The primary health need test
The single question at the heart of CHC eligibility is this: does this person have a primary health need? If the answer is yes, the NHS must fund their care in full — whether that care is provided in a care home, a nursing home, or in their own home.
A primary health need exists when the main reason someone requires care is because of a health condition — as opposed to needing help with daily living tasks like washing, dressing, or cooking. The distinction matters because health needs are the responsibility of the NHS (free at the point of use), while social care needs are the responsibility of local authorities (means-tested and often self-funded).
The test is not based on a specific diagnosis. There is no list of conditions that automatically qualify you for CHC. Instead, the NHS assesses the impact of your conditions on your day-to-day care needs using a standardised tool called the Decision Support Tool (DST), which examines 12 care domains.
The DST scores each domain at one of five levels: no needs, low, moderate, high, or severe (with a “priority” level for the most extreme cases). The overall pattern of scores — not a simple total — determines whether you have a primary health need. Generally, one “severe” score or two or more “high” scores indicates eligibility, but the panel must also consider how needs interact across domains.
Key point: The primary health need test looks at the overall impact of your health conditions on your care needs — not at any single diagnosis. Two people with the same condition can have very different outcomes depending on how that condition affects their daily life.
The four characteristics: nature, intensity, complexity, unpredictability
The NHS National Framework requires assessors to consider four characteristics when deciding whether someone has a primary health need. These are the lens through which every care need is evaluated. Understanding them is essential for framing your evidence.
Nature
What type of care does the person need? The key question is whether the care requires clinical knowledge, specialist healthcare skills, or ongoing medical oversight. Care that goes beyond what a social care worker can safely provide points towards a health need.
Example: PEG feeding, catheter management, complex wound care, seizure management, or specialist medication administration that cannot be delegated to non-clinical staff.
Intensity
How much care is needed, and how often? Needs that require frequent, sustained, or round-the-clock intervention indicate a high level of intensity. The assessors must consider the total volume of care across the whole day and night.
Example: Needing repositioning every 2 hours around the clock, requiring 1:1 supervision during all waking hours, or needing personal care interventions more than 4 times daily.
Complexity
How do different needs interact? When multiple health conditions create a combined care challenge that requires skilled coordination, this indicates complexity. A person with three moderate needs that interact may have greater overall complexity than someone with one severe need.
Example: Dementia causes refusal of diabetes medication, leading to unpredictable blood sugar levels that require clinical monitoring — three conditions interacting to create a care challenge greater than the sum of its parts.
Unpredictability
How quickly can the person's condition change? Needs that are unpredictable — where the person can deteriorate rapidly or behave in unexpected ways — require a higher level of readiness and clinical oversight.
Example: Sudden severe agitation with no warning or pattern, breakthrough seizures despite medication, rapid onset choking episodes, or fluctuating consciousness levels.
Important: The assessors must consider all four characteristics together. A person whose needs score moderately across all four characteristics may still have a primary health need if the combined picture demonstrates that healthcare oversight is the dominant requirement. Always present your evidence through the lens of these four criteria.
What conditions commonly qualify for CHC
There is no list of conditions that automatically qualify for CHC. Eligibility depends on the impact of the condition, not the diagnosis. However, certain conditions are more commonly associated with successful CHC applications because they tend to produce care needs that are high in nature, intensity, complexity, or unpredictability.
Dementia (moderate to severe)
Particularly when combined with behavioural challenges, wandering, aggression, inability to recognise danger, and refusal of care. The interaction between cognitive, behavioural, and psychological needs often creates significant complexity.
Stroke (with lasting impairment)
Severe stroke often affects mobility, communication, swallowing, cognition, and continence simultaneously. The interaction between these domains is key to demonstrating a primary health need.
Advanced neurological conditions
Motor neurone disease, multiple sclerosis, Parkinson's disease (advanced stage), and Huntington's disease often produce rapidly changing needs with high unpredictability.
Advanced cancer (with complex symptoms)
Where symptom management requires ongoing clinical oversight — particularly pain management, breathing difficulties, and nutrition support. The Fast Track pathway may also apply for rapidly deteriorating conditions.
Acquired brain injury
Traumatic brain injury or brain damage from stroke, anoxia, or infection often creates complex combinations of cognitive, behavioural, and physical needs that require specialist care coordination.
Severe mental health conditions
Where psychiatric needs require clinical oversight, specialist medication management, or where the person poses a risk to themselves or others that cannot be managed in a standard social care setting.
Complex physical conditions
Spinal injuries, multiple organ failure, ventilator dependence, complex wound care needs, or conditions requiring regular clinical interventions such as PEG feeding or tracheostomy care.
This list is not exhaustive. Any condition — or combination of conditions — can lead to CHC eligibility if the resulting care needs meet the primary health need threshold. The key is always to focus on the impact of the condition on day-to-day care, not the diagnosis itself.
CHC is not means-tested — and age is not a factor
Two of the most common misconceptions about CHC are that it depends on your financial situation or your age. Neither is true.
CHC is not means-tested. Unlike social care — where your local authority can charge you based on your savings, income, and property — CHC is funded entirely by the NHS and is free at the point of use. It does not matter if you own your home, have savings above the social care threshold, or have a private pension. If you meet the primary health need test, the NHS pays for everything: care home fees, nursing care, personal care, and equipment.
This is why CHC eligibility is so important financially. A family paying care home fees of £1,000 to £1,500 per week (typical in much of England) would save £50,000 to £78,000 per year if CHC is awarded. Over several years, the total can easily exceed £200,000.
There is no age limit. CHC is available to any adult, regardless of age. While the majority of CHC recipients are elderly — because conditions like dementia, stroke, and frailty are more common in older age — younger adults with complex health conditions are equally entitled. A 40-year-old with a severe acquired brain injury has exactly the same right to CHC as an 85-year-old with advanced dementia, provided they meet the primary health need threshold.
Key point: If your local authority is charging you for care, and you believe your loved one has a primary health need, applying for CHC could eliminate those charges entirely. The NHS cannot refuse to assess someone because of their age or financial situation.
The legal framework: the Coughlan case
The legal basis for CHC eligibility was established by the Court of Appeal in R v North and East Devon Health Authority, ex parte Coughlan [1999]. This landmark case set the boundary between NHS-funded healthcare and local authority-funded social care.
Pamela Coughlan was a severely disabled woman who had been promised a “home for life” by the NHS. When the health authority tried to close her facility and transfer responsibility to the local authority, she challenged the decision. The Court of Appeal ruled that where a person's primary need is a health need, the NHS — not the local authority — must fund their care.
The Coughlan judgment established a key principle: the NHS cannot transfer responsibility for healthcare to local authorities simply because the care is being provided in a social care setting. If the dominant reason for the care package is a health need, it remains an NHS responsibility.
“Where the primary need is a health need, the NHS is responsible for the full package of care, including accommodation if necessary.”
— R v North and East Devon Health Authority, ex parte Coughlan [1999] EWCA Civ 1871
This principle is now enshrined in the NHS National Framework for Continuing Healthcare, which provides the detailed process for assessing eligibility. The Framework has been updated several times since 1999, but the core legal test from Coughlan remains unchanged.
A second important legal principle is the “well-managed needs” rule. The Framework states that needs should be assessed based on what would happen if the current care package were withdrawn — not on how well the care is currently managing those needs. If an ICB argues that someone doesn't qualify because their needs are being “well-managed,” this is legally incorrect and should be challenged. Read our full guide to well-managed needs and how to challenge this argument.
Who can apply and how to start the process
Anyone can request a CHC assessment. You do not need a referral from a GP, hospital, or social worker — although any of these professionals can also make a referral. The process starts with a Checklist screening, which is a shorter initial assessment to determine whether a full DST assessment is warranted.
Request a Checklist screening
Contact your local Integrated Care Board (ICB) and ask for a CHC Checklist screening. You can find your ICB on the NHS England website. The Checklist can be completed by a healthcare professional — typically a nurse or social worker — and should be done within a reasonable timeframe.
The Checklist screening
The Checklist covers the same 12 domains as the full DST but at a higher level. If the person scores positively in at least two domains (or one domain at a high level), they should be referred for a full assessment. The threshold is deliberately low — the Checklist is meant to screen in, not screen out.
The full DST assessment
If the Checklist triggers a full assessment, a multidisciplinary team (MDT) will complete the Decision Support Tool. You and your loved one have the right to attend and contribute. The MDT should consider all available evidence, including your written submissions. The target is 28 days from Checklist to DST decision.
The decision
The MDT makes a recommendation, which is then ratified (or not) by the ICB. If CHC is awarded, the NHS will arrange and fund the care package. If it is refused, you have the right to a local review and, if necessary, an Independent Review Panel.
Retrospective claims
If your loved one should have been assessed for CHC in the past but wasn't — for example, at hospital discharge — you can request a retrospective assessment. If the review finds they were eligible, the NHS must refund care fees paid during the eligible period.
Frequently asked questions about CHC eligibility
Who is eligible for NHS Continuing Healthcare?
Anyone with a 'primary health need' is eligible for CHC, regardless of age, condition, or financial situation. The test is whether the main reason you need care is a health need — not a social care need. There is no list of qualifying conditions. Instead, the NHS assesses the nature, intensity, complexity, and unpredictability of your needs using the Decision Support Tool (DST).
Is CHC means-tested?
No. CHC is entirely free and is not means-tested. Unlike social care provided by local authorities, CHC is funded by the NHS and based solely on clinical need. It does not matter how much money or property you have. If you have a primary health need, the NHS must pay for your care — including care home fees, home care, and equipment.
Is there an age limit for CHC?
No. CHC is available to adults of any age, including younger adults with complex health conditions. While the majority of CHC recipients are over 65, there is no minimum or maximum age. The only criterion is whether the person has a primary health need. Children have a separate continuing care framework.
Can someone with dementia qualify for CHC?
Yes. Dementia is one of the most common conditions in CHC-eligible individuals. However, a diagnosis alone does not guarantee eligibility — the assessment looks at the impact of the condition on care needs. People with moderate to severe dementia often score highly across multiple DST domains including behaviour, cognition, communication, and psychological needs. The interaction between these domains is key.
What is the difference between CHC and social care?
Social care is arranged and funded by local authorities, is means-tested, and covers needs like help with washing, dressing, and daily living. CHC is funded by the NHS, is free regardless of income, and covers all care needs when the primary reason for care is a health need. The legal boundary was established in the Coughlan case (1999), which held that where nursing care is the primary need, the NHS — not the local authority — must fund it.
Can I apply for CHC myself?
Yes. Anyone can request a CHC Checklist screening — you do not need a referral from a GP or hospital. You can contact your local Integrated Care Board (ICB) directly and ask for a Checklist assessment. Care homes, GPs, hospitals, and social workers can also refer someone for screening. If you believe your loved one should have been assessed previously, you can request a retrospective review.
What happens if my loved one is found not eligible?
If the assessment finds no primary health need, you have the right to request a local review from the ICB within a reasonable time. You should provide additional evidence and explain which domain scores you believe are incorrect. If the local review is unsuccessful, you can escalate to an Independent Review Panel (IRP) through NHS England. Around 30% of appeals result in the decision being overturned.
If CHC is refused, you have the right to appeal. Around 40% of appeals succeed.
Related guides
NHS Continuing Healthcare Funding Guide
The complete guide to CHC — who qualifies, the assessment process, and what to do if refused.
CHC Checklist Guide
How the initial CHC Checklist screening works and how to make sure your loved one passes it.
CHC Assessment: Preparing for the DST
How to prepare evidence for all 12 DST domains and what to do on the day of the MDT meeting.
CHC Eligibility Checker
Answer a few questions about your loved one's care needs to see whether they may qualify for CHC.
Well-Managed Needs in CHC
Why 'your relative's needs are well-managed' is not a valid reason to refuse CHC — and how to challenge it using the National Framework.