How CHC works in Wales
NHS Continuing Healthcare in Wales follows the same core principle as in England: if a person has a “primary health need” — meaning the main reason they need care is a health condition rather than a social care need — then the NHS pays for their care in full. This includes care home fees, nursing care, and domiciliary care. It is not means-tested.
However, the Welsh Government operates its own framework, separate from NHS England's National Framework. The responsible bodies, financial thresholds, assessment tools, and appeals process all differ. If your loved one lives in Wales, it is essential to understand these differences — applying English rules to a Welsh case is one of the most common mistakes families make.
Wales has historically taken a more progressive approach to social care funding than England. The capital threshold is higher, domiciliary care charges are capped, and free prescriptions have been available since 2007. This means that even if a CHC application is unsuccessful, the financial impact on Welsh families is often less severe than in England — though care home fees still represent a significant cost.
Local Health Boards vs Integrated Care Boards
In England, CHC assessments are managed by Integrated Care Boards (ICBs) — 42 regional NHS bodies that commission healthcare services. In Wales, the equivalent bodies are Local Health Boards (LHBs), but they work quite differently.
Wales has seven LHBs, each responsible for planning and delivering all NHS services in their area. Unlike English ICBs, which commission services from separate hospital trusts and providers, Welsh LHBs combine commissioning and provision into a single organisation. This means the body that decides your CHC application also runs the hospitals and community health services in your area.
Betsi Cadwaladr University Health Board
North Wales (Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire, Wrexham)
Powys Teaching Health Board
Powys (mid-Wales)
Hywel Dda University Health Board
West Wales (Carmarthenshire, Ceredigion, Pembrokeshire)
Swansea Bay University Health Board
Swansea and Neath Port Talbot
Cwm Taf Morgannwg University Health Board
Bridgend, Merthyr Tydfil, Rhondda Cynon Taf
Aneurin Bevan University Health Board
South East Wales (Blaenau Gwent, Caerphilly, Monmouthshire, Newport, Torfaen)
Cardiff and Vale University Health Board
Cardiff and the Vale of Glamorgan
Key point: Your LHB is determined by where your loved one is ordinarily resident — not where they are currently receiving care. If they moved into a care home in a different LHB area, the original LHB may still be responsible.
The Welsh CHC framework
The Welsh Government published its own Continuing NHS Healthcare Framework, which governs how LHBs must assess and determine eligibility for CHC in Wales. While the overall approach is similar to England's National Framework — both use a multidisciplinary team assessment and a Decision Support Tool — there are important procedural differences.
The Welsh framework emphasises a person-centred approach and requires LHBs to involve the individual and their family or representative throughout the assessment. It uses the same 12-domain structure as England for the Decision Support Tool, covering behaviour, cognition, psychological needs, communication, mobility, nutrition, continence, skin integrity, breathing, drug therapies, altered states of consciousness, and other significant needs.
The framework also sets out the duties of LHBs regarding timescales. The target is for the full assessment to be completed within 42 days of the initial screening — longer than England's 28-day target. In practice, delays are common in both countries, but knowing the Welsh target gives you grounds to chase progress.
The Welsh framework was updated under the broader context of the Social Services and Well-being (Wales) Act 2014, which reformed social care in Wales. This Act introduced a new assessment framework for social care needs and placed a stronger emphasis on well-being outcomes, preventative services, and the voice of the individual. Where a person's needs sit on the boundary between health and social care, both frameworks interact.
Key differences from England
If you are familiar with the CHC process in England, here are the most important differences to be aware of in Wales:
Capital limit: £50,000 vs £23,250
The most significant financial difference. In England, if your savings exceed £23,250, you pay the full cost of your care. In Wales, the threshold is £50,000. Below £24,000, the local authority pays in full. This means Welsh residents have considerably more financial protection if CHC is not granted.
Domiciliary care charge cap: £100/week
Wales caps the maximum weekly charge for non-residential social care at £100 per week, regardless of how many hours of care are provided. In England, there is no equivalent national cap — councils can charge up to the full cost. For people receiving 25+ hours of home care per week, this effectively makes much of their care free or heavily subsidised in Wales.
Local Health Boards, not ICBs
CHC decisions in Wales are made by one of seven Local Health Boards, which combine commissioning and provision. In England, the 36 Integrated Care Boards (following April 2026 mergers) handle CHC but do not directly provide services. This can affect how decisions are made and who is involved in the assessment.
Assessment timescale: 42 days vs 28 days
The Welsh framework allows 42 days from screening to full assessment decision, compared with 28 days in England. Both countries regularly exceed their targets, but the Welsh target is officially longer.
Community Health Councils
Wales retains Community Health Councils (CHCs) as independent patient watchdogs — they were abolished in England in 2003. Welsh CHCs can provide free advice and advocacy for people going through the CHC process, and have statutory powers to inspect NHS services and be consulted on changes.
Free prescriptions
All prescriptions are free in Wales (since 2007), unlike England where charges apply for most working-age adults. While not directly related to CHC, this is relevant context for understanding the overall financial landscape of healthcare in Wales.
The assessment process in Wales
The CHC assessment process in Wales follows a similar structure to England, but with some procedural differences. Here is how it works:
Checklist screening
The process begins with a CHC Checklist — a preliminary screening tool that determines whether a full assessment is needed. Any health or social care professional can complete the Checklist, but it is most commonly done by a nurse or social worker. If the Checklist indicates a possible primary health need, the case is referred for a full assessment. You can request a Checklist screening at any time — you do not have to wait for a professional to suggest it.
Multidisciplinary team assessment
A multidisciplinary team (MDT) carries out the full assessment using the Decision Support Tool (DST). The team typically includes a nurse assessor from the LHB and a social worker from the local authority, along with other professionals who know the individual. You and your loved one should be invited to attend and contribute. The DST examines needs across the same 12 domains used in England.
Decision Support Tool completion
Each of the 12 domains is scored at one of five levels: no needs, low, moderate, high, severe (plus a priority level for the most extreme cases). As in England, the decision is based on the overall pattern of needs rather than a simple points total. The panel must consider the nature, intensity, complexity, and unpredictability of needs across all domains.
Eligibility decision
The LHB makes the final eligibility decision based on the completed DST. If the assessment shows a primary health need, the person qualifies for CHC and all care costs are paid by the NHS. The target is for this decision to be made within 42 days of the initial Checklist screening. You should receive written notification of the decision and the reasons for it.
Care planning
If CHC is granted, the LHB becomes responsible for arranging and funding all care. A care plan is developed in partnership with the individual and their family. This may involve care in a nursing home, residential home, or the person's own home. The LHB must review the care package regularly to ensure it continues to meet the person's needs.
How to apply for CHC in Wales
You do not need to wait for a professional to suggest CHC — you can request an assessment at any time. Here is how to get started:
How to appeal a CHC decision in Wales
If your loved one's CHC application is refused, you have the right to challenge the decision. The appeals process in Wales has two stages:
Stage 1 — Local review by the LHB. Write to the LHB within a reasonable time of receiving the decision, explaining why you disagree. Provide any additional evidence that was not considered during the original assessment. The LHB should convene a review panel to reconsider the case. You are entitled to attend and present your case.
Stage 2 — Independent Review Panel. If the local review upholds the original decision, you can request an Independent Review Panel. This is an independent panel that examines whether the correct process was followed and whether the decision was reasonable based on the evidence. The panel can recommend that the LHB reconsider its decision, but it cannot overturn it directly.
Key point: Community Health Councils in Wales can provide free advocacy support during the appeals process. Contact your local CHC early — they can help you prepare your case and may attend meetings with you.
Beyond the formal appeals process, you can also raise a complaint through the NHS Wales Putting Things Right process, or contact the Public Services Ombudsman for Wales if you believe there has been maladministration. In rare cases, families have successfully challenged CHC decisions through judicial review, though this should be considered a last resort.
Frequently asked questions about CHC in Wales
Is CHC the same in Wales as in England?
The underlying principle is the same — if you have a 'primary health need', the NHS pays for your care in full. However, the process in Wales is governed by a separate framework issued by the Welsh Government, not NHS England. The assessment tools are similar but not identical, the responsible bodies are Local Health Boards (LHBs) rather than Integrated Care Boards (ICBs), and the financial thresholds for means-tested social care are significantly more generous in Wales.
What are Local Health Boards (LHBs)?
Wales has seven Local Health Boards that are responsible for planning and delivering all NHS services in their area, including CHC assessments and funding decisions. They are: Betsi Cadwaladr (North Wales), Powys Teaching, Hywel Dda (West Wales), Swansea Bay, Cwm Taf Morgannwg, Aneurin Bevan (South East Wales), and Cardiff and Vale. Unlike England, where ICBs commission services separately from hospital trusts, LHBs combine both functions.
What is the capital limit for care in Wales?
In Wales, the capital limit for means-tested social care is £50,000 — more than double the £23,250 threshold in England. This means that if you are not eligible for CHC, you will not have to pay the full cost of your care until your savings exceed £50,000. Below £50,000 you receive some financial help, and below £24,000 the local authority pays in full (subject to the care charge cap). This is a significant advantage for Welsh residents.
Is home care free in Wales?
Wales has a weekly cap on non-residential social care charges, currently set at £100 per week regardless of the level of care provided. This is far more generous than England, where councils can charge the full cost. For people receiving more than around 25 hours of home care per week, this effectively means much of their domiciliary care is free or heavily subsidised — even without CHC eligibility.
How do I appeal a CHC decision in Wales?
If your CHC application is refused, you can first request a local review by the LHB, providing additional evidence and explaining why you disagree with the decision. If the local review is unsuccessful, you can escalate to an Independent Review Panel, which operates similarly to the English system. Community Health Councils (CHCs) in Wales can also provide independent advocacy and help you through the appeals process.
What role do Community Health Councils play?
Community Health Councils are independent bodies unique to Wales that act as the patient's voice in the NHS. They can provide advice, support, and advocacy for people going through the CHC process. Unlike England, where Healthwatch has a more limited role, CHCs in Wales have statutory powers to inspect NHS premises and must be consulted on service changes. They are a valuable free resource if you are navigating a CHC assessment or appeal.
Does the Social Services and Well-being (Wales) Act 2014 affect CHC?
Yes. This Act governs how social care is assessed and delivered in Wales. It places a duty on local authorities to assess anyone who appears to need care and support, and to consider their well-being outcomes. If a person's needs are primarily social rather than health-related, they fall under this Act rather than CHC. However, the boundary between health and social care needs is often contested, and families should ensure that health needs are not downplayed during social care assessments.
Related guides
NHS Continuing Healthcare
The complete guide to NHS Continuing Healthcare — what it is, who qualifies, and how to apply.
CHC Eligibility
How to determine whether your loved one qualifies for CHC funding, including the primary health need test.
CHC Assessment
How to prepare for the DST meeting, including all 12 domains and evidence preparation strategies.
CHC Funding
The complete guide to CHC funding — what's covered, how it works, and what to do if refused.