Eligibility
The most common questions families have about who qualifies for NHS Continuing Healthcare and how eligibility is determined.
What is NHS Continuing Healthcare (CHC)?
NHS Continuing Healthcare is a package of care arranged and funded entirely by the NHS for people outside hospital who have ongoing healthcare needs. If someone is assessed as having a 'primary health need,' all of their care — including care home fees, home care, and nursing — is paid for by the NHS. It is free at the point of use and is not means-tested.
Who pays for CHC — the NHS or the local authority?
If someone qualifies for CHC, the NHS pays for the full cost of their care. This is different from social care, which is arranged and means-tested by the local authority. The distinction matters enormously: social care can cost families tens of thousands of pounds per year, while CHC is entirely free. The legal test is whether the person's primary need for care is a health need rather than a social care need.
Is CHC means-tested?
No. CHC is based entirely on assessed health needs, not on income, savings, or property. This is one of the most important things to understand: even if your loved one has substantial assets, they are entitled to fully-funded care if they meet the eligibility criteria. Many families pay for care privately for years without knowing they could have qualified for CHC.
What conditions qualify for CHC?
There is no list of qualifying conditions. CHC eligibility is based on the nature, intensity, complexity, and unpredictability of someone's care needs — not on their diagnosis. That said, conditions commonly associated with CHC eligibility include advanced dementia, severe stroke, Parkinson's disease, motor neurone disease, Huntington's disease, multiple sclerosis, and cancer requiring complex symptom management. The key question is always whether the overall need for care is primarily a health need.
Assessment
How the CHC assessment process works, what happens at the MDT meeting, and how the Decision Support Tool is scored.
How long does the CHC assessment take?
The NHS Framework target is 28 days from the initial Checklist screening to the full DST assessment decision. In practice, many Integrated Care Boards (ICBs) take 2-3 months or longer. If the process is delayed beyond 28 days, write to the ICB citing the Framework target and request an update. If needs are urgent or someone is approaching end of life, ask about the Fast Track pathway, which should be completed within 48 hours.
Can I attend the MDT meeting?
Yes. The NHS National Framework is clear that the person being assessed and their family or representative should be invited to participate in the DST assessment. You can attend meetings, submit written evidence, and challenge any domain scoring you disagree with. Always bring someone with you for support and to take notes — it is very difficult to advocate and record what is said at the same time.
How is the DST scored?
The Decision Support Tool (DST) examines 12 care domains — including behaviour, cognition, mobility, continence, skin integrity, and breathing. Each domain is scored at one of five levels: no needs, low, moderate, high, or severe (with an additional 'priority' level for extreme cases). The outcome is not determined by a simple points total. The MDT panel must consider the overall pattern of needs and whether, taken together, the person's primary need for care is a health need.
What is the Checklist screening?
The Checklist is the initial screening tool used to decide whether someone should be referred for a full CHC assessment. It is a simpler version of the DST and can be completed by a nurse, social worker, or other healthcare professional. If the Checklist indicates that the person may have a primary health need, they should be referred for a full DST assessment. Importantly, the Checklist is just a screening — it does not determine eligibility on its own.
Appeals
What to do if your loved one is refused CHC, how the appeals process works, and common arguments used by ICBs.
What if my loved one is refused CHC?
If CHC is refused, you have the right to challenge the decision. First, request a copy of the completed DST and the panel's written reasoning. Check each domain score against the evidence you provided — if scores seem too low, you can request a local review from the ICB. You should submit additional evidence and a written statement explaining which scores you believe are incorrect and why. If the local review is unsuccessful, you can escalate to an Independent Review Panel (IRP) through NHS England.
How do I appeal a CHC decision?
The appeals process has two stages. Stage one is a local review by the ICB — you write to them explaining which domain scores you disagree with and providing supporting evidence. The ICB should reconsider the decision within a reasonable timeframe. If the local review upholds the original decision, stage two is a referral to an Independent Review Panel (IRP) through NHS England. The IRP is an independent panel that reviews the case afresh. You can attend the IRP hearing, present evidence, and bring a representative. The IRP's recommendation is not legally binding on the ICB, but it carries significant weight.
What is the 'well-managed needs' argument?
This is the most common reason ICBs give for refusing CHC — they argue that because someone's needs are being 'well-managed' by their current care, they don't demonstrate a primary health need. This reasoning is legally flawed. Paragraphs 162–163 of the 2022 National Framework state that 'well-managed needs are still needs'. Needs must be assessed on the basis of what would happen if the care package were withdrawn. If this argument is used during your assessment, challenge it immediately.
Funding
How CHC funding works in practice — what it covers, how it interacts with other benefits, and what happens when circumstances change.
Does CHC cover care at home?
Yes. CHC is not limited to care homes. If someone qualifies, the NHS must fund whatever care package meets their assessed needs — whether that is in a care home, a nursing home, or in the person's own home. In fact, the NHS Framework states that people should be offered a choice about where they receive care. Home-based CHC packages can include personal care, nursing care, equipment, and therapies.
What about jointly-funded care (NHS-funded Nursing Care)?
If someone does not qualify for full CHC but has some nursing needs, they may be eligible for NHS-funded Nursing Care (FNC). This is a flat-rate weekly payment (currently around £219.71 per week in 2025/26) made directly to the care home to cover the cost of registered nursing care. FNC is not the same as CHC — the person still pays for the rest of their care fees. If you believe your loved one's needs go beyond what FNC covers, request a full CHC assessment.
Does CHC affect other benefits?
It depends on where care is provided. If someone receives CHC in a care home, they will lose Attendance Allowance (AA) or the care component of Disability Living Allowance / Personal Independence Payment after 28 days. However, if CHC is provided at home, these benefits usually continue. Other benefits such as State Pension are not affected by CHC. Always check with a benefits adviser before making assumptions.
What happens when someone on CHC dies?
CHC funding ends on the date of death. Any care fees already paid by the NHS up to that point remain covered. If there is an outstanding retrospective claim (a claim for a period when the person should have been receiving CHC but was not), the claim can still be pursued by the estate or family after death. The NHS cannot refuse to process a retrospective claim simply because the person has died.
Can the ICB withdraw CHC once it has been granted?
Yes, but only through a proper reassessment. The ICB must carry out a full DST review and demonstrate that the person's needs have genuinely changed. They cannot withdraw CHC simply to save money. If CHC is withdrawn and you disagree, you have the same right to challenge the decision through a local review and then an Independent Review Panel. During the dispute, the ICB should normally continue funding until the matter is resolved.
Retrospective claims
How to reclaim care fees your family should never have paid, including how far back you can claim and how much you could recover.
What is a retrospective CHC claim?
A retrospective claim is a request for the NHS to refund care fees for a period in the past when someone should have been assessed for CHC but was not, or was assessed incorrectly. If a retrospective review finds that the person met the eligibility criteria during that period, the NHS must reimburse all care costs that were paid privately or by the local authority.
How far back can a retrospective claim go?
In England, there is no fixed statutory time limit on retrospective CHC claims. NHS England has previously processed claims dating back to the early 2000s. However, the further back a claim goes, the harder it can be to gather evidence. In Wales, the framework and processes differ slightly. If you believe your loved one should have been assessed for CHC at any point in the past, it is worth submitting a claim regardless of how long ago the period was.
How much money can a retrospective claim recover?
The amount depends on how long the person should have been receiving CHC and how much was paid for their care during that period. Care home fees in England typically range from £800 to £1,500 per week, so a retrospective claim covering even a few years can be worth tens of thousands of pounds — sometimes over £100,000. The NHS must refund the full amount paid, including any top-up fees.