What CHC is
NHS Continuing Healthcare (CHC) is a package of NHS-funded care for adults aged 18+ in England whose primary need for ongoing support is health-related. Where someone qualifies, the NHS pays 100% of the assessed care costs — whether that care is delivered in a care home, a nursing home, or in their own home. There is no means test, no cap, and no co-payment.
It is set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (Department of Health and Social Care, revised 2022) and commissioned by Integrated Care Boards (ICBs).
Who qualifies — the "primary health need" test
The legal test is whether your needs, taken as a whole, are primarily a health responsibility rather than a social-care one. The framework assesses this against four key characteristics:
- Nature — the type of needs and the interventions they require.
- Complexity — how the needs interact and the skill required to manage them.
- Intensity — the quantity, severity and continuity of needs.
- Unpredictability — the degree to which needs fluctuate and risk escalation.
You do not need a specific diagnosis. A dementia patient with severe behavioural and physical needs can qualify; a younger adult with complex neurological disability or a high-needs respiratory condition can qualify. The label does not decide it — the pattern across domains does.
The 12 care domains
The Decision Support Tool scores you across 12 domains, each on a severity scale (No needs / Low / Moderate / High / Severe / Priority — some domains cap at lower levels):
- Breathing
- Nutrition (food and drink)
- Continence
- Skin integrity (including tissue viability)
- Mobility
- Communication
- Psychological and emotional needs
- Cognition
- Behaviour
- Drug therapies and medication / symptom control
- Altered states of consciousness
- Other significant needs (catch-all)
A single "priority" rating in any domain, or two or more "severe" ratings, normally indicates a primary health need. But the framework is clear: it is the overall picture — including the four characteristics above — that decides, not the box-ticking.
How to trigger an assessment
You cannot self-refer. A registered professional (nurse, social worker, GP, hospital discharge team) must complete the CHC Checklist. The most common trigger is hospital discharge — every patient leaving hospital with significant ongoing needs is supposed to be screened. In practice it gets skipped. Ask explicitly.
If the Checklist meets the threshold, your ICB has 28 days to convene a multi-disciplinary team (MDT) and complete the Decision Support Tool. Bring an advocate or family member to the MDT. Beforehand, gather your medical records (via a Subject Access Request), care plans, recent specialist letters and incident logs.
If you are refused — the appeals route
Most CHC decisions go to refusal at first MDT. The framework gives you three layers of challenge:
- ICB internal review — request in writing within 6 months of the decision. The ICB must reconsider with an independent panel.
- NHS England Independent Review Panel (IRP) — if the ICB review fails, ask NHS England for an IRP. The panel includes an independent chair and clinical members.
- Parliamentary and Health Service Ombudsman — final escalation if IRP refuses. See our PHSO guide.
Specialist no-win-no-fee advocates (Beacon, Care to be Different) frequently overturn refusals. Beacon publishes annual outcomes data showing high overturn rates on full appeal — refusal at MDT is not the end of the road.
Retrospective claims
If you (or a deceased relative's estate) paid for care during a period when CHC should have been awarded, you can claim that money back. The deadline is generally within 6 months of the period in question, though limited extensions apply. Recoveries of £50,000–£500,000+ are common where care home fees ran for years.
You will need to evidence the person's health needs during the disputed period — medical records, care plans, GP notes, district nurse logs, hospital admissions. A SAR to every NHS body that touched their care is the first step.
Funded Nursing Care (FNC) — the consolation prize
If you live in a nursing home and need a registered nurse but do not qualify for full CHC, the NHS pays a flat-rate weekly contribution toward the nursing element. The 2025/26 rate is £253.02 per week (set by the Department of Health and Social Care). FNC is paid direct to the care home, not to you. It does not cover personal care or accommodation.
FNC and CHC are decided in the same assessment process. You should never be offered FNC without a full CHC assessment first — if you are, push back and request the Checklist.
Frequently asked questions
›What is NHS Continuing Healthcare?
CHC is fully NHS-funded care for adults whose primary need for support is health-related, not social. It covers 100% of care home or care-at-home costs — there is no means test, no cap, and no contribution from you.
›Who qualifies for CHC?
Adults assessed as having a 'primary health need' under the National Framework for NHS Continuing Healthcare. The test is whether your needs across the 12 care domains, when considered as a whole, are primarily a health responsibility rather than a social-care one — using nature, complexity, intensity and unpredictability.
›How do I apply?
You cannot apply directly. A health or social-care professional must complete the CHC Checklist as a screening tool. If you screen in, your ICB arranges a full assessment by a multi-disciplinary team using the Decision Support Tool.
›What if I am refused?
You have a right to an internal review by your ICB within 6 months of the decision. If still refused, you can ask NHS England for an Independent Review Panel (IRP). After IRP, you can complain to the Parliamentary and Health Service Ombudsman.
›Can I claim back care costs I have already paid?
Yes — if you can show you should have been awarded CHC during a previous period. Retrospective claims must usually be made within 6 months of the period in question (with limited extensions). Recoveries can run into tens or hundreds of thousands of pounds.
›How is CHC different from Funded Nursing Care?
FNC is a smaller weekly NHS contribution (£253.02/week in 2025/26) toward the nursing element of care home fees for people who do not meet CHC but need a registered nurse. CHC covers all care costs, FNC covers only the nursing component.