NHS continuing healthcare (CHC) | Eligibility

When you are living with an illness or disability, funding the care you need can be a challenge. Being aware of the financial support you are entitled to will help ensure you are living the best quality of life for you.

If you have certain health needs, you may be entitled to a package of care known as NHS continuing healthcare (CHC). This can be used to fund care in a variety of settings, including your own home as well in a care home or a nursing home.

What is NHS continuing healthcare?

NHS continuing healthcare is a care package available to adults with long-term, ongoing complex health needs, known as a ‘primary health need’. People who qualify get social care for free, including services received from the local council, organised and funded by the NHS.

NHS continuing healthcare is not means tested. It covers the costs of someone’s health and social care needs, such as personal care or specialist support. Care home residents who receive NHS continuing healthcare have their care home costs paid for by the NHS.

NHS CHC covers the full cost of a care home, including personal care and nursing care as well as accommodation costs.

It is for people living in England, Wales and Northern Ireland. In Scotland, people aged 65 and over receive free personal and nursing care.

Free personal and nursing care in Scotland

Older people in Scotland can receive free personal and nursing care, regardless of their income, assets or partner status. Anyone aged 65 and over and assessed by the local authority as needing it qualifies, and will have their care paid for, up to a certain limit.

Even if their care is paid for, they still have to pay the remaining accommodation costs in a care home.

Who qualifies for NHS continuing healthcare funding?

NHS continuing healthcare is not for people with specific health conditions or illnesses, but rather how the condition affects you. For the NHS to pay for your social care services, you must be an adult and have a ‘primary health need’.

The latest figures from NHS England in 2024 show eligibility rates have fallen to their lowest levels since figures for NHS CHC were first published in 2017.

Nationally there has been a sharp fall (43%) in the number of people being newly assessed as eligible on the Standard pathway, from 4,628 in Quarter 1 2017/18 to 2,624 in Quarter 4 2023/24. This is a decline of almost half (43%). Over the same period, the number of people found eligible for Fast Track CHC rose by nearly a third (30%).

Retirement specialist Just Group found 73% of over-45s have not heard of CHC. Stephen Lowe, group communications director at Just Group, said: “NHS Continuing Healthcare is hugely valuable to seriously ill people and their families but so few know about it that it is often described as the NHS’s ‘best kept secret’.”

Postcode lottery

Being found eligible for continuing healthcare seems to be very much down to where you live, according to the figures from NHS England. The proportion of CHC assessments where someone is deemed to be eligible ranges from 3.4% to 57.9%, depending on where you live.

Caroline Abrahams, charity director for Age UK called it “deeply unfair to expose families dealing with the serious ill health of a loved one to further trauma by making them battle for money in an opaque system, where decision-making seems pretty ad hoc and happens behind closed doors”.

She added: “The extreme postcode lottery for CHC makes a mockery of the idea that this is a rules-based system which is not influenced by the state of local NHS finances. It plainly is.”

What is a primary health need?

A primary health need is not a particular diagnosis, but you must have ongoing physical or mental health needs, which may include:

• Problems with mobility
• Mental or physical disabilities
• Health deteriorating rapidly
• Complex medical conditions
• Terminal illnesses
• Cognitive or behavioural disorders

To be eligible for NHS continuing healthcare, the care you require must focus on either treating or preventing your health needs, or both.

Does dementia qualify for NHS continuing healthcare?

If you are living with dementia and have complex health and care needs, you may be eligible for NHS continuing healthcare. 

However being diagnosed with dementia does not automatically make you qualify. This will depend on the severity and complexity of your health needs.

People with dementia may demonstrate challenging behaviour and limited communication, which could prevent them from receiving essential care, posing a risk to their health.

But, people who are living with dementia are often assessed as having social care needs rather than health care needs. If this is the case, they may be found to be ineligible.

What is the difference between CHC and FNC?

Continuing Healthcare funding and Funded Nursing Care are not means tested and are paid for by the NHS. People are assessed clinically to see if they require complex care and then they are given Continuing Healthcare funding. If they need nursing care they are given Funded Nursing Care.

How do you apply?

If you think you qualify for NHS continuing healthcare funding, you can speak to your care home, social care worker or GP who can arrange to have your health needs assessed.

If you are living in a nursing home, care workers should consider your eligibility when your nursing needs are reviewed. This should take place annually.

How does the NHS continuing healthcare assessment work?

The assessment for NHS continuing healthcare is carried out in two stages by a multidisciplinary team (MDT) of healthcare professionals to see if you fulfil the criteria for funding. You should be fully involved in the process and your opinions considered.

This video provides a step by step guide to how the NHS CHC assessment works, including eligibility criteria and how a decision is made.

The team will look at:

• what kind of help you need
• how complex your needs are
• the intensity of your needs
• the unpredictability of your needs, including any risks to your health if the right care is not provided at the right time

After you have applied for funding, you will first have to complete an initial screening. This is normally carried out by a nurse, doctor, social worker or other healthcare professionals.

In the first stage, your health needs will be assessed using the Checklist tool.

NHS CHC checklist

The assessment checklist will cover the following general health needs:

• Mobility
• Breathing
• Continence
• Communication
• Psychological and emotional
• Nutrition
• Skin integrity
• Cognition
• Behaviour
• Drug therapies and medication: symptom control
• Altered states of consciousness
• Other care needs if any

If your health is deteriorating quickly and/or you are terminally ill, the healthcare professional may request for you to be fast tracked through the process.

The full NHS continuing healthcare assessment

If the first assessment indicates you may qualify for funding, you will be referred to a second assessment. This is usually within 28 days. The full assessment is either organised by your local NHS Clinical Commissioning Group (CCG) or a third party commissioned to do the assessment on their behalf.

At this stage, a team of health and social care professionals who are involved in your care will gather evidence about your physical, mental health and social care needs. Looking at the evidence, the team will complete a Decision Support Tool (DST) to weigh your needs.

Your health needs will be marked ‘priority’, ‘severe’, ‘high’, ‘moderate’, ‘low’ or ‘no needs’ to decide if you have a ‘primary health need’.

The team then makes their recommendation to the CCG, which is responsible for approving and funding your NHS continuing healthcare package.

How long does NHS continuing healthcare last?

If you are eligible for NHS continuing healthcare, the costs of your care package will be covered as agreed by the CCG. NHS CHC is reviewed after three months and then at least once per year.

If your health needs change, your eligibility and funding arrangements can change too. You have a right to challenge.

Can you top up NHS continuing healthcare?

You cannot top up NHS continuing healthcare funding like you can with local authority residential care funding.

However if you do pay for extra services privately on top of the services that are paid for by the NHS and the services are given by different staff you may be able to pay a top up fee.

What happens if you are not eligible for NHS CHC?

If the healthcare professionals or the CCG decide you are ineligible for NHS continuing healthcare, there are steps you can take.

• You can appeal the CCG’s decision and ask them to reconsider your case. You can also use the NHS complaints system.
• You can request to be referred to your local authority, who can carry out a needs assessment as well as a means test to see how much of your care you should pay for.
• Even if you are ineligible for NHS continuing healthcare, you may be assessed as requiring nursing care in a care home. You then qualify for NHS-funded nursing care, which means they will contribute to some of the costs.

Hospital based complex clinical care – Scotland

Until 2015, NHS continuing healthcare funding was also available in Scotland before being replaced by hospital based complex clinical care (HBCCC). This is primarily for people who are not yet eligible for free personal care (under the age of 65).

HBCCC works under the same premise as NHS continuing healthcare. It allows people to receive the medical treatment they need outside of a hospital setting wherever possible. The NHS remains responsible for meeting these medical needs and will cover the costs.

The eligibility for hospital based complex clinical care is based on one question:

Can your care needs be properly met in any setting other than a hospital?

If you have been in hospital for a while, an assessment will be carried out by a consultant or equivalent specialist (helped by the multi-disciplinary team) to decide on where the best place is to meet your needs. If this assessment deems the answer to the question to be yes, then you’ll be discharged to the most suitable setting. 

This will either be:

• Your own home with support
• A care home
• Supported accommodation

Anybody who was already receiving NHS continuing healthcare at the time of replacement will continue to do so for as long as they remain eligible.