NHS Continuing Healthcare: Free NHS Funding for Complex Needs

Before any family accepts a means-tested care bill, one question should always be asked first: could this care be the NHS's responsibility? NHS continuing healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults whose main need for care is a health need. It is free, it is not means-tested, and it can be provided in your own home or in a care home, where it covers the fees in full, including accommodation. This factsheet explains how it works in England as at July 2026, and how to ask for an assessment.

What CHC is, and who it is for

CHC is for people with long-term, complex health needs. Eligibility turns on a single question: does the person have a primary health need? That is judged by looking at all of their needs together against four characteristics: their nature (what the needs are like and what care they call for), intensity (how severe and constant they are), complexity (how they interact and the skill needed to manage them) and unpredictability (how much they fluctuate and the risk if care is not timely).

Two things follow from that. Eligibility is about needs, never diagnosis: no condition qualifies automatically, and none disqualifies. And your finances are irrelevant: whether you would otherwise self-fund makes no difference to the assessment, and the rules do not allow it to. The test has its roots in a Court of Appeal case (Coughlan, 1999) which drew the line between what councils may lawfully provide and what must be the NHS's responsibility.

How the assessment works

Step one is a screening Checklist, completed by a health or social care professional such as a nurse, GP or social worker. You cannot fill it in yourself, but anyone can ask for one: you have the right to request a Checklist, either through the professionals involved in your care or directly from the continuing healthcare team at your local Integrated Care Board (ICB, the NHS body that funds local care). The Checklist threshold is deliberately low, so screening in does not mean you will qualify; it means you get a full assessment.

Step two is the full assessment: a multidisciplinary team of at least two professionals reviews the person's needs using the Decision Support Tool, which works through twelve areas of need, from breathing, nutrition and mobility to cognition, behaviour and medication, rating each from no need up to severe or priority. As a guide, one priority-level need, or two severe, would normally be expected to lead to eligibility, but the decision is always about the overall picture against the four characteristics, not arithmetic.

You and your family (or your attorney or deputy) are part of this: you should be given notice of the meetings, invited to contribute, and your views recorded. The ICB then makes the decision, normally within 28 days of the referral, and should follow the team's recommendation other than in exceptional circumstances. If it takes longer without good reason and you are found eligible, care costs from day 29 should be refunded.

There is also a Fast Track route for people whose condition is deteriorating rapidly and who may be entering the last phase of life: a doctor or nurse completes the Fast Track tool and the ICB should have funded care in place normally within 48 hours, with no Checklist and no Decision Support Tool.

If you are eligible

The NHS becomes responsible for the whole package: all assessed health and associated social care needs. In a care home, that means the fees in full, including board and accommodation. At home, the NHS funds the care package. You can ask for a personal health budget, including direct payments, to shape how the care is delivered. Packages cannot be topped up in the way council care can; you can only buy genuinely additional private services outside the assessed package.

Eligibility is reviewed after three months and then at least annually. Reviews should focus on whether the care plan still meets your needs; funding should only be withdrawn after a proper joint reassessment, and assessors must not treat needs that are well managed as needs that have gone away.

If you are not eligible

Three routes remain. NHS-funded nursing care applies if you live in a nursing home and need care from a registered nurse: the NHS pays £267.68 a week (the rate from 1 April 2026) direct to the home, whoever pays the rest of the fees, including self-funders. A joint package may apply where some needs are beyond what a council can lawfully provide: the NHS funds those elements free of charge, and only the social care element is means-tested. Otherwise, care is arranged through the council under the means test, which our Local Authority Care Fees: The Financial Assessment Explained factsheet explains.

Challenging a refusal

Refusals can be, and regularly are, overturned. If a Checklist screens you out, you can ask the ICB to reconsider. After a full assessment, you have six months to ask the ICB for a local review of the decision; if that does not resolve it, you can apply within six months to NHS England for an Independent Review Panel, and beyond that to the Parliamentary and Health Service Ombudsman. In the most recent official figures (late 2025), around one in seven local reviews resulted in eligibility, so a considered challenge is far from hopeless.

Families who paid for care during a period when CHC should have been considered can also ask for a retrospective assessment of that period (usually only for periods after 1 April 2012), with reimbursement where eligibility is established.

A hypothetical example

Imagine Eileen, who has advanced Parkinson's with swallowing problems, unpredictable falls, complex medication and growing confusion. Her family assumes that because she owns her home she must self-fund, until her daughter asks the district nurse for a CHC Checklist. She screens in; at the Decision Support Tool meeting her daughter describes a typical week, backed by the dated notes she has kept. The team finds severe needs in two areas and recommends eligibility; the ICB agrees within the 28 days. The NHS funds Eileen's nursing home place in full, and the means test never happens. This is a hypothetical example for illustration only.

Common mistakes

Waiting to be offered it. CHC is rarely volunteered. Ask for a Checklist, in writing, through your professionals or the ICB's continuing healthcare team directly.

Accepting “you won't qualify” without an assessment. Nobody can know that without a Checklist, and you have the right to request one. If professionals disagree about whether one is needed, one should be completed.

Arguing diagnosis instead of needs. A dementia or Parkinson's label wins nothing by itself. What counts is the nature, intensity, complexity and unpredictability of the day-to-day needs, so describe those.

Letting well-managed needs be marked down. A need that is controlled because of constant skilled care is still a need. Say so at the assessment.

Keeping no records. Our practical suggestion to every family: keep a dated diary of needs, incidents and interventions. Assessments are evidence-based, and the family's records often carry the day.

Missing the six-month window. Reviews and appeals have deadlines. Diarise them the day the decision letter arrives.

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This factsheet is general information for England and Wales, not legal, tax or financial advice. Last reviewed: July 2026.