Could NHS Continuing Healthcare pay for all your care costs — and how do you find out if you qualify?

What is NHS Continuing Healthcare — and why do so few people know about it?

NHS Continuing Healthcare is a care package funded entirely by the NHS for adults whose primary need is health-related, rather than social. If you qualify, the NHS pays for all of your care — including nursing home fees, care workers at home, specialist equipment, and personal care. There is no cap on costs and no financial assessment.

The key word is “primary.” Everyone’s care needs contain a mix of health and social elements, but CHC applies when your health needs are so significant that they are the main driver of the care you require.

So why don’t more people know? Partly because the responsibility for raising it falls to NHS and social care professionals — and they don’t always do so. Research by the charity Beacon CHC suggests many families only discover CHC exists after spending large amounts on private care fees. You are legally entitled to ask for an assessment at any time, and the NHS has a duty to carry one out.

Who is likely to qualify — and what does “primary health need” mean in practice?

CHC is not restricted to any particular diagnosis. People living with advanced dementia, Parkinson’s disease, multiple sclerosis, motor neurone disease, serious strokes, or complex wound care needs have all qualified. So have people with severe respiratory conditions, uncontrolled epilepsy, and those who require frequent clinical intervention throughout the day and night.

Assessors look at four key characteristics of your needs:

• Intensity — how much support you need and how often
• Complexity — how difficult or interrelated your needs are to manage
• Unpredictability — how quickly your condition can change without warning, and the risk this creates
• Nature — whether your needs require a level of skill that only a trained clinician can safely provide

You do not need to be terminally ill or housebound to qualify. But your needs must go significantly beyond what most people manage day to day.

What are the 12 care domains used to assess your eligibility?

If you pass the initial checklist, a multidisciplinary team (MDT) carries out a full assessment using the Decision Support Tool — a structured framework that scores your needs across 12 care domains:

• Behaviour, Cognition, Psychological and emotional needs
• Communication, Mobility, Nutrition (food and hydration)
• Continence, Skin and tissue viability, Breathing
• Drug therapies and medication, Altered states of consciousness, Other significant care needs

Each domain is rated from no needs through low, moderate, high, and severe — or, for some domains, priority. A “severe” rating in any single domain is a strong indicator of eligibility. A “priority” rating in behaviour, cognition, breathing, or medication almost always triggers a CHC award.

One practical tip that families often find valuable: keep a diary of the person’s care needs in the weeks before an assessment — noting night-time needs, any incidents or falls, how often clinical help is called on, and what happens when care is delayed or unavailable. This kind of detailed, dated evidence can make a real difference to the outcome.

How do you request an assessment — and what actually happens next?

You can request a CHC assessment through your GP, hospital consultant, district nurse, or your local council’s adult social care team. You can also contact your NHS Integrated Care Board (ICB) directly — a search for your area name plus “Integrated Care Board” will find the right organisation.

If you or someone you care for is being discharged from hospital, ask the discharge team about CHC before agreeing to any care home placement or private home care package. Once a person is settled in privately funded care, CHC tends not to be revisited — but it should be, because needs may well have met the threshold at the point of discharge.

The process has two stages: a Checklist assessment (usually carried out by a nurse or social worker), followed — if positive — by the full MDT Decision Support Tool assessment. The NHS Integrated Care Board should give you a written decision within 28 days of receiving the completed tool.

What if your application is refused — is it worth challenging the decision?

Yes — and many families do, successfully. A significant proportion of CHC appeals result in eligibility being granted, particularly when better evidence is gathered or specialist support is sought. If you are turned down, you have six months to request an Independent Review. However, once you make that request, you have just six weeks to submit all of your written evidence — so do not delay in building your case after a refusal.

The charity Beacon CHC provides free, independent support to families throughout the assessment and appeal process. Age UK and Carers UK can also help you find local advocacy. Getting specialist support significantly improves outcomes, particularly where needs are complex or fluctuating.

Is there a faster route if someone is very seriously ill?

Yes. The CHC Fast Track is designed for people with a rapidly deteriorating condition or who are approaching the end of their life. A senior clinician can complete a Fast Track assessment on the same day, and care can be arranged within 48 hours — bypassing the usual two-stage checklist and MDT process entirely.

If someone you care for is in hospital and staff are discussing end-of-life care, ask specifically about Fast Track CHC. It can allow the person to return home with full NHS-funded support, rather than remaining in hospital or paying for private care in their final weeks. This is a right that is too often not mentioned unless families know to ask for it.