What it is, who qualifies, and how to make sure your relative isn't missed

Every year, thousands of families in England pay for home care they may have been entitled to receive for free. NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS — but it's not automatically offered, it's often poorly explained, and many families only discover it exists after they've already been paying privately for months.

This guide explains exactly what NHS CHC is, who qualifies, how the assessment works, and what to do if you believe your relative has been unfairly turned down.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is a package of ongoing care arranged and fully funded by the NHS for adults in England who have a "primary health need." Unlike local authority-funded care — which is means-tested and capped — NHS CHC has no means test. It doesn't matter how much money your relative has. If they qualify clinically, the NHS pays for all of it.

NHS CHC can fund care provided in the home, in a care home, or in a nursing home. For families looking at home care specifically, it can cover visits from carers, live-in care, nursing support, and specialist care for conditions like dementia, Parkinson's disease, or post-stroke rehabilitation.

In England, CHC is administered by Integrated Care Boards (ICBs) — formerly Clinical Commissioning Groups (CCGs). The rules are the same across England, though how well the assessment is managed varies significantly by ICB.

Who qualifies — and what "primary health need" means

The key phrase in CHC eligibility is "primary health need." This means the person's overriding need is for health care, not just social or personal care. The NHS has a legal duty to fund care where health needs are the primary driver — even if those needs also involve day-to-day living support.

There is no single qualifying condition. CHC is assessed across four domains:

The nature of the need (is it physical, cognitive, psychological, or behavioural?)
The intensity of the need (how frequent, how severe?)
The complexity of the need (does it require specialist knowledge to manage?)
The unpredictability of the need (does it present risks that require expert management?)

Conditions that frequently lead to CHC eligibility include: advanced dementia, Parkinson's disease, motor neurone disease, acquired brain injury, multiple sclerosis, and complex post-surgical needs. But eligibility is always individual — assessed on the person's actual needs at the time, not their diagnosis alone.

The two-stage assessment process

Stage 1: The CHC Checklist

The first step is a Checklist screening assessment, which can be carried out by any trained health or social care professional — a nurse, occupational therapist, or social worker. It covers 11 care domains and determines whether there is enough evidence to proceed to a full assessment.

If the checklist indicates possible eligibility, the case moves to Stage 2. If it doesn't, the family can request a review of that decision.

The checklist should be offered before hospital discharge if there is any indication the patient may qualify. If it hasn't been initiated and you believe your relative should be considered, you can ask the discharge team, ward nurse, or GP to refer for a CHC checklist. You can also self-refer to your local ICB.

Stage 2: The Decision Support Tool (DST)

The full assessment uses a standardised Decision Support Tool, completed by a multidisciplinary team (MDT) that includes both health and social care professionals, the patient (where possible), and family or advocates.

Each of the 11 care domains is rated (low, moderate, high, severe, or priority), and the overall picture is considered to reach a recommendation. The final decision rests with the ICB.

The assessment should take place in the most appropriate setting — and if your relative is in hospital, it should ideally happen before they are discharged. In practice, this doesn't always happen and some assessments take place at home or in a care setting after discharge.

What happens if your relative qualifies

If CHC eligibility is confirmed, the ICB is responsible for commissioning a care package. For home care, this typically means the ICB will arrange a care provider — though in some cases families can request a Personal Health Budget, which allows them to choose and manage the care themselves.

There is no co-payment from the family. The NHS funds the full cost of the care package.

Personal Health Budgets Since 2014, NHS CHC recipients in England have had a legal right to request a Personal Health Budget. This gives families the control to choose their own CQC-registered provider rather than accepting whoever the ICB commissions. If this option appeals, ask the ICB to confirm your relative's right to a PHB in writing at the point of CHC confirmation.

What happens if your relative is turned down — and what to do

CHC is significantly under-claimed. Research and advocacy organisations including the Beacon CHC helpline have documented widespread inconsistency in assessments, including cases where eligible individuals are turned down due to poorly conducted checklists or pressure to discharge quickly.

If your relative is turned down at either stage, you have the right to:

Request the written rationale for the decision — the ICB must provide this
Request a Local Resolution meeting with the ICB to present additional evidence
Appeal to NHS England if the Local Resolution outcome is unsatisfactory
Seek independent advocacy — organisations like Beacon CHC or CHC Champions offer free guidance to families appealing decisions

Keep records of everything: care plans, GP notes, hospital discharge summaries, and any correspondence with the ICB. In successful appeals, families often rely on written evidence of the nature and intensity of the care need.

NHS-funded nursing care — a different, simpler route

Separate from CHC, there is a lower-threshold entitlement called NHS-funded Nursing Care (FNC). This is a flat weekly payment the NHS makes toward the nursing care component of a nursing home placement — it's less relevant for home care, but worth knowing if a nursing home is being considered. The FNC rate in 2025/26 is £235.88 per week.

Frequently asked questions

Does CHC eligibility change over time? Yes. CHC eligibility is reviewed periodically (usually every 3 months initially, then annually). If a person's condition improves significantly, they may be reassessed and CHC may be withdrawn — with an obligation on the ICB to arrange an appropriate transition.

Can CHC fund live-in care? Yes, where live-in care is the most appropriate and cost-effective option to meet assessed health needs, it can be funded through CHC.

Can I claim back costs already paid? Yes, in some circumstances. If your relative was eligible for CHC during a period when they were self-funding — and an assessment was not properly offered — you can make a retrospective claim going back potentially years. This is complex but worth pursuing with professional advocacy support.

Does CHC apply in Wales, Scotland, and Northern Ireland? Equivalent frameworks exist across all four nations, but the details differ. Scotland has Continuing Healthcare, Wales has Welsh Continuing NHS Health Care, and Northern Ireland has a similar entitlement under health and social care integration. The principles are broadly similar, but assessment processes and ICB equivalents vary.

How Care-AI-UK helps CHC families

If your relative has been awarded a CHC package and you have the right to choose your own provider through a Personal Health Budget, Care-AI-UK can help you find CQC-registered providers in your area who accept CHC-funded packages. Our matching tool filters by care type, location, and availability — free for families.

Find CHC-compatible home care providers →

In this series:

NHS Continuing Healthcare: The Fully Funded Care Most Families Don't Know to Ask For