NHS Continuing Healthcare: Could Your Care Be Fully Funded?
Not every care home stay has to be self-funded. NHS Continuing Healthcare pays the full cost of care for people with significant ongoing health needs — but most families have never heard of it. Here’s who qualifies, how the assessment works, and what to do if you’re turned down.
Most families start planning for care with one assumption: it’s going to cost a lot, and they’re going to be the ones paying it. For many, that’s true. But for a meaningful number of people with significant ongoing health needs, it isn’t — and nobody tells them.
NHS Continuing Healthcare (CHC) is a package of care that’s arranged and fully funded by the NHS, for free, regardless of income or savings. It’s one of the least understood parts of the care system, largely because nobody has an incentive to bring it up — care homes aren’t assessing for it, and local authorities would rather you didn’t know it applies to you before they do. Here’s what it actually is, who qualifies, and how to apply.
What NHS Continuing Healthcare Actually Is
CHC is different from the means-tested local authority funding most people expect. It’s not based on what you earn or own — it’s based purely on your health needs. If you’re assessed as eligible, the NHS pays for your care in full, whether that’s in a care home, a nursing home, or your own home.
The test isn’t “does this person have health needs” — almost everyone in care does. It’s whether the person has a primary health need: whether the main reason they need care is to manage or treat a health condition, rather than general old-age support. Someone with complex, unpredictable, or intense nursing needs is far more likely to qualify than someone who simply needs help with daily living.
Crucially, this is not the same as NHS-funded Nursing Care (FNC) — a smaller, more common payment. FNC contributes a fixed weekly amount (£267.68 standard rate, or £368.24 at the higher rate, from April 2026) toward the nursing element of a care home place, and it’s what most people not eligible for full CHC end up with instead. It helps, but it’s a fraction of the cost — full CHC covers everything.
How the Assessment Works
Step 1: The Checklist. This is a screening tool, usually completed by a nurse, social worker, or care home staff member, and it doesn’t decide funding — it only decides whether you’re entitled to a full assessment. It’s meant to be a low bar, but in practice families often have to request it themselves rather than wait for it to be offered.
Step 2: The Decision Support Tool (DST). If the checklist passes, a multidisciplinary team — typically including a nurse and social worker — scores the person’s needs across 12 “care domains” (things like mobility, nutrition, skin condition, behaviour, cognition, and medication) on a scale from “no needs” to “priority.” A primary health need is generally established through a combination of the nature, complexity, intensity, and unpredictability of those needs — not any single score in isolation.
Step 3: The decision. The relevant Integrated Care Board (ICB) — the body that replaced Clinical Commissioning Groups — should confirm the outcome within 28 days of receiving the completed DST.
Fast-track pathway. For someone nearing the end of life with a rapidly deteriorating condition, there’s a separate fast-track process designed to get funding in place within days, without going through the full checklist and DST process.
Why Families Miss Out
CHC isn’t refused because people don’t qualify — a lot of the time it’s refused, or never applied for, because of how the process is handled:
The checklist is never triggered in the first place, because nobody flags it during a hospital discharge or care home move. Assessments happen too early, before the full extent of someone’s needs is clear — a snapshot taken during a good week understates genuine need. Or the domains are scored too conservatively, because assessors are, in effect, managing a budget as well as an assessment. None of this means the underlying entitlement isn’t there. It means the process is worth pushing on.
What to Do If You’re Turned Down
A refusal isn’t final. There’s a formal route to challenge it:
Local resolution. Ask the ICB to review the decision — this is often where a poorly evidenced DST gets corrected.
Independent Review Panel (IRP). If local resolution doesn’t resolve it, you can request an independent review. You have six months from the local decision to do this, and once requested, NHS England should convene the panel within three months. In practice, IRPs commonly take three to six months, and a small number of cases run well past a year, especially if multiple hearings are needed.
Retrospective claims. If someone paid for their own care but you believe they should have been assessed and found eligible for CHC at the time, it’s possible to claim that funding back — though evidence from the relevant period makes a significant difference to how strong the case is.
Given how long the appeals process can run, the practical advice for families is the same as with any of this: start the conversation early, keep records of every assessment and conversation, and don’t assume a “no” is the end of it.
When to Ask for an Assessment
Anyone can request a CHC checklist — you don’t need to wait for a hospital, GP, or care home to offer one. The right moments to raise it: before or during a hospital discharge, when a care needs assessment is being arranged by the local authority, when someone’s health needs change significantly, or at any point during an existing care home stay if it was never assessed at the point of admission.
If a Health and Welfare Lasting Power of Attorney is already in place, the attorney can request and be involved in the assessment on the person’s behalf — one more reason that piece of paperwork is worth having sorted before a health crisis, not during one.
FAQs
Is NHS Continuing Healthcare means-tested? No. Eligibility is based entirely on health need, not income, savings, or property. This is what makes it different from local authority-funded care, which does take your finances into account.
Can someone get CHC funding for care at home, not just in a care home? Yes. CHC can fund a full package of care in a person’s own home, in a care home, or in a nursing home — the setting depends on what best meets the person’s assessed needs, not the funding itself.
How long does the whole process take? There’s no fixed timeline for getting to the checklist and DST stage, though the ICB should confirm a decision within 28 days once the DST is complete. If a decision is disputed, appeals can add several more months.
Does everyone in a care home with dementia qualify for CHC? No — a dementia diagnosis alone doesn’t guarantee eligibility. What matters is the nature, complexity, intensity, and unpredictability of the needs that come with it, assessed against the same criteria as any other condition.
Legal disclaimer: This article is for general guidance only and does not constitute financial or legal advice. Continuing Healthcare rules, rates, and processes can change — always check current guidance via the NHS or your local Integrated Care Board before making decisions.
As the Company Director at Wiserr, I lead an innovative and impactful platform that provides information and advice on care and health services in local areas. We empower informed decisions and enhance the quality of life for thousands of users, and we are featured in over 3000 GP practices across the UK.
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