The short answer
- It pays for everything, and savings do not come into itA package of care arranged and funded by the NHS for adults whose main need is health. At home it covers the care, including live-in care; in a care home it covers the fees. There is no means test.
- The test is the need, not the diagnosisAssessors score twelve areas of need and weigh how intense, complex and unpredictable they are. A diagnosis on its own never qualifies, and dementia on its own usually does not.
- Ask for the checklist by nameAny nurse, doctor or social worker can complete the screening checklist. If it passes, a full assessment follows and a decision should usually come within 28 days.
- A no can be challenged, and often isYou have 6 months to ask for a review, then an independent panel, then the Ombudsman. Beacon gives 90 minutes of free specialist advice.
Rules are for England under the National Framework for NHS Continuing Healthcare, revised 2022. Wales, Scotland and Northern Ireland run their own versions. Figures are 2026/27.
What it is
A package of care the NHS pays for in full
Continuing Healthcare, usually shortened to CHC, is for adults whose care needs arise mainly from their health. The law calls this a primary health need. When the NHS agrees that someone has one, it becomes responsible for arranging and paying for the whole package, and the council and the family stop paying for the care itself.
The word that matters is primary. Everyone who needs care has some health needs, and the council is expected to meet a fair amount of nursing-type care within ordinary social care. The question the assessors are asking is whether, taken as a whole, the care your relative needs goes beyond what a council could reasonably be expected to provide. They answer it by looking at four characteristics of the needs, and each one can tip the balance on its own or in combination.
Nature
Intensity
Complexity
Unpredictability
Two things follow from that. Needs that are well managed still count: if your father's pressure sores have healed because a nurse dresses them twice a week, the assessment must record the need as it would be without that care, not as it looks today. And the setting does not decide it. CHC can be paid at home, in a residential home, in a nursing home or in a hospice, and the NHS should ask where your relative wants to be. How live-in care is funded covers what an award pays for when the answer is a carer living in the house.
Who qualifies
The needs that tend to meet the test, and the things that do not decide it
Families are often told, in good faith, that their relative will not qualify before anyone has looked. The people who tend to be found eligible have needs that call for skilled, frequent or unpredictable intervention, in more than one area at once.
Needs that tend to meet the test
- Breathing that needs suction, oxygen managed by a nurse, or a ventilator
- Tube feeding with swallowing problems and weight loss
- Pressure sores that need a nurse several times a week
- Seizures or blackouts that need a skilled response, not just observation
- Behaviour that puts the person or others at risk and needs a planned, skilled approach
- Pain or symptoms that need medicines adjusted day to day by a clinician
Things that do not decide it on their own
- A diagnosis, however serious, on its own
- Dementia on its own, without needs in the other domains
- Living in a nursing home, or paying nursing home fees
- Being over a certain age or having savings
- Needing a lot of personal care: washing, dressing, meals, medication prompts
- Needs that are well managed, which must still be counted as if they were not
The point about dementia catches many families out. A person in the late stages of dementia can have severe needs in cognition, behaviour, mobility and nutrition together, and that combination often does qualify. Dementia as a diagnosis, with needs that are mainly for personal care and supervision, usually does not. The test is always about what the care involves day to day, which is as true of Huntington's disease, with its changes in movement, thinking and mood, as of dementia. The seven stages of dementia sets out what changes at each stage, and the point at which a CHC checklist becomes worth asking for.
The 12 domains
The twelve areas the assessors score, and what usually meets the threshold
The full assessment uses a form called the Decision Support Tool. It has twelve care domains, and in each one the team picks the description that best matches your relative's needs, from no needs up to severe or, in four domains, priority. The combination of levels is what points to a decision.
The scale each domain is scored on
- 1. No needs
- 2. Low
- 3. Moderate
- 4. High
- 5. Severe
- 6. Priority
Not every domain goes all the way up. Four carry a priority level, five stop at severe, and three stop at high. A dashed gap in a bar below means that level does not exist for that domain.
1Breathing
up to priorityShortness of breath, oxygen, suction, a tracheostomy, ventilation.
2Nutrition, food and drink
up to severeHelp with eating and drinking, swallowing problems, weight loss, tube feeding.
3Continence
up to highPads and routines, catheters, stomas, and how much skilled intervention they need.
4Skin and tissue viability
up to severePressure sores, wounds and dressings, and how often they need a nurse.
5Mobility
up to severeGetting about, transfers, hoisting, and the risk of falls or of not being able to move at all.
6Communication
up to highWhether a person can make their needs known, with or without help.
7Psychological and emotional needs
up to highAnxiety, low mood or distress, and the effect on their health and wellbeing.
8Cognition
up to severeMemory, understanding and awareness of risk, including dementia.
9Behaviour
up to priorityBehaviour that puts the person or others at risk, and how hard it is to manage.
10Drug therapies and medication
up to priorityMedicines, symptom control and pain, and whether they need skilled adjustment.
11Altered states of consciousness
up to prioritySeizures, blackouts, coma, and the skilled response they need.
12Other significant care needs
up to severeAnything that matters and does not fit the other eleven.
What usually meets the threshold
Priority in any one domainclear case
Only breathing, behaviour, drug therapies and altered states of consciousness carry a priority level. One of them at priority is a clear case.
Severe in two or more domainsclear case
Two severe needs across any of the domains that reach severe is also a clear case.
One severe plus needs in several other domainsjudgement
Not automatic. The team weighs the four characteristics to decide whether, taken together, the needs are beyond what a council could be expected to meet.
A number of high or moderate needsjudgement
The same judgement. Several high needs that interact can meet the test; several moderate needs that are each straightforward usually do not.
The levels are descriptions, not scores to add up. A severe level in mobility, for example, describes someone who is completely unable to weight bear and whose position has to be changed regularly by skilled staff to avoid harm. The team is expected to fill in every domain with evidence from care records, the GP, the district nurses, the care home and you, and then to step back and look at the four characteristics across the whole picture. Where the levels do not make a clear case either way, that judgement decides it, and it is where a well-prepared family, with a care diary of dated examples to hand, makes the most difference.
The process
From asking for a checklist to a decision, and how long each step takes
There are two stages. A short screening checklist decides whether a full assessment is needed. The full assessment is done by a team, with you and your relative present, and ends in a recommendation to the NHS integrated care board, which makes the decision.
- Day 0
Ask for the checklist
Ask the GP, a district nurse, the ward or the social worker for a Continuing Healthcare checklist, by name. Anyone involved in the care can complete it and they should not refuse because they think the answer will be no. If your relative is in hospital, the checklist should normally wait until they are home and settled, with reablement or interim care in place first, so that the assessment reflects their real needs.
- Week 1
The checklist itself
Eleven areas of need, each marked A (high), B (moderate) or C (no or low), by a nurse, doctor, other health professional or social worker. A full assessment follows if there are two or more As, five or more Bs, one A and four Bs, or an A in any of the four areas that carry a priority level. You should be told the outcome in writing either way.
- Weeks 1 to 4
The full assessment
A multidisciplinary team of at least 2 professionals from different healthcare professions, usually including a nurse and a social worker, completes the Decision Support Tool with you and your relative there. They gather evidence first: care records, the GP, district nurses, the care home or carers, and you. Ask for the date in advance so you can prepare.
- Day 28
The decision
The team recommends, the integrated care board decides, and a decision should usually reach you within 28 days of the checklist or the request. Only in exceptional circumstances should it take longer, and if it does the NHS, not you, carries the cost of the care in the meantime. The letter should set out the reasons and how to challenge them.
- 3 months
The first review
A review of the care plan within 3 months of the decision, then at least once a year. Reviews are meant to check the care is right, not to reassess eligibility, and needs that are well managed must not be mistaken for needs that have gone away.
The integrated care board that decides depends on your relative's area, and ICB boundaries do not match council ones. Continuing Healthcare by area shows which of England's ICBs covers each council, how many people there are eligible, how quickly it decides, and how to reach its Continuing Healthcare team.
The assessment day
How to prepare, what to say, and what to have with you
The full assessment usually takes two to three hours and it is the one meeting that decides this. Families who go in with evidence, examples from bad days and a clear idea of the twelve domains get better decisions than families who rely on the team to know their relative.
Before the assessment
0 of 11 ticked
Evidence to gather
On the day
What not to do
What it pays for
What Continuing Healthcare covers at home and in a care home
At home, the NHS pays for the care in your relative's care plan: the carers, the nursing, the equipment and the therapy. In a care home it pays the home's fees, including the accommodation. It does not pay rent, mortgage, food or ordinary bills at home, and it does not allow top-ups in a care home the way council funding does.
Continuing Healthcare beside the two routes it is most often confused with
| NHS Continuing Healthcare | Council funding | NHS-funded nursing care | |
|---|---|---|---|
| Who it is for | Anyone whose main need is health: care that is complex, intense or unpredictable | Anyone with eligible care needs and savings under the limit | People in a nursing home who need care from a registered nurse but do not qualify for CHC |
| Means-tested | |||
| What it pays | The whole package: care at home including live-in, or a care home place including accommodation | A contribution, or all of it below the lower limit; usually as care hours or a direct payment | £267.68 a week paid to the nursing home for the nursing part of the fees |
| Who decides | The NHS integrated care board, on a multidisciplinary assessment | Adult social care, on a needs assessment and a financial assessment | The NHS, usually after a CHC assessment finds the person not eligible |
| Disability benefits | Continue at home. In a care home they stop after 28 days | Continue, and count as income in the means test | Continue |
| How to ask | Ask any nurse, doctor or social worker for the Continuing Healthcare checklist | Ask adult social care for a care needs assessment | The care home or the ICB arranges it once CHC has been considered |
Who it is for
- NHS Continuing Healthcare
- Anyone whose main need is health: care that is complex, intense or unpredictable
- Council funding
- Anyone with eligible care needs and savings under the limit
- NHS-funded nursing care
- People in a nursing home who need care from a registered nurse but do not qualify for CHC
Means-tested
- NHS Continuing Healthcare
- Council funding
- NHS-funded nursing care
What it pays
- NHS Continuing Healthcare
- The whole package: care at home including live-in, or a care home place including accommodation
- Council funding
- A contribution, or all of it below the lower limit; usually as care hours or a direct payment
- NHS-funded nursing care
- £267.68 a week paid to the nursing home for the nursing part of the fees
Who decides
- NHS Continuing Healthcare
- The NHS integrated care board, on a multidisciplinary assessment
- Council funding
- Adult social care, on a needs assessment and a financial assessment
- NHS-funded nursing care
- The NHS, usually after a CHC assessment finds the person not eligible
Disability benefits
- NHS Continuing Healthcare
- Continue at home. In a care home they stop after 28 days
- Council funding
- Continue, and count as income in the means test
- NHS-funded nursing care
- Continue
How to ask
- NHS Continuing Healthcare
- Ask any nurse, doctor or social worker for the Continuing Healthcare checklist
- Council funding
- Ask adult social care for a care needs assessment
- NHS-funded nursing care
- The care home or the ICB arranges it once CHC has been considered
England, 2026/27. Council funding is means-tested against the £23,250 upper capital limit; Continuing Healthcare and funded nursing care are not.
If your relative is at home, the NHS should offer a personal health budget: the value of the care plan as an amount you control, so that you can choose the carers rather than take whoever the NHS commissions. It cannot be spent on care home fees, but it can pay for a carer you have chosen yourself, including a live-in carer found on PrimeCarers, whose weekly cost is typically £1,120 for ordinary needs and £1,340 where the care is complex. If a family member is part of the care plan, the NHS should train them for it and arrange cover so that they can take breaks. Publicly funded care explained covers how a budget works in practice, and the cost of live-in care what a package tends to cost.
If the answer is no
How to challenge a decision, and how to claim for care you should not have paid for
Many first decisions are changed on review, because the levels were set too low or the four characteristics were not properly weighed. There are three stages, each with a time limit, and free specialist help at every one of them.
- 1
Ask the integrated care board for a review
Within 6 monthsYou have 6 months from the date of the decision letter to ask, in writing, for a review. The ICB should acknowledge within 5 working days and explain its process. Say which domain levels you dispute and why, with evidence, and ask for a copy of the completed Decision Support Tool if you do not have one. This stage is called local resolution. - 2
Ask NHS England for an independent review
Within 6 monthsIf local resolution upholds the decision, you have 6 months from that outcome to ask NHS England, in writing, for an independent review. A panel with an independent chair looks again at whether the primary health need test was applied properly and whether the process was followed. NHS England can also send a case straight to the panel if local resolution would only cause delay. - 3
Go to the Parliamentary and Health Service Ombudsman
Within 12 monthsIf the panel upholds the decision and you still disagree, the letter should explain how to refer the case to the Ombudsman, within 12 months of the outcome. If a decision is overturned at any stage, the NHS should refund what you have paid for care since the date it said no. - 4
Claim for a period that was never assessed
Any timeIf your relative paid for care when they should have been assessed for Continuing Healthcare, you can ask the ICB to review a previously unassessed period of care, for any period after 1 April 2012. The ICB should complete a claim for a period of a year or less within about 6 months, and longer periods within 12. If the claim succeeds, the fees are refunded. - 5
Get free specialist advice first
FreeBeacon is the independent Continuing Healthcare advice service. It gives up to 90 minutes of free personalised advice on 0345 548 0300, and can tell you whether an appeal is worth making before you start. Age UK's factsheet 20 covers the rules in detail, and its local branches help with the paperwork.
Funded nursing care
The smaller NHS payment if your relative does not qualify
If the assessment finds that your relative does not have a primary health need but they live in a nursing home and need care from a registered nurse, the NHS pays a flat weekly amount towards the nursing part of the fees. It is called NHS-funded nursing care and it is not means-tested either.
The words you will hear
- ICB
- Integrated care board, the NHS body for your area that decides on and pays for Continuing Healthcare.
- Primary health need
- The legal test. Taken as a whole, the care needed is mainly about health, and beyond what a council could be expected to provide.
- Checklist
- The short screening form, eleven areas each marked A, B or C, that decides whether a full assessment follows.
- Decision Support Tool (DST)
- The full assessment form: twelve care domains, each scored from no needs up to severe or priority, completed by the team with you present.
- MDT
- The multidisciplinary team, at least two professionals from different healthcare professions, who complete the DST and recommend a decision.
- Fast track
- A shorter route for someone whose condition is deteriorating quickly, on one clinician's recommendation, with care in place within about two days.
- Personal health budget
- Your CHC money, agreed as an amount you control and spend on the care plan, including carers you choose yourself.
- Well-managed needs
- A need that looks small because good care is keeping it under control. The rules say it must be scored as it would be without that care.
- Local resolution
- The first stage of appeal, run by the ICB. You have six months from the decision letter to ask for it.
- Independent review panel
- The second stage, arranged by NHS England with an independent chair. Six months from the local resolution outcome to ask.
- PUPoC
- A previously unassessed period of care: a claim for care you paid for when you should have been assessed, for any period after 1 April 2012.
- NHS-funded nursing care
- A flat weekly payment, £267.68 in 2026/27, to a nursing home for the nursing part of the fees, for people who do not qualify for CHC.
Questions
Questions families ask about NHS Continuing Healthcare
Adults whose main need is health rather than help with daily living, because the care they need is intense, complex or unpredictable, or of a kind a council could not be expected to provide. The decision rests on a full assessment across twelve care domains, not on a diagnosis or where the person lives. It is not means-tested and age makes no difference.
Not on its own. Somebody with dementia whose needs are mainly personal care and supervision usually does not meet the test. Somebody in the later stages, with severe needs in cognition, behaviour, mobility and nutrition together, often does. It is the combination and the intensity of the needs that count, so ask for the checklist as needs grow rather than assuming. The seven stages of dementia shows when that point tends to come.
You do not apply in the usual sense. Ask a nurse, doctor or social worker for the Continuing Healthcare checklist, by name. If it passes, the NHS arranges a full assessment by a multidisciplinary team, and a decision should usually reach you within 28 days. If you are refused a checklist, ask for the refusal in writing and contact the integrated care board's Continuing Healthcare team directly.
The National Framework says a decision should usually be made within 28 days of the checklist or the request for an assessment. The fast-track route, for somebody whose condition is deteriorating quickly, should have care in place within about 48 hours. Reviews happen within 3 months of the decision and then at least once a year.
No. Savings, income and the value of the home are not looked at. If your relative is eligible, the NHS pays the full cost of the care package at home, or the full fees in a care home, whatever their finances.
Yes. The NHS must fund, and if asked arrange, a package that meets the assessed health and personal care needs at home. That can include live-in care and waking nights. You can ask for it as a personal health budget and choose the carers yourself. It does not cover rent, mortgage, food or ordinary household bills. Live-in care at home explains what a package involves.
The value of your relative's Continuing Healthcare care plan, agreed as an amount of money you control and spend on the plan. Anyone receiving Continuing Healthcare at home has the right to one unless there are clear clinical or financial reasons against it. It lets you choose your own carers, including self-employed carers found through an introductory service, rather than take whoever the NHS commissions. It cannot be used simply to pay care home fees.
At home it continues. In a nursing home, Attendance Allowance and both parts of PIP or DLA stop after 28 days of NHS-funded fees; in a residential home the care parts stop and the mobility part continues. Tell the Disability Benefits Centre about the award either way. State Pension is unaffected.
Ask the integrated care board for a review within 6 months of the decision letter, disputing the domain levels with evidence. If that fails, ask NHS England for an independent review panel within 6 months, and after that the Parliamentary and Health Service Ombudsman within 12 months. Beacon gives up to 90 minutes of free specialist advice on 0345 548 0300 before you decide.
Possibly. If your relative paid for care during a period when they should have been assessed for Continuing Healthcare, you can ask the integrated care board to review that previously unassessed period, for any time after 1 April 2012. Gather the care records and evidence of the needs at the time. If the claim succeeds the fees are refunded.