NHS continuing healthcare: who qualifies and how to apply

NHS continuing healthcare is an ongoing package of health and social care that the NHS arranges and funds on its own, for adults aged 18 or over who are found to have a 'primary health need'. Because the NHS pays, it isn't means-tested: your savings, income and home don't affect whether you qualify or what you get. It can be provided in your own home or in a care home, and in a care home the NHS pays the fees.

Eligibility depends on your assessed needs, not on a diagnosis, and can change if your needs change. The rules are in the Department of Health and Social Care's national framework (July 2022, revised, with a correction in July 2023). The integrated care board (ICB) for your area makes the decision.

If you aren't eligible but still have some health needs, the NHS may pay for part of your support in a 'joint package' with the council.

The checklist is a screening tool that decides whether you get a full assessment, and its threshold is deliberately set low. ICBs must assess you if it seems you may need CHC. A nurse, doctor, other healthcare professional or social worker can complete it, and you should get a signed, dated copy with the reasons for the result.

The checklist scores 11 care domains, the same as the full assessment apart from 'other significant care needs', in column A, B or C, with A the highest level of need. The Department's checklist guidance (2022) says a full assessment is needed if any of the results in the table is met. A positive checklist only means you go on to a full assessment; it doesn't mean you'll qualify. A negative one means you're not eligible, and the outcome must be given to you in writing.

If someone's condition is deteriorating rapidly and may be entering a terminal phase, the fast-track pathway tool is used instead of the checklist and full assessment. NHS.UK says a care package should then be in place as soon as possible, usually within 48 hours.

A full assessment is carried out by a multidisciplinary team of at least 2 professionals from different healthcare professions, usually including health and social care staff already involved in your care. The team records your needs in the Decision Support Tool (DST) across 12 care domains, gives each a level from 'no needs' up to 'severe' or 'priority', and recommends to the ICB whether you have a primary health need. You and, where appropriate, your family or carers should be involved, and your views taken into account.

The DST guidance says a clear recommendation of eligibility would be expected if you have a priority-level need in any of the 4 domains that carry that level, or 2 or more severe needs across all the domains. A severe need combined with needs in several other domains, or a number of high or moderate needs, may also show a primary health need depending on how they combine. Levels aren't added up: the guidance says you can't treat 2 moderates as equal to 1 high.

Well-managed needs are still needs: good care that keeps a problem under control doesn't make the need disappear. If the team can't agree between two levels, it should choose the higher one.

The ICB should normally decide within 28 days of getting a completed checklist or a request for a full assessment. If it finds you eligible but took longer than 28 days without a good reason, NHS.UK says it should refund your care costs from day 29 until the date of the decision.

Start by asking the ICB to review its decision through its local resolution process, which every ICB must have and publish, with timescales. The framework expects an informal discussion first, where the ICB explains its decision with reference to the DST and you can add information it missed, then a formal meeting if that doesn't settle it.

If you're still unhappy, you can ask NHS England for an independent review of the eligibility decision or of the procedure the ICB followed. NHS England's public guide (version 3, July 2023) says you must return its application form within six weeks and that the process typically takes three to six months. The panel's recommendations should be accepted in all but exceptional circumstances, and you can only add new evidence if the ICB should reasonably have considered it.

After an independent review, you can complain to the Parliamentary and Health Service Ombudsman. Some issues, including an ICB refusing a full assessment after a negative checklist, go through the NHS complaints procedure rather than independent review. If you or a relative paid for care that should have been considered for CHC, you can ask for a 'previously unassessed period of care' review; NHS.UK says these are usually only considered for care after April 2012.

Once you're eligible, the ICB should review your needs and package within 3 months and then at least once a year. CHC can end if your needs change, and you can challenge that decision in the same way.

NHS-funded nursing care (FNC) is a flat weekly payment the NHS makes directly to a care home that provides nursing, for residents who aren't eligible for CHC but have been assessed as needing care from a registered nurse. You should be assessed for CHC before any decision on FNC, and most people don't need a separate assessment. FNC is paid whoever funds the rest of the fees, including people who pay for themselves.

The rate is the same across England. From 1 April 2026 it is £267.68 a week. People who moved into a care home before 1 October 2007 and were on the old high band get £368.24 a week, unless their needs change or they move to a home without nursing. FNC only covers the registered nurse element: the rest of the fee is paid by you or means-tested by the council.

Worked example: FNC at £267.68 a week is worth £267.68 × 52 = £13,919.36 a year. The higher rate is £368.24 × 52 = £19,148.48 a year, or £100.56 a week more. Because the NHS pays the home directly, ask the home to confirm in writing whether its quoted weekly fee includes or excludes the FNC payment. And on timing: if an ICB takes 50 days to find someone eligible for CHC with no good reason for the delay, the refund should cover their care costs from day 29 to day 50.

CHC and council funding don't overlap. The Care Act statutory guidance says councils must not charge for any service the NHS has a duty to provide, including CHC and the NHS nursing contribution. If you're not eligible for CHC, NHS.UK says you can be referred to the council, which assesses your needs and then your finances. Our care home funding guide explains that means test.

Benefits change too. GOV.UK says most benefits usually stop within 28 days of going into a care home if the stay is funded by NHS continuing healthcare, so report the stay to each benefit office. See our Attendance Allowance guide.

If you get CHC at home, the ICB can offer a personal health budget, including a direct payment for healthcare, to give you more choice over who provides your care. If a relative challenges a decision for you without a lasting power of attorney or deputyship, the framework says the ICB should check it's what you want, or use a best-interests process if you lack capacity.

The process above applies in England. In Wales, continuing NHS healthcare is run by local health boards under the Welsh Government's own national framework and Decision Support Tool. Health boards pay one all-Wales nursing care rate, reviewed each year, but we couldn't find the 2026/27 figure published on GOV.WALES.

In Scotland, Hospital Based Complex Clinical Care (HBCCC) replaced NHS continuing healthcare on 1 June 2015. Eligibility turns on one question: can the person's care needs be properly met in any setting other than a hospital? If they can, the person is discharged to a community setting and the council's charging rules apply, though the NHS stays responsible for medical needs. People found eligible under the old rules before 1 June 2015 keep full NHS funding while they remain eligible. Scotland's personal and nursing care payments are in the table.

In Northern Ireland, nidirect says some people have their care fully paid for by their Health and Social Care (HSC) trust, which it calls 'continuing health care', and that trusts pay £100 a week towards nursing in a nursing home. In February 2021 the Department of Health said its preferred reform was a single eligibility question like Scotland's and that it would work with trusts to put it in place. Ask your HSC trust how it assesses eligibility now.