NHS Continuing Healthcare: What It Is, Who Qualifies, and What It Doesn't Cover

Navigating the social care system in the UK is notoriously complex. One of the most misunderstood elements is NHS Continuing Healthcare (CHC) — a funding stream that can cover the full cost of care for people with significant health needs, but which many people either do not know about or find impossible to access.

This guide explains what CHC is, who qualifies, how the assessment process works, and — crucially — what happens if you do not qualify.

NHS Continuing Healthcare is a package of ongoing care arranged and funded entirely by the NHS for adults in England who have a "primary health need" — that is, whose care needs arise primarily from a health condition rather than from social or personal care needs.

CHC can fund care in a variety of settings, including:

• The person's own home
• A care home (with or without nursing)
• A hospice

If a person qualifies for CHC, the NHS pays for all of their care — including accommodation in a care home if that is where they live. This is in contrast to local authority-funded care, which is means-tested and may require the person to contribute to costs.

CHC is available in England. Scotland, Wales, and Northern Ireland have their own equivalent systems (NHS Continuing Care in Scotland, Continuing NHS Healthcare in Wales, and Continuing Healthcare in Northern Ireland).

This is where many people come unstuck. CHC is not available to everyone who has significant care needs — it is specifically for people whose needs are primarily health-related, complex, intense, or unpredictable.

The eligibility criteria are assessed using a tool called the Decision Support Tool (DST), which evaluates needs across twelve care domains:

1. Behaviour
2. Cognition
3. Communication
4. Psychological and emotional needs
5. Mobility
6. Nutrition (food and drink)
7. Continence
8. Skin (including tissue viability)
9. Breathing
10. Drug therapies and medication
11. Altered states of consciousness
12. Other significant care needs

For each domain, needs are rated as no needs, low, moderate, high, or severe/priority. A person is likely to qualify for CHC if they have:

• One domain rated as "priority", or
• Two or more domains rated as "severe", or
• A combination of high and severe ratings across multiple domains

The key test is whether the person has a "primary health need" — whether their overall care needs are so complex, intense, or unpredictable that they require the oversight of a healthcare professional.

CHC is most commonly awarded to people with:

• Advanced cancer or other terminal illness
• Severe dementia with complex behavioural needs
• Significant neurological conditions (such as advanced Parkinson's disease, motor neurone disease, or multiple sclerosis)
• Complex wound care or other clinical needs requiring regular nursing input
• Severe mental health conditions requiring ongoing clinical management

The majority of people with care needs — including many people with significant needs — do not qualify for CHC. People who need help with personal care, medication management, mobility, and daily living tasks, but whose needs are stable and manageable, are generally not eligible.

This is a source of considerable frustration for families who feel that their relative's needs are substantial and that the NHS should be contributing to their care costs. Unfortunately, the eligibility criteria are strict, and the assessment process can feel opaque and inconsistent.

The process begins with a checklist screening, usually carried out by a nurse or social worker. The checklist is a simplified version of the full assessment and is designed to identify people who may be eligible for a full assessment. If the checklist indicates possible eligibility, the person proceeds to a full assessment.

The full assessment is carried out by a multidisciplinary team (MDT) — typically including a nurse, a social worker, and other relevant professionals. The MDT completes the Decision Support Tool and makes a recommendation about eligibility.

The final decision is made by the NHS Integrated Care Board (ICB) — the local NHS body responsible for commissioning health services. The ICB considers the MDT's recommendation and makes a formal eligibility decision.

If CHC is awarded, the ICB arranges and funds a care package. The person and their family should be involved in planning the care package.

The process should take no more than 28 days from the initial checklist to the eligibility decision, though in practice it often takes longer.

CHC decisions are frequently contested. If you believe a person has been wrongly assessed as ineligible, you have the right to request a review. The review process involves:

1. Local review — a review by the ICB
2. Independent review — if the local review is unsuccessful, you can request an independent review by NHS England
3. Parliamentary and Health Service Ombudsman — if you remain dissatisfied

The process is complex and can be lengthy. Many families find it helpful to seek advice from a specialist solicitor or from a charity such as the Beacon CHC Advisory Service (beaconchc.co.uk), which provides free advice and support to people navigating the CHC process.

For people in care homes who do not qualify for full CHC but who have nursing needs, there is a separate funding stream called NHS-Funded Nursing Care (FNC). This is a flat-rate contribution (currently £235.88 per week in 2026/27) paid directly to the care home to cover the cost of nursing care provided by a registered nurse.

FNC is not means-tested and does not depend on the person's financial circumstances. It is available to anyone in a care home with nursing who has been assessed as having nursing needs.

Even for people who qualify for CHC, it is important to understand what it does and does not cover.

CHC covers:

• All health and personal care needs arising from the primary health need
• Accommodation in a care home (if that is where the person lives)
• Nursing care
• Therapies (physiotherapy, occupational therapy, speech and language therapy) related to the primary health need

CHC does not cover:

• Non-health-related social activities and outings
• Companionship and social support beyond what is clinically necessary
• Practical support such as shopping, errands, and household tasks that are not directly related to health needs
• Transport for non-medical purposes

This is where non-clinical support services like Karken Healthcare can play a complementary role. Even for people who receive CHC, there are often aspects of daily life — social connection, practical help, getting out and about — that fall outside the scope of funded care.

Most people with care needs will not qualify for CHC. The alternatives include:

Local authority-funded care If a person has care needs and limited financial resources, they may be eligible for care funded by their local authority. Local authority funding is means-tested — the person's income and assets are assessed, and they may be required to contribute to costs. Contact your local council's adult social care team to request a needs assessment.

Self-funded care People with assets above the means-test threshold (currently £23,250 in England) are expected to fund their own care. This can be expensive, and many families find the costs challenging to manage.

Non-clinical support services For people whose needs do not require clinical care, non-clinical support services — like those provided by Karken Healthcare — offer an affordable and flexible alternative. Companionship, practical help, medication collection, and transport support can make a significant difference to quality of life without the cost of a full care package.

The CHC process is complex, and many families find it difficult to navigate alone. The following resources can help:

• Beacon CHC Advisory Service: beaconchc.co.uk — free advice and support
• Age UK: ageuk.org.uk | Helpline: 0800 678 1602
• Carers UK: carersuk.org | Helpline: 0808 808 7777
• NHS England CHC guidance: england.nhs.uk/continuing-healthcare

Karken Healthcare Ltd provides non-clinical, non-CQC regulated home support services across the United Kingdom. We do not provide clinical care, nursing care, or advice on NHS funding. For advice on NHS Continuing Healthcare, please contact the Beacon CHC Advisory Service or your local Integrated Care Board.