NHS Continuing Healthcare explained

What CHC actually is

CHC is not a benefit and it is not social care. It is NHS funding awarded when a person's day-to-day needs are judged to be primarily health needs rather than social care needs. Because it is NHS funding, it is free at the point of use and is not affected by savings, income or property.

In England it is arranged by the local Integrated Care Board (ICB). In Wales the equivalent funding is called Continuing NHS Healthcare (CNHC) and is arranged by the Local Health Board. In both countries the same body carries out the assessment and reviews it over time.

England works to the National Framework for NHS Continuing Healthcare; Wales works to the Continuing NHS Healthcare National Framework for Wales. The principles are close, but the paperwork, timescales and appeal routes differ.

Who can be eligible

Eligibility is not based on a diagnosis. Two people with the same condition can reach different outcomes, because the decision rests on the nature, intensity, complexity and unpredictability of their needs — often called the four key indicators.

• Adults aged 18 or over living in England or Wales (Scotland and Northern Ireland have separate systems)
• Needs that are ongoing rather than short-term recovery or rehabilitation
• A need profile where health needs are the primary driver of the care required
• Common contexts include advanced dementia, progressive neurological conditions, brain injury, complex respiratory needs and end-of-life care

What CHC pays for

If eligible, the NHS funds the whole assessed care package. In a care home that means the full fee — accommodation and care. At home it means a package of nursing and personal care, equipment and, where assessed as needed, support for family carers.

It does not cover top-up choices such as a larger room in a care home, which some families choose to pay for separately.

The process in outline

Most people meet CHC through a Checklist screening, then a full multidisciplinary Decision Support Tool assessment if the Checklist is positive. The ICB (England) or Local Health Board (Wales) then makes the eligibility decision, which can be challenged if you disagree.

• Checklist — a short screening to decide whether a full assessment is needed
• Decision Support Tool (DST) — a full multidisciplinary assessment across 12 care domains
• Decision by the ICB (England) or Local Health Board (Wales) — in England usually within 28 days of the Checklist
• Review — an initial review after around 3 months, then annually

Where families most often lose out

In practice, the most common problems are not disagreements about the law — they are process problems. Families are not told a Checklist has been done, are not invited to the DST, or attend without evidence of what a typical week really looks like. Preparation, evidence and knowing what you are entitled to are what change outcomes.