NHS Continuing Healthcare: A Plain-English Guide for Families

What is NHS Continuing Healthcare and Who Qualifies?

NHS Continuing Healthcare (CHC) is a government scheme that funds care for people who have a 'primary health need'. This phrase is key: it means the person's needs are fundamentally health-related rather than simply social care needs. CHC is not means-tested and is available regardless of age, income, or savings. Your relative might qualify for CHC if they need ongoing support due to conditions like advanced Parkinson's disease, MS, dementia with significant medical complications, complex heart or neurological conditions, or recovery from serious stroke. The scheme covers both care home placements and home-based care, including community nursing support. Importantly, CHC is not about how much money someone has - it's about what kind of care they need. If the NHS decides their primary need is health-related, they fund it fully.

• CHC is not means-tested - your relative's savings and income don't affect eligibility
• Available regardless of age (anyone can qualify, not just elderly people)
• Covers both residential and home-based care
• Includes funding for nursing care and support from specialist staff

Understanding 'Primary Health Need'

The term 'primary health need' can feel vague, but it's the crux of CHC eligibility. Essentially, it means a person's care needs are predominantly health-related - requiring intervention, support, or supervision from trained healthcare professionals. Examples include managing complex medications, wound care, physiotherapy, speech and language support, or behaviour management for dementia. The key distinction is that these needs must be the main reason care is needed, not just an add-on to basic social care. If someone needs help with washing and dressing (social care) plus monitoring of blood pressure and medication (health care), the health element must be the driving factor. The NHS Decision Support Tool helps assessors think through this systematically across 11 domains: breathing, continence, skin integrity, nutrition and hydration, mobility, communication, psychological and emotional needs, cognition, behaviour, and drug therapies and medication.

• Requires ongoing supervision or intervention from healthcare professionals
• Includes medical conditions requiring specialist monitoring or treatment
• Must be the primary reason for care, not secondary

How the CHC Assessment Process Works

If you suspect your relative might qualify, the first step is to request an assessment through your local NHS Continuing Healthcare team. You'll need to complete an initial screening questionnaire. If this suggests they might have a primary health need, a full assessment follows. This uses the NHS's Decision Support Tool, which evaluates your relative across 11 care domains. During the assessment, the multidisciplinary team (nurses, doctors, social workers, therapists) gather information about your relative's physical health, mental health, cognitive abilities, and level of support needed. You'll usually be invited to meetings and asked for your input. The assessors aren't just looking at diagnoses - they're looking at what your relative actually needs day-to-day. After assessment, a panel decision is made. This takes a few weeks. You'll receive a written decision explaining whether CHC has been awarded, and if not, why not with clear reasons.

• Start with screening questionnaire submitted to local NHS team
• Full assessment uses the Decision Support Tool across 11 domains
• Multidisciplinary team gathers information over several weeks
• Written decision provided with clear reasons for approval or refusal

Preparing for Your Assessment: Evidence and Records

The key to a successful CHC assessment is evidence. Don't rely on the assessors to know everything about your relative's condition and care needs. Gather medical records, GP summaries, hospital discharge letters, and reports from specialists (neurologists, cardiologists, etc.). Create a care diary for at least two weeks before the assessment, documenting exactly what support your relative needs: how many times they need assistance with personal care, medication reminders, falls, mood changes, confusion episodes, and any healthcare interventions. Write down specific examples of how their condition affects daily life. If your relative is in hospital or a rehabilitation unit, ask for a copy of their current care plan. Contact their GP and ask them to submit information to the assessment team about the complexity of managing their health. The more detailed and specific your evidence, the stronger your case. Bring a trusted friend or family member to assessment meetings to help take notes.

• Gather all medical records and specialist reports before assessment
• Keep a detailed care diary showing daily support needed (2+ weeks)
• Document specific incidents and health changes with dates
• Ask your GP to contribute information about medical complexity

What Happens If You're Refused - And How to Appeal

If the assessment team decides CHC is not appropriate, you have the right to appeal. This is important: don't accept a refusal quietly. You'll receive a decision letter explaining the reasons. Read it carefully. If you disagree, you have 28 days to lodge an appeal with your local NHS Continuing Healthcare Advice & Liaison Service (CHCALS). They're independent of the original decision-makers and will review your case. You can submit additional evidence and information. Many families find that gathering stronger evidence and resubmitting makes the difference. If the appeal is refused, you can escalate to the Local Government Ombudsman. Throughout this process, consider getting support from an independent adviser - many local carers' centres offer free help. Never feel pressured to accept a 'no' quickly. Some families find that contacting their MP helps draw attention to complex cases. The appeals process is designed to protect vulnerable people from being wrongly excluded.

• You have 28 days to appeal a refusal decision
• Contact your local Continuing Healthcare Advice & Liaison Service
• Submit additional evidence supporting your case
• If unhappy with appeal result, escalate to Local Government Ombudsman

CHC vs. NHS Funded Nursing Care vs. Local Authority Funding

It's easy to muddle these three schemes, but they're quite different. NHS Continuing Healthcare (CHC) is full NHS funding for people with a primary health need. There's no means test, and the NHS covers everything - care, nursing, accommodation, specialist equipment. NHS Funded Nursing Care (NFNC) is a narrower scheme: it covers nursing care delivered by registered nurses (injections, wound dressing, complex medication) but only if the person lives in a care home. It doesn't cover board and lodging, and you may have to pay for personal care. Local authority funding is social care funding (not health funding). The council assesses your relative's care needs and financial situation; if they qualify, the council contributes towards care costs based on a means test. For home care specifically, CHC is valuable because it can fully fund specialist care at home, including nursing visits, without tying you to a care home. If your relative has significant health needs but you want them at home, CHC is often the answer - but you have to meet that 'primary health need' test.

• CHC: full NHS funding, no means test, for people with primary health need
• NFNC: NHS pays only for nursing care in care homes, not accommodation
• Local authority funding: social care funding based on means test
• For home care: CHC can fund specialist domiciliary care including nursing

How CHC Works With Home Care Specifically

If your relative qualifies for CHC and you want them to stay at home, the NHS can fund home care visits. These might include nursing care (wound dressing, catheter care), personal care (washing, dressing, toileting), medication management, and specialist support for conditions like dementia or Parkinson's. The care is arranged through your local NHS continuing healthcare team or a local care provider contracted to deliver NHS-funded care. You maintain greater autonomy at home: your relative stays in their familiar environment, family involvement is usually higher, and you can often adapt routines more flexibly than in a care setting. However, home care has limits. It relies on visits at set times, not 24-hour cover. If your relative's needs become so complex that they need round-the-clock monitoring - for instance, if they're prone to falls in the night, or have unpredictable medical episodes - a care home or hospital setting might become necessary. CHC funding doesn't change based on setting, so the cost to you is the same, but the environment and level of continuous supervision differ. Many families find home care with CHC funding provides the best of both worlds: professional support plus home.