Key Facts
- CHC pays 100% of care costs — no means test, no savings threshold, no property assessment
- 51,154 people in England receiving CHC funding as of Q3 2025/26 (NHS Digital)
- The test is one question: does the person have a primary health need?
- Assessment uses the Decision Support Tool (DST) covering 12 care domains
- Typical family saves £52,000+/year in care home fees if approved (based on average nursing care fees of £1,000+/week)
- 80% of initial applications are refused — but appeals frequently succeed (Healthwatch England, 2025)
- The NHS target is 28 days from positive checklist to completed assessment
CHC funding pays 100% of your relative's care costs. NHS Continuing Healthcare has no means test, no savings threshold, no property assessment. The only question: does your relative have a "primary health need"? Over 51,000 people in England receive it right now. The system does not offer it. You have to ask.
TL;DR: 51,154 people in England were receiving NHS Continuing Healthcare as of Q3 2025/26 (NHS Digital), yet research by Independent Age found most eligible people are never assessed. CHC pays 100% of care costs — nursing home fees of £1,000–£1,200+/week — with no means test. You have to request it yourself.
What is CHC funding?
CHC stands for NHS Continuing Healthcare. It is a package of care arranged and funded entirely by the NHS for adults with complex, ongoing health needs. The legal basis is the National Framework for NHS Continuing Healthcare (2022), published by NHS England.
If your relative qualifies, the NHS pays 100% of their care costs. That means care home fees — which run to £1,000 per week or more for nursing care — personal care, and nursing care. Your family pays nothing.
There is no means test. There is no savings threshold. There is no property assessment. CHC eligibility turns entirely on health need, not finances. A person with £500,000 in savings and a person with nothing receive the same funding if their health needs qualify.
The test is a single question: does this person have a "primary health need"? That means their day-to-day care needs, taken as a whole, arise primarily from health conditions rather than from social care needs. If the answer is yes, the NHS — not the local authority — must fund their care.
According to NHS Digital CHC statistics, approximately 51,154 people in England were receiving CHC funding in Q3 2025/26. However, that figure represents a fraction of those who should qualify.
Who qualifies for CHC funding?
Eligibility rests on one legal test: primary health need. Your relative qualifies if their care needs, taken together, arise primarily from health conditions rather than social care needs.
The NHS measures this using the Decision Support Tool (DST), which scores need across 12 clinical domains:
- Behaviour
- Cognition
- Communication
- Psychological and emotional needs
- Mobility
- Nutrition, food, and drink
- Continence
- Skin integrity
- Breathing
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
Each domain receives a score from No/Low Needs through to Priority (the most severe). The scoring pattern across all 12 domains — not any single domain in isolation — determines whether a primary health need exists. Read our detailed guide to all 12 care domains and how they're scored.
There is no age restriction. There is no diagnosis restriction. CHC does not require a specific condition. The question is always about the level and nature of need, not the label.
That said, from our work supporting families across England, certain presentations commonly qualify: advanced dementia with behavioural and cognitive decline, complex nursing needs requiring daily clinical intervention, serious continence problems that affect skin integrity and mobility, and multiple co-existing conditions where the combined care burden is primarily health-driven. If your relative is on a DoLS authorisation — the legal procedure that authorises a care home or hospital to restrict the freedom of someone who lacks capacity — that is itself documented evidence of the kind of intensive supervised need that often warrants a CHC checklist screening.
For example, a person paying £1,200 per week in care home fees for nursing-level dementia care may qualify for CHC funding that covers every penny of that cost. The difference between self-funding and full NHS funding is often whether the right assessment was done — not whether the person's needs were severe enough. See our detailed guide to what dementia families need to know about CHC.
Many CHC applicants are also entitled to Attendance Allowance — a separate DWP benefit that some CHC applicants also receive while the assessment is in progress. AA pays £72.65–£108.55 per week (April 2026) and is not means-tested. The two systems are administered separately and don't always communicate; families filing for either are usually entitled to consider both.
What does CHC funding cover?
CHC funding covers the full cost of care for people who qualify. This includes:
- Care home fees — the full amount, not a contribution or top-up
- Nursing care — clinical and nursing support
- Personal care — washing, dressing, continence support, feeding
- Care at home — CHC is not limited to care homes; the NHS can fund a care package delivered in the person's own home
Notably, CHC does not cover accommodation costs where a nursing home separates care charges from "hotel costs" (room and board). But the care element — which is the bulk of the fee in most nursing homes — is fully funded.
In contrast, under local authority social care funding, your relative pays an assessed contribution and the council pays the rest. Under CHC, the NHS pays everything related to care. The financial difference for families can run to tens of thousands of pounds per year.
The CHC assessment process
The CHC assessment process has three formal stages.
Stage 1: The CHC checklist
The CHC checklist is a 12-domain screening tool. Any registered nurse, social worker, or allied health professional can complete it. It does not require a specialist. The ward nurse looking after your relative right now can do it.
The checklist determines whether there is enough evidence of health need to trigger a full assessment. A positive checklist does not award funding — it opens the door to the next stage.
Stage 2: The full Decision Support Tool (DST) assessment
A multidisciplinary team — typically a nurse, a social worker, and other professionals involved in your relative's care — carries out the full DST assessment. They score each of the 12 domains based on evidence from care records, clinical notes, and direct observation.
The National Framework (2022) sets a target of 28 days from a positive checklist to a completed full assessment. This is a target, not an absolute deadline, but Integrated Care Boards (ICBs) should meet it. If the process runs significantly beyond 28 days, chase the ICB in writing.
You and your relative have the right to attend the DST assessment and contribute evidence. If the person has lost capacity, a registered Lasting Power of Attorney gives you the legal standing to act on their behalf throughout the process. Family observations of day-to-day care needs often capture detail that clinical records miss. Use our evidence templates to prepare a written statement for every domain.
You also have the right to request a CHC checklist before hospital discharge. The National Framework (2022) requires that a checklist be completed before discharge to a care home, provided you have requested one. Do not sign any care home admission paperwork or self-funding agreement before the checklist has been done.
Stage 3: The ICB decision
Once the MDT has completed the DST, the completed tool goes to an ICB decision panel — typically a senior NHS clinician or panel — who reviews the domain scores and determines whether a primary health need exists. The panel does not reassess your relative; it makes a funding decision based on the completed DST. You should receive the decision in writing. If the decision is a refusal, you are entitled to the full completed DST and the panel's written reasons.
Is your relative facing hospital discharge or paying care home fees? The NHS may be legally required to fund their care entirely — no means test. Check CHC eligibility in 3 minutes
Check eligibility nowWhat happens if CHC funding is refused?
A refusal is not the end of the process. It is the beginning of a challenge.
Request written reasons. The ICB must explain why your relative was found not to have a primary health need. Ask for the completed DST with domain scores and the panel's reasoning. You are entitled to this.
Appeal through the ICB's formal process. Every ICB operates a local resolution and appeals process for CHC decisions. You can challenge the scoring in specific domains, provide additional evidence the panel did not consider, and request a fresh assessment. Put your appeal in writing. Reference the specific domains you believe were scored inaccurately and attach supporting evidence — care home records, GP letters, nursing assessments, family observations.
Escalate to the NHS Parliamentary and Health Service Ombudsman. If the ICB's internal appeals process does not resolve the dispute, the Ombudsman can investigate. The Ombudsman has the power to overturn ICB decisions and direct funding to be awarded.
Claim retrospectively. If your relative was self-funding in a period when they should have qualified for CHC, you can apply for a retrospective CHC claim. There is no fixed national six-year look-back window. Fees already paid during eligible periods — sometimes tens of thousands of pounds — may be refunded. The retrospective review examines clinical records from the relevant period to establish whether a primary health need existed at the time, even if no CHC assessment was ever done.
CHC funding versus social care funding
| CHC funding | Council social care funding | |
|---|---|---|
| Who pays | NHS | Local authority (with resident contribution) |
| Means tested? | No | Yes |
| Assets assessed? | No | Yes — above £23,250 you self-fund (England, 2024-25) |
| What is covered | 100% of care costs | Care contribution only — resident pays assessed amount |
| Who decides eligibility | NHS Integrated Care Board | Local authority |
| Can be refused if health needs are not primary | Yes | No — if assessed as needing care, council must fund |
The practical difference: under the Care Act 2014, a person with a home worth £300,000 and savings of £40,000 pays their own care fees until assets fall below £23,250. Under CHC, the same person pays nothing from day one if their health needs qualify. The financial gap between these two routes can exceed £100,000 over the course of a care home stay.
Why do families have to fight for CHC funding?
The system does not tell you CHC exists. You have to find it yourself — and then you have to push for the assessment.
NHS Digital reports approximately 51,154 people receiving CHC in England as of Q3 2025/26. Research by Independent Age (2023) found that the majority of people who would meet the eligibility criteria are never assessed, or are assessed and incorrectly refused. A Nuffield Trust analysis published in September 2025 confirmed this picture, finding the national eligibility rate has fallen to just 17% of those assessed — down from 31% in 2017/18. The gap between who qualifies on paper and who actually receives funding is vast.
There are structural reasons for this. Accordingly, local authorities have a financial interest in routing people through social care rather than CHC. When a person receives CHC, the NHS pays. When they receive council-funded social care, the local authority pays — and recovers a contribution from the individual. The NHS budget and the social care budget sit in different pots. The incentive to assess for CHC is weak.
Hospitals routinely discharge patients to care homes without completing a CHC checklist. In our experience, families are handed self-funding agreements and told to sign before anyone mentions CHC. The CHC checklist — which the National Framework (2022) requires before discharge to a care home — is not mentioned. Not because the clinical staff are acting in bad faith, but because the system does not prioritise it.
As a result, families start paying £1,000 or more per week in care home fees that the NHS should be covering. By the time they discover CHC exists, months or years of fees have already been paid. Those fees can be recovered through a retrospective claim — but the process takes time, and the financial damage has already been done.
The single most effective intervention is knowing about CHC before you sign anything. We've helped families recover tens of thousands of pounds through retrospective claims — but the most impactful cases are the ones where families requested the checklist before signing care home paperwork and never had to pay privately at all.
CHC funding by Integrated Care Board
Approval rates, contacts and local advocacy guidance for every Integrated Care Board in England and Local Health Board in Wales.
East of England
Midlands
North East and Yorkshire
South East
South West
Wales
North East
West Midlands
Approval rate shown is the 2024/25 standard-eligibility approval rate for that ICB. National average for 2024/25 is approximately 17%.
CHC eligibility varies sharply by Integrated Care Board: the highest-approving ICBs in England settle around the high-20s percentile, while the lowest sit in single digits. Knowing your local rate, named contacts and Freedom of Information route is one of the strongest things you can do before a Checklist meeting.
Don't pay another month of care home fees without checking this. The NHS funds 100% for people who qualify. Find out if your relative is one of them.
Check eligibility nowReady to build your case? Our Case Strength Report (£97) reviews your loved one's care needs against all 12 DST domains and tells you exactly where you stand — before your first meeting with the ICB.