NHS Continuing Healthcare — the complete guide to fully-funded NHS care.

What is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults aged 18 and over who have a “primary health need.” It covers the full cost of care — whether that care is delivered in a care home, nursing home, or in the person's own home.

CHC is not a benefit. It is not means-tested. It is not based on your diagnosis. It is a legal entitlement for anyone whose main reason for needing care is a health need that goes beyond what a local authority could reasonably be expected to provide. If you qualify, the NHS pays for everything: accommodation, personal care, nursing care, equipment, therapies, and any other care required to meet your assessed needs.

The distinction matters enormously. If you don't qualify for CHC, your care is funded by the local authority — which ismeans-tested. That means your savings, your property, and your income are all taken into account. If you have assets above the upper capital limit (currently £23,250 in England), you pay for your own care in full. For many families, this means losing a family home or watching a lifetime of savings disappear at a rate of £1,000 or more per week.

CHC exists because the law recognises that some people's care needs are primarily health-related, and health care in the UK is free at the point of use. The legal basis goes back to the National Health Service Act 2006, which places a duty on the NHS to provide care for those with health needs. CHC is the mechanism by which that duty is fulfilled for people who need ongoing care outside hospital.

Who funds CHC — and why it matters

In England, CHC is funded and administered by Integrated Care Boards (ICBs), the NHS bodies responsible for commissioning healthcare in each area. There are 36 ICBs across England (following the April 2026 mergers that reduced the original 42), and each one has a CHC team that handles assessments, decisions, and ongoing case management.

The funding comes from the NHS budget — the same budget that funds hospitals, GPs, and community health services. This is important because it means CHC competes with other NHS spending priorities. ICBs face enormous financial pressures, and CHC is one of the most expensive items on their books. A single CHC package can cost the NHS £50,000 to £150,000 per year, depending on the level of care required.

This financial pressure creates an inherent tension at the heart of the CHC process. The ICB is both the assessor and the funder — the body that decides whether you qualify is the same body that has to pay if you do. This is widely recognised as a conflict of interest, and it goes a long way towards explaining why the rejection rate is so high.

By contrast, if care is funded by the local authority, it comes from the council's social care budget. The local authority has its own financial pressures and its own means-testing regime. The boundary between NHS-funded CHC and local authority-funded social care is one of the most contested areas in public policy, and families are caught in the middle.

Understanding this dynamic is essential. When you apply for CHC, you are not asking for a favour. You are asserting a legal right. But you are doing so in a system where the decision-maker has a financial incentive to say no. That is why preparation, evidence, and knowledge of the legal framework matter so much.

The primary health need test

The central question in every CHC assessment is whether the person has a “primary health need.” This is the legal test that determines eligibility. If the main reason you need care is a health need — rather than a social care need — then the NHS should be funding your care.

The NHS National Framework for Continuing Healthcare defines a primary health need as one where the person's care needs, taken together, are of a nature, intensity, complexity, or unpredictability that goes beyond what a local authority could reasonably be expected to provide. This is sometimes called the “quality and/or quantity” test — it looks at both the type of care needed and the amount of care required.

Crucially, the test is not about diagnosis. Having dementia, Parkinson's disease, or any other specific condition does not automatically qualify or disqualify someone. The test looks at the person's actual care needs — what they require on a day-to-day basis — not the label attached to their condition. Two people with the same diagnosis can have very different care needs, and therefore different eligibility outcomes.

The test is also not about where care is delivered. You can qualify for CHC whether you live in a care home, a nursing home, or your own home. The location of care is irrelevant to the eligibility decision. What matters is the nature of the care you need, not where you happen to receive it.

The full CHC assessment process

The CHC process has three main stages. Understanding each stage — and knowing your rights at every point — is critical to a successful outcome.

For a detailed guide to the Checklist stage, see our CHC Checklist guide. For help preparing for the full assessment, read our CHC Assessment preparation guide.

The 12 domains and four characteristics

The DST examines 12 care domains. Each domain is scored at one of five levels — no needs, low, moderate, high, or severe — with an additional “priority” level for the most extreme cases. The domains are:

The DST is not a simple scoring system. There is no magic number of “high” or “severe” scores that guarantees eligibility. Instead, the panel must consider the overall pattern of needs and apply four characteristics to determine whether the person has a primary health need:

In practice, a person with one “severe” domain, or two or more “high” domains, is generally considered to have a primary health need. But the interaction between domains is equally important. Someone with multiple “moderate” scores can qualify if their needs interact in a way that creates an overall level of complexity requiring healthcare oversight. For a detailed breakdown of each domain and what evidence to prepare, see our DST guide.

What CHC covers and how much families save

If your loved one qualifies for CHC, the NHS funds the entirety of their care package. This includes:

The financial impact is significant. The average cost of a care home in England is around £800 to £1,200 per week for residential care, and £1,000 to £1,500 per week or more for nursing care. That's £52,000 to £78,000 per year at the higher end. For specialist dementia or complex care placements, costs can exceed £100,000 per year. When care is delivered at home as a domiciliary care alternative, CHC covers the full hourly package at the UK 2026 average of around £32/hour — typically £25,000 to £50,000 a year the family would otherwise self-fund.

If your loved one does not qualify for CHC but has some nursing needs, they may be entitled to Funded Nursing Care (FNC) — a flat-rate NHS contribution towards nursing costs in a care home. The current FNC rate is £219.71 per week. FNC is significantly less than full CHC, but it is still worth claiming if CHC is not awarded. Where CHC is awarded, respite for the family carer is included in the standard package — see our respite care 2026 guide for the four UK funding routes and the workflow for booking it.

Why 80% of applications are rejected

Around 80% of CHC applications are refused at first attempt. This is a staggering rejection rate for a legal entitlement, and it is not because 80% of applicants genuinely don't qualify. The reasons are systemic:

Financial pressure on ICBs.CHC is one of the most expensive items in any ICB's budget. Every CHC award costs the NHS tens of thousands of pounds per year. ICBs face enormous financial constraints, and there is significant — if often unspoken — pressure to keep CHC numbers down.

The “well-managed needs” argument. This is the single most common reason for refusal. The ICB argues that because the person's needs are being well-managed by their current care, they don't demonstrate a primary health need. This is legally wrong — the National Framework explicitly states that needs should be assessed on the basis of what would happen if care were withdrawn, not on how well they are currently being managed. Read our detailed guide to the well-managed needs principle and how to challenge it.

Inconsistent application of the Framework. Different ICBs apply the criteria differently. There are well-documented regional variations, with some ICBs having eligibility rates several times higher than others for comparable populations. This postcode lottery effect means your outcome can depend as much on where you live as on the severity of your needs.

Families are unprepared.The CHC process is complex and unfamiliar. Most families encounter it for the first time during a crisis — a hospital discharge, a sudden deterioration, a care home placement. They don't know the legal framework, the assessment criteria, or their rights. ICB panels, by contrast, handle these cases every day.

The high rejection rate is not a sign that you shouldn't apply. It is a sign that you need to prepare properly. Families who understand the process, gather the right evidence, and know how to present their case have a significantly better chance of success. And if the initial decision is wrong, the appeals process exists specifically to correct it.

How to appeal a CHC decision

If CHC is refused, you have a clear right of appeal. The process has two stages:

Stage 1: Local review. You request the ICB to review its decision. Write to the ICB explaining which domain scores you believe are incorrect, providing additional evidence where possible. The ICB should arrange a review meeting where the evidence is reconsidered. You have the right to attend and present your case. A local review is not just a rubber stamp — if you provide compelling additional evidence, scores can and do change.

Stage 2: 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 comprising a chair, a health assessor, and a social care assessor, none of whom are connected to the ICB that made the original decision. The IRP reviews the case afresh, considers all the evidence, and makes a recommendation. Around 40% of cases that reach the IRP result in a changed outcome.

There is no formal time limit for requesting a local review, but you should act promptly — ideally within 6 months of the decision. For the IRP, there is also no strict deadline, but NHS England recommends that requests are made within 6 months of the local review outcome.

Beyond the IRP, you also have the option of complaining to the Parliamentary and Health Service Ombudsman, or pursuing judicial review through the courts. These routes are rarely needed, but they exist as ultimate safeguards. For a detailed guide to the appeals process, see our CHC application and appeals guide.

Retrospective CHC claims

If your loved one should have been assessed for CHC in the past but wasn't — or if they were assessed but the decision was wrong — you can request a retrospective review. If the review finds that they should have been eligible, the NHS must refund the care fees that were paid during the period of eligibility.

Retrospective claims can cover periods going back many years. The NHS launched a formal retrospective review process in 2012, and since then has paid out billions of pounds to families who were wrongly denied CHC. Claims can be made for people who are still alive or on behalf of someone who has died — the estate can pursue the claim.

The process involves reviewing the person's care records from the relevant period and applying the eligibility criteria that were in force at the time. This can be complex, particularly for claims covering periods before the current National Framework was introduced. However, the principle is clear: if the person should have been eligible, the NHS should have been paying.

Retrospective claims can result in refunds of tens or even hundreds of thousands of pounds. If your loved one has been in a care home for several years without being assessed for CHC, or if they were assessed and refused but you believe the decision was wrong, it is worth investigating a retrospective claim.

The legal framework and key case law

CHC is rooted in the National Health Service Act 2006, which places a duty on the Secretary of State (and by delegation, ICBs) to provide healthcare services. The 2022 National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care sets out the assessment process and eligibility criteria in detail.

Two cases are particularly important for understanding CHC:

The National Framework is not legislation — it is statutory guidance. But the courts have held that ICBs must follow it, and a failure to apply the Framework correctly is grounds for challenging a decision. If an ICB ignores paragraphs 162–163 (the well-managed needs principle), fails to consider the interaction of needs across domains, or uses a rigid scoring threshold instead of clinical judgement, the decision is legally vulnerable.

For families, the key takeaway is this: you have legal rights in the CHC process. The decision is not purely clinical — it is a legal determination with a well-established framework and case law behind it. Understanding that framework gives you the tools to challenge decisions that are wrong.

CHC in Wales vs England

Wales has its own CHC framework, separate from the English system. The legal basis is the same — a primary health need — but the administrative structures and processes differ.

In Wales, CHC is administered by Local Health Boards (LHBs) rather than ICBs. There are seven LHBs covering the whole of Wales. The assessment process uses a Welsh version of the DST, and the eligibility criteria are broadly equivalent to those in England.

The main practical difference is in the appeals process. In England, the final appeal route is the Independent Review Panel through NHS England. In Wales, complaints and appeals go through the NHS Wales “Putting Things Right” process, and ultimately to the Public Services Ombudsman for Wales. The timescales and procedural requirements differ, so families in Wales need to follow the Welsh process specifically.

For a detailed guide to the Welsh system, see our Continuing Healthcare Wales guide.

The Fast Track pathway

The Fast Track pathway is designed for people who have a rapidly deteriorating condition that may be entering a terminal phase. If a clinician — usually a doctor, nurse, or other appropriate clinician — determines that the person's condition is deteriorating rapidly, they can complete a Fast Track assessment tool that bypasses the normal Checklist and DST process entirely.

A Fast Track referral should be processed within 48 hours. The purpose is to ensure that people who are approaching end of life are not delayed by the full assessment process. The Fast Track does not require a prognosis of a specific number of weeks or months — the test is whether the person's condition is rapidly changing and they need an urgent care package.

If the Fast Track application is refused, care should still be provided while the decision is challenged. For a full guide to the Fast Track process, including who can make a referral and what to do if it's refused, see our Fast Track CHC guide.

Frequently asked questions about NHS Continuing Healthcare

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