhere (home or care home). FNC covers only the nursing element in a nursing home. The key difference is scope and location.
The current FNC contribution is £219.71 per week (2024/25). This rate is typically uprated annually; check with your local ICB for the 2025/26 rate.
FNC is available only to people in nursing homes, not to those receiving care at home. If you live in a care home with personal care but no nursing needs, you will not receive FNC.
If the NHS decides you do not qualify for CHC, you have the right to appeal that decision. The appeals process has several stages, and many people have decisions overturned on appeal.
You have the right to request that the ICB reviews its decision. This must be done in writing within a specific timescale (usually within 28 days of the decision letter). Provide any new evidence or information that supports your eligibility.
A different team at the ICB will review your case. This review should be completed within 28 days.
If you are still not satisfied, you can request an Independent Review Panel. This is a formal appeal heard by people who were not involved in the original decision.
The IRP will carefully consider all the evidence and make a new decision. This is a significant step, and having professional support (advocate, solicitor, or specialist advisor) can be very helpful.
Common reasons for appeal:
If the IRP upholds the refusal and you believe the NHS acted wrongly or unfairly, you can complain to the Parliamentary and Health Service Ombudsman (PHSO). This is the final stage in the complaints process.
You do not have to appeal alone. Support is available from:
If you or a family member paid for care that should have been covered by CHC, you may be entitled to claim back those costs. This is called a retrospective claim.
You can make a retrospective CHC claim if:
Retrospective claims can go back to 2012, when the current NHS CHC assessment framework was introduced. Some older cases may be eligible under the previous framework.
To make a retrospective claim:
Retrospective claims can take several months to resolve. Having professional support (advocate or solicitor) can strengthen your case.
Many people receiving CHC funding choose to have their care provided at home rather than in a care home. Living Plus Care Services can deliver CHC-funded home care packages in both Hatfield, Hertfordshire and Peterborough, Cambridgeshire.
If you are eligible for CHC and want to receive care in your own home, the NHS will either arrange a care provider or offer you a Personal Health Budget to choose your own. The care can be flexible: morning and evening visits, round-the-clock live-in care, or anything in between.
Similar to council direct payments, NHS direct payments give you money to arrange and pay for your own care directly. This is an alternative to having the NHS arrange care on your behalf.
A Personal Health Budget is money allocated by the NHS that you can use to purchase healthcare directly. You have control over how the money is spent and which provider delivers your care. This offers maximum choice and flexibility.
With a PHB, you can choose any CQC-registered provider, including Living Plus Care Services. The NHS pays the provider directly, and you manage the arrangement.
The NHS body responsible for CHC in England is now the Integrated Care Board (ICB). There are two ICBs relevant to Living Plus Care Services' operational areas.
Responsible for NHS CHC decisions in Hatfield and surrounding Hertfordshire areas.
To request a CHC assessment in Hertfordshire, contact your GP or the local NHS team. You can also request an assessment directly from the ICB.
Responsible for NHS CHC decisions in Peterborough and surrounding Cambridgeshire areas.
To request a CHC assessment in Peterborough, contact your GP or the local NHS team.
Both areas have local advocacy services offering free, impartial support with CHC assessments and appeals. Ask your GP or social worker for details, or contact your local council's information service.
Living Plus Care Services offers free home assessments and can explain your options in detail. We are here to support you through the process and help you access the care you need.
Get in Touch: www.livingpluscare.co.uk/contact