What is CHC funding and who qualifies?
NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for people who have a “primary health need.” Unlike social care provided by local authorities, CHC is free at the point of use and is not means-tested. If your loved one qualifies, the NHS pays for all of their care — whether that's in a care home, a nursing home, or in their own home.
The typical family saves £50,000 or more per yearif their loved one is found eligible for CHC. Yet around 80% of initial applications are refused. The process is complex, poorly explained, and heavily weighted in favour of the NHS. Most families don't know the process exists until they're already paying for care.
CHC is available to anyone with a primary health need — regardless of their diagnosis. It is not limited to people in care homes. People receiving care at home, in supported living, or even in hospital can be assessed. The key question is not what condition someone has, but how much care their condition requires and whether that care is primarily a health need rather than a social care need.
Key point: CHC eligibility is based on the level and type of care needed — not on the diagnosis. Someone with advanced dementia, a neurological condition, cancer, or multiple co-existing conditions can all qualify if their overall care need is primarily health-related.
Step 1: Request a Checklist screening
The CHC process begins with a Checklist screening. This is a short initial assessment that determines whether your loved one should proceed to a full CHC assessment. The Checklist covers the same 12 care domains as the full Decision Support Tool (DST) but in less detail.
Who can request it? Anyone. You do not need a GP referral or professional recommendation. The person themselves, a family member, a carer, a social worker, a care home manager, or any healthcare professional can request a Checklist screening. The NHS National Framework is clear: any person who appears to have a need for ongoing care should be considered for CHC.
How to request it: Write to your local Integrated Care Board (ICB) — this is the NHS body responsible for CHC in your area (in Wales, it is the Local Health Board or LHB). You can find your ICB by searching on the NHS website using your postcode. Send a letter or email requesting a CHC Checklist screening, naming the person, their date of birth, their current care setting, and a brief summary of their care needs. We've included a template letter below.
Timelines:The ICB should arrange the Checklist screening promptly. There is no statutory deadline for the Checklist itself, but the NHS target is 28 days from Checklist to DST decision. If you don't hear back within two weeks, chase the ICB in writing and keep a record of all correspondence.
Common problem: Some care homes and hospitals fail to screen patients for CHC at discharge. If your loved one was discharged without being offered a Checklist, you can request one at any time — even months or years later. You may also be entitled to a retrospective review covering the period since discharge.
Step 2: Prepare for the Checklist
The Checklist is often 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 of your loved one's needs — they may have only read a summary of the care notes.
Before the Checklist screening, prepare a written summary of your loved one's care needs across as many of the 12 domains as possible. Focus on:
Ask for your written summary to be attached to the Checklist form. If the Checklist comes back negative (meaning they don't recommend a full assessment), you have the right to challenge this. Write to the ICB explaining why you believe the Checklist was completed incorrectly and request it be reviewed.
Step 3: If positive — the full DST assessment
If the Checklist screening is positive, your loved one will be referred for a full CHC assessment using the Decision Support Tool (DST). This is the main assessment that determines eligibility. It is carried out by a multidisciplinary team (MDT) — typically a nurse assessor, a social worker, and other relevant clinicians.
The DST examines care needs across 12 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 five levels: no needs, low, moderate, high, or severe (with a “priority” level for extreme cases).
The DST is not a simple points-based system. The panel must consider the overall patternof needs and whether the dominant reason for care is a health need. However, in general, a person with one “severe” score, two or more “high” scores, or five or more “moderate” scores with significant interaction between needs is likely to qualify.
The 28-day target runs from the Checklist to the DST decision. If the ICB is dragging its feet, write to them citing the National Framework target and requesting a date for the assessment. If your loved one's condition is deteriorating, emphasise the urgency and ask whether the Fast Track pathway applies.
Step 4: Prepare evidence for all 12 domains
This is the most important step in the entire process. The families who succeed are the ones who arrive at the MDT meeting with written evidence covering every single domain. The assessors may not have access to all the relevant information — particularly your first-hand observations of your loved one's daily care 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" argument
If your loved one's needs are being managed well by their current care, the ICB may argue they don't demonstrate a primary health need. This is legally flawed. The 2022 National Framework (paragraphs 162–163) is clear: well-managed needs are still needs. Prepare your evidence on the basis of what would happen if the care package were withdrawn.
Identify and fill 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. Our Case Strength Report (£97) can map your evidence against all 12 domains and identify exactly where the gaps are before the assessment.
Step 5: Attend the MDT meeting
The MDT meeting is where the full assessment takes place. You and your loved one have the right to attend and contribute. The NHS National Framework states that the person being assessed and their family or representatives should be invited to participate in the DST 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: Receive the decision
After the MDT meeting, the ICB will make a decision on eligibility. This may be communicated on the day or sent in writing afterwards. You should receive a written decision with clear reasoning, including the scores for each domain and an explanation of why the panel concluded the person does or does not have a primary health need.
If eligible: The ICB will arrange a care package funded entirely by the NHS. This may include care home fees, nursing home fees, or a package of care at home. The ICB is responsible for commissioning this care, though you have the right to request a personal health budget, which gives you more control over how the funding is spent.
If not eligible:Do not accept the decision without scrutiny. Request a copy of the completed DST and the panel's full reasoning. Compare the domain scores with your evidence. If you believe any scores are incorrect, you have the right to challenge the decision through the appeals process described in Step 7.
Important: If CHC is refused but your loved one still has significant health needs, they may qualify for a funded nursing care(FNC) contribution — a flat-rate payment of approximately £219.71 per week (2025/26 rate) towards the cost of registered nursing care in a care home. This is not the same as full CHC but can reduce costs significantly. The ICB should consider FNC automatically if CHC is refused.
Step 7: If refused — local review and IRP
If the CHC application is refused, you have two levels of appeal. The process is free and you do not need a solicitor — CHC advocacy is not a regulated legal activity.
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.
Many families succeed on appeal. The IRP regularly finds that ICBs have failed to follow the correct process, applied the wrong legal test, or failed to consider evidence properly. Do not be discouraged by an initial refusal — it is often just the first 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 assessment?
Anyone can request a CHC Checklist screening — the person themselves, a family member, a carer, a GP, a social worker, or a care home manager. You do not need a referral from a doctor. The NHS National Framework states that any person who appears to have a need for ongoing care should be considered for CHC. If a professional refuses to refer, you can write directly to your local Integrated Care Board (ICB) to request a screening.
How long does the CHC application process take?
The NHS target is 28 days from the initial Checklist screening to the DST decision. In practice, delays are common and many families wait 2-3 months or longer. If your case exceeds the 28-day target, write to the ICB citing the National Framework timeline and request an update. If your loved one is deteriorating rapidly or approaching end of life, ask about the Fast Track pathway, which should be completed within 48 hours.
What is the CHC Checklist?
The CHC Checklist is an initial screening tool used to decide whether someone should proceed to a full CHC assessment. It covers the same 12 care domains as the full Decision Support Tool but in less detail. If the Checklist indicates a positive result — meaning there is reason to believe the person may have a primary health need — they should be referred for a full assessment. If the Checklist is negative, you have the right to challenge this and request a review.
What happens at the MDT meeting?
The MDT (multidisciplinary team) meeting is where the full CHC assessment takes place. A panel of professionals — typically a nurse assessor, a social worker, and other relevant clinicians — will go through each of the 12 DST domains, discuss the evidence, and agree a score for each one. You and your loved one have the right to attend, contribute evidence, and challenge scores you disagree with. The meeting usually takes 2-3 hours.
What if the CHC application is refused?
If CHC is refused after the full assessment, you can request a local review from the ICB. You should submit additional evidence and a written statement explaining which domain 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. The IRP is an independent panel that reviews whether the correct process was followed and whether the decision was reasonable.
Can I apply for CHC retrospectively?
Yes. If your loved one should have been assessed for CHC in the past but was not — for example, at hospital discharge — you can request a retrospective review. If the review finds they should have been eligible, the NHS must refund care fees paid during that period. There is no formal time limit for retrospective claims, though earlier periods may be harder to evidence. The NHS has been accepting claims dating back to 2012 in many cases.
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 Explained
What the CHC Checklist is, how it works, and how to prepare for the initial screening.
CHC Assessment: The 12 DST Domains
A detailed guide to preparing evidence for each of the 12 DST domains and the MDT meeting.
CHC Eligibility Checker
A free tool to help you assess whether your loved one may be eligible for CHC funding.