The 30-day frame, in one paragraph
Applying for NHS Continuing Healthcare funding starts with one request: a CHC Checklist from your local Integrated Care Board (ICB). Anyone can request it — you, a family member, a GP, district nurse or social worker (National Framework, July 2022). The ICB has a 28-day target to complete the full assessment after a positive Checklist. Only 17% of standard CHC assessments now result in eligibility (Healthwatch, October 2025) — so what you gather before the assessor arrives is what tips the scales.
What is CHC funding and who qualifies in 2026?
NHS Continuing Healthcare (CHC) is fully NHS-funded care for adults aged 18+ with a “primary health need”. It is free at the point of use and not means-tested. In Q4 2024/25, 29,126 people were assessed eligible for CHC in England — but 26,933 of those came via the Fast Track route for rapidly deteriorating or terminal illness. Only 2,193 came via the Standard route (NHS England, Q4 2024/25).
That gap matters for strategy. If your relative's condition is rapidly deteriorating, ask the GP or hospital consultant about Fast Track: it should be completed within 48 hours and bypasses the standard process. For everyone else, the application route below is the standard one — and the 17% Standard eligibility rate is the real number to plan against.
CHC eligibility is decided on the level and type of care needed — not on the diagnosis. Someone with advanced dementia, a progressive neurological condition, late-stage cancer, or multiple co-existing conditions can all qualify. The legal test is the primary health need test, which assesses four characteristics together: nature, intensity, complexity and unpredictability of care need.
Key point: CHC is not awarded for diagnoses, it is awarded for needs. The Nuffield Trust (September 2025) found CHC spending rose roughly 17% between 2017 and 2023 even as eligibility fell — meaning the bar for “primary health need” has tightened, not the funding. Evidence preparation is doing more work than it used to (Nuffield Trust, 2025).
What should I do on Day 1, Week 1 and Month 1?
On Day 1, phone your ICB CHC team and request a Checklist. In Week 1, send Subject Access Requests for GP, hospital and care home records — UK GDPR gives you a one-month statutory response window. By Day 28, the ICB must have decided eligibility in at least 80% of cases (NHS England ICB assurance standard). Most CHC guides describe this process abstractly; what follows is the working order families who succeed actually use.
Day 1
Make the request
Phone the ICB CHC team. Ask, in writing afterwards, for a CHC Checklist. Anyone can request one — you do not need a GP referral.
Week 1
Gather the evidence
Send a Subject Access Request (SAR) for GP, hospital and care home records. By UK GDPR, you must receive these within one calendar month.
Month 1
Track the 28-day clock
The ICB is required to decide eligibility within 28 days of a positive Checklist in 80% of cases. Log everything; escalate in writing if it slips.
Step 1: Who do I contact to request a CHC Checklist?
The application starts with a Checklist request to your local Integrated Care Board (ICB). You do not need a solicitor and you do not need permission. Anyone — the person needing care, a family member, a GP, a district nurse, a social worker, or a care home manager — can request one (National Framework for NHS Continuing Healthcare, July 2022).
How to find your ICB.Search the NHS website for “Find your ICB” using your postcode. Every ICB has a CHC team contactable by phone or email; many publish a dedicated CHC referral inbox. In Wales the equivalent body is the Local Health Board (LHB).
What to say on the call. “I would like to request a Continuing Healthcare Checklist for [name], date of birth [DOB], currently at [care setting].” That sentence is enough. The ICB cannot refuse a reasonable request and must keep a record of it. If the team-member you speak to tells you to “ask the GP” or that “the care home should do it”, ask them to log your request anyway and follow up the same day in writing using the template letter below.
The 28-day clock. Once the Checklist is positive, the ICB is required by the National Framework to make an eligibility decision in 28 calendar days, in at least 80% of cases (NHS England ICB assurance standard). If the decision takes longer and the result is positive, NHS reimbursement should normally start from Day 29 onwards. Keep dated records from the moment you make the request — the clock starts here.
Common problem. Some care homes and hospitals fail to screen patients for CHC at discharge. If your relative was discharged without being offered a Checklist, you can request one at any time — including months or years later. For periods of care that should have been NHS-funded but were paid out-of-pocket, see our note on retrospective review.
Step 2: What documents do I need to apply for CHC?
Assessors decide on evidence, not advocacy. The single most undervalued Week 1 action is sending a Subject Access Request (SAR) to the GP surgery, the hospital and the care home to obtain the medical records. By law, NHS bodies and GP practices must provide records within one calendar month under UK GDPR (ICO right-of-access guidance).
The Checklist is usually completed by a nurse assessor or social worker, sometimes at the care home or hospital. You have the right to be present and to contribute. Do not assume the professional completing it has a full picture — they may have read only a summary. The records you gather in Week 1 are what closes that gap.
The Week 1 evidence list:
Make it specific. The worst days, not the average days, drive eligibility decisions. Write down dated examples: “On 14 January, Mum fell three times in four hours and required two carers to transfer her back to bed.” Note how needs interact (dementia → refusal of medication → uncontrolled pain → agitation). For a longer walk-through, see our Subject Access Request guide and the free SAR letter pack with three pre-written letters for GP, hospital and ICB.
If the Checklist comes back negative. You have the right to challenge it. Write to the ICB within the 6-month review window, attach the new evidence the assessor did not see, and ask for the Checklist to be re-screened. A negative Checklist is the screen, not the verdict.
Capacity check. If your relative lacks the mental capacity to consent or contribute, you will need a registered Lasting Power of Attorney for Health & Welfare, or a Court of Protection deputyship, to act on their behalf. Without one, the ICB will speak to next-of-kin but you may struggle to formally request records or challenge a negative decision.
Step 3: What happens after a positive Checklist?
A positive Checklist triggers a full Decision Support Tool (DST) assessment. The ICB convenes a Multi-Disciplinary Team (MDT) with at least two health or social-care professionals from different disciplines — typically a nurse assessor, a social worker, and any specialist clinicians who know the case. The MDT then completes the Decision Support Tool, a 12-domain assessment that determines whether your relative has a “primary health need”.
The DST examines care needs across 12 care domains: behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin and tissue viability, breathing, drug therapies and medication, altered states of consciousness, and other significant needs. Each domain is scored at one of six levels: no needs, low, moderate, high, severe, or priority — the latter used in four Priority-eligible domains (behaviour, breathing, drug therapies and medication, and altered states of consciousness) where a single Priority score can secure CHC eligibility on its own.
The DST is not a pure points-based system. The panel must judge the overall pattern using four key indicators: nature, intensity, complexity and unpredictability. In broad terms, a person with one Priority score, or two or more Severe scores, normally indicates primary health need. So does “a number of domains with High and/or Moderate needs” when the four indicators are met together (National Framework, July 2022).
Fast Track. If your relative's condition is rapidly deteriorating or they have a terminal diagnosis, the GP or hospital consultant can request Fast Track. Fast Track bypasses the standard MDT process — the ICB should arrange a care package within 48 hours of the Fast Track tool being submitted. In Q4 2024/25, Fast Track accounted for 26,933 of the 29,126 CHC-eligible determinations (NHS England, Q4 2024/25).
Step 4: How do I prepare evidence for the 12 DST domains?
Map your evidence to every one of the 12 domains, in writing, before the MDT meets. The families who clear the eligibility threshold are the ones who arrive with a domain-by-domain evidence pack the panel cannot ignore. The assessors do not have your first-hand observations and may not have read every page of the clinical record. Your job in this step is to close those gaps deliberately.
Before you buy
Records needed before paid evidence preparation is useful.
CareAdvocate can only map what is in front of us. If your file is thin, request records first so the paid report has enough substance.
- At least 3 months of care home daily notes, if available.
- GP summary, medication history, and recent consultation notes.
- Hospital discharge summaries and specialist assessments.
- Incident logs, falls records, weight charts, continence notes, and skin/wound records.
- Family observations with dates, especially bad days and night-time needs.
Request clinical records
Write to the care home, hospital, and GP requesting copies of all care records, daily logs, discharge summaries, nursing assessments, and specialist reports. Under GDPR, they must provide these within 30 days. These form the clinical evidence base for your case.
Write a personal statement for each domain
For each of the 12 DST domains, write a short statement describing your loved one's needs from your perspective. Use specific examples with dates and times. Describe what happens on bad days. Explain what would happen if the current care were withdrawn. This evidence is uniquely yours — the panel won't have it from any other source.
Use the four criteria to frame your evidence
The assessors must consider four characteristics: nature (does it require clinical skill?), intensity (how much and how often?), complexity (how do needs interact?), and unpredictability (how quickly can things change?). Frame every piece of evidence using these terms.
Address the "well-managed needs" trap
If your relative's needs are being managed well by their current care package, the ICB may argue they no longer demonstrate a primary health need. This is the single most common reason families lose at MDT — and it is legally flawed. Frame your evidence around what would happen if the care package were withdrawn. See our deeper note on the well-managed needs trap.
Identify and fill the gaps
Review your evidence against all 12 domains. If any domains are thin, go back to the care home or GP for more specific records before the MDT meets. The £97 Case Strength Report is a way to find out — before you submit — whether your existing records actually support a primary-health-need argument.
For the legal background to the “well-managed needs” trap and how to frame your evidence around it, see our deeper guide to the well-managed needs trap in CHC assessments.
Step 5: What happens at the MDT meeting?
The MDT meeting is where eligibility is decided. You and your relative have the right to attend, to contribute, and to see the completed Decision Support Tool. The MDT panel goes through each of the 12 domains in turn, agrees a score for each, and then judges whether the four key indicators (nature, intensity, complexity, unpredictability) together demonstrate a primary health need. For a full walk-through of how the MDT works, see our guide to the MDT assessment process.
What to bring:
During the meeting:The panel will go through each domain in turn, discussing the evidence and agreeing a score. Listen carefully to how each domain is scored. If you disagree with a score, say so immediately — explain why, citing your evidence. Ask the assessor to record your objection. Focus on bad days and worst-case scenarios, not average days. If anyone cites “well-managed needs,” challenge it with paragraphs 162–163 of the 2022 National Framework.
The meeting typically takes 2-3 hours. At the end, ask for a copy of the completed DST and the panel's reasoning. If you are not given a clear outcome on the day, ask when you will receive the decision in writing.
Step 6: Tracking the decision and the 28-day clock
The ICB must reach a CHC eligibility decision within 28 calendar days of a positive Checklist, in at least 80% of cases(NHS England ICB assurance standard). The decision should come in writing with the completed DST, the agreed domain scores, and the panel's reasoning. Always ask for that document — it is the basis of any later appeal.
Regional reality. CHC eligibility varies almost five-fold across England. The Nuffield Trust (September 2025) found rates ranging from around 20 to 95 CHC-eligible people per 50,000 adults depending on ICB — even after adjusting for age and need. Your odds depend partly on where you live (Nuffield Trust, 2025).
If eligible: The ICB will commission a care package funded in full by the NHS — at home, in a care home or in a nursing home. You can request a personal health budget, which gives the family more control over how the funding is spent.
If the 28-day clock slips: Log every contact, every promise made and missed. Write to the ICB CHC team and copy the ICB complaints inbox citing the 28-day standard. If the eventual decision is positive and the ICB took more than 28 days, NHS reimbursement of fees normally runs from Day 29. If escalation fails, the next step is the ICB's formal complaints process, then the Parliamentary and Health Service Ombudsman (PHSO).
If not eligible:Do not accept the decision without scrutiny. Request the completed DST and the panel's full reasoning. Compare the domain scores against your evidence pack. If you believe any scores are wrong, the appeals process described in Step 7 is your route.
Funded Nursing Care fallback. If CHC is refused but your relative lives in a nursing home, the NHS still contributes a flat-rate payment for the registered-nursing element of their care. The 2026/27 Funded Nursing Care (FNC) rate is £267.68 per week in England — a 5.4% rise on the £254.06 paid in 2025/26 (Beacon CHC, 2026). The ICB should consider FNC automatically if CHC is refused — but check, because the assessment is sometimes missed.
Step 7: What happens if my CHC application is refused?
Around 80% of Standard CHC assessments end in non-eligibility — but a “no” is not automatically the final word. You can ask the ICB to reconsider through Local Resolution within 6 months, then escalate to an Independent Review Panel (IRP) run by NHS England, and ultimately to the Parliamentary and Health Service Ombudsman. The process is free and you do not need a solicitor, but the best route depends on whether the decision has real grounds to challenge. For the detailed walk-through, see our complete CHC appeal guide.
Local review
Write to the ICB requesting a local review of the decision. In your letter, explain which domain scores you believe are incorrect and provide additional evidence to support your case. You can submit new evidence that was not available at the MDT meeting. The ICB should carry out the review within a reasonable time — typically 2-4 weeks. You can attend the review meeting and present your case in person.
Independent Review Panel (IRP)
If the local review is unsuccessful, you can escalate to an Independent Review Panel through NHS England. The IRP is an independent panel that reviews whether the ICB followed the correct process and whether the decision was reasonable based on the evidence. Write to NHS England requesting an IRP, explaining what went wrong. The IRP will typically hold a hearing within 3-6 months. If the IRP finds in your favour, the ICB is required to reassess.
If the refusal appears flawed, the strongest appeal usually focuses on specific domain scoring, missing evidence, well-managed-needs reasoning, or process errors. If the file is evidence-deficient, gathering records first may be smarter than rushing into a submission. For families who want a written stop/go view before paying for full preparation, our Grounds of Appeal Assessment checks whether Local Resolution, IRP, evidence refresh, complaint, or no-action guidance is the right next step.
Template letter for requesting a CHC screening
Use this template to write to your local ICB requesting a CHC Checklist screening. Adapt it to your circumstances and send it by email or recorded delivery post.
Dear [Name of CHC Team / ICB],
I am writing to request a NHS Continuing Healthcare (CHC) Checklist screening for [full name of person], date of birth [DOB], who is currently [residing at / receiving care at] [care setting and address].
[Name] has significant and complex health needs, including [brief summary of main conditions and care needs — e.g. advanced dementia, frequent falls requiring two-person transfers, PEG feeding, challenging behaviour requiring constant supervision].
I believe [he/she/they] may have a primary health need as defined by the NHS National Framework for Continuing Healthcare and I am requesting a Checklist screening in accordance with the Framework.
I understand that anyone can request a Checklist screening and that the NHS is required to consider any person who appears to have a need for ongoing care. I would be grateful if you could confirm receipt of this request and provide a date for the screening.
I would like to attend the Checklist screening and contribute evidence about [name]'s care needs, as is my right under the National Framework.
Yours faithfully,
[Your name, relationship to the person, contact details]
Tip: Always send correspondence by email so you have a dated record. If sending by post, use recorded delivery. Keep copies of everything — you may need it if you appeal later.
Frequently asked questions about applying for CHC funding
Who can request a CHC Checklist?
Anyone. The person needing care, a family member, a carer, a GP, a district nurse, a social worker or a care home manager can all request a Checklist directly from the local Integrated Care Board (ICB). You do not need a doctor's referral. The 2022 National Framework requires ICBs to act on reasonable requests, and the ICB cannot refuse to log your request even if the person you speak to suggests it should come from someone else.
How long does the CHC application process take?
The ICB is required to make a CHC eligibility decision within 28 calendar days of a positive Checklist in at least 80% of cases (NHS England ICB assurance standard). In practice, Healthwatch (October 2025) and Nuffield Trust (September 2025) report wide regional variation and frequent delays. If the eventual decision is positive but the ICB took longer than 28 days, NHS reimbursement of care fees normally runs from Day 29 onwards.
What's the difference between Standard and Fast Track CHC?
Fast Track is for people who are rapidly deteriorating or have a terminal diagnosis — it should be completed within 48 hours of the Fast Track tool being submitted by a clinician. Standard CHC is the regular Checklist-then-DST route. In Q4 2024/25, 26,933 of 29,126 eligible CHC determinations in England came via Fast Track; only 2,193 came via the Standard route (NHS England, Q4 2024/25). The Standard eligibility rate is now around 17%.
Do I need a solicitor to apply for CHC?
No. NHS Continuing Healthcare is an NHS process, not a court process. Many families apply and succeed without legal representation. CHC advocacy and evidence preparation are not regulated legal activities. Where families benefit from outside help, the value is usually in evidence preparation rather than legal advice — mapping records against the 12 DST domains, identifying gaps, and writing the family statement.
Can I apply for CHC if my relative lacks mental capacity?
Yes, but you will normally need a registered Lasting Power of Attorney for Health & Welfare, or a Court of Protection deputyship, to act on their behalf — particularly when requesting medical records or formally challenging a decision. Without one, the ICB will still speak to next-of-kin, but your formal rights are limited. See our Lasting Power of Attorney guide for how to put one in place.
Can I apply for CHC retrospectively if my relative paid for care that should have been NHS-funded?
Yes. If your relative should have been assessed for CHC in the past but was not — for example, at hospital discharge — you can request a retrospective review (sometimes called a Previously Unassessed Period of Care, or PUPoC). If the review finds eligibility, the NHS must refund care fees paid during that period. NHS England has historically accepted claims dating back to 2012. Earlier periods are harder to evidence but not always excluded.
Should I apply alone, or get evidence-preparation help?
Most families can request a Checklist alone — what changes outcomes is the strength of the evidence the ICB sees before deciding. Three free routes and three paid options below. We are an evidence-preparation service, reviewed by legal professionals and social care professionals; we do not provide legal advice and we make no outcome guarantees.
If you use a paid report, your records stay protected
Paid preparation can involve care home notes, GP records, hospital summaries, and family statements. These safeguards apply before you upload anything.
- Medical records are stored in AWS London and processed in UK/EU regions.
- Files are encrypted at rest and transferred over HTTPS.
- Access is limited to the reviewer handling your case.
- Medical records and case data are normally deleted 90 days after report delivery.
- Your medical data is not sold, shared for advertising, or used to train public AI models.
Free · DIY
CHC Eligibility Screener
60-second free triage. Indicates whether the standard Checklist threshold is likely to be met before you call the ICB.
Run the screener →£97 · Diagnostic
Case Strength Report
Map your records against all 12 DST domains in five working days. Tells you whether the existing evidence supports pursuing CHC.
See the CSR →£597 · Stage 1
Checklist Evidence Pack
Full Stage 1 evidence pack mapped to the 11 Checklist domains, ready to submit to the ICB ahead of the Checklist screening.
See the CEP →£499–£799 · Stage 2
MDT Preparation Pack
DST-mapped evidence pack and family statement aligned to all 12 domains and the four key indicators, prepared for the MDT meeting.
See the MDT Prep Pack →Free · 90 min
Beacon CHC advice
NHS England's chosen supplier for free CHC information and advice. 90-minute capped sessions, capacity-limited. Independent of CareAdvocate.
Visit Beacon →Appeal · £147
Grounds of Appeal Assessment
If the DST decision has gone against you, check whether there are real grounds to challenge before paying for full appeal preparation.
Assess appeal grounds →Related guides
NHS Continuing Healthcare: Family Guide
The full overview of CHC — who qualifies, the assessment process, and what to do if refused.
The CHC Checklist Explained
What the CHC Checklist is, the 11-domain A/B/C scoring, and how to prepare.
What is the Decision Support Tool?
The 12-domain Stage 2 assessment used by the MDT to determine primary health need.
How to Appeal a CHC Decision
Local Resolution, Independent Review Panel, and the PHSO route — explained.
Who Pays for a Care Home?
The four-payer landscape: NHS CHC, FNC, council means test, self-funding.
What Families Say About the CHC Process
Healthwatch (October 2025) on what 1,000+ families told them about applying for CHC.
About this guide. Last updated 15 May 2026. Reviewed by legal professionals and social care professionals. CareAdvocate is an NHS Continuing Healthcare evidence-preparation service; we do not provide legal advice, and we do not guarantee outcomes. Statistics in this guide come from NHS England Q4 2024/25 statistics, Healthwatch (October 2025), Nuffield Trust (September 2025), the National Framework for NHS Continuing Healthcare (July 2022, revised July 2023) and the ICO's UK GDPR right-of-access guidance. Free, independent advice on CHC is also available from Beacon, NHS England's chosen supplier for CHC information and advice.