What is NHS Continuing Healthcare?

The short version

Most long-term care in England is treated as “social care”: washing, dressing, feeding, supervision. Social care is means-tested. If your relative has assets above £23,250 the council will not pay, and the family pays the bill. Care home fees in England range from roughly £900 to £1,800 a week depending on region and the complexity of care.

NHS Continuing Healthcare is the exception. If your relative’s care needs are judged to be primarily caused by a health condition rather than ordinary frailty or age, the NHS picks up the entire bill. The care home, the nursing component, the personal care, the medication, the equipment. All of it. No means test.

This is worth £50,000 to £100,000 a year. Most families have never heard of it. Most who hear of it do not apply. Most who apply are turned down. Most who are turned down do not appeal. The few who succeed pay nothing.

What “primary health need” means

The National Framework for NHS Continuing Healthcare uses the phrase “primary health need”. It is not defined in law but is the central test of eligibility. In practice an assessor weighs four characteristics of the person’s overall care needs:

• Nature of the needs. Are they clinical (managing a condition) or more about supporting daily life?
• Intensity of the needs. How much input from skilled staff is required?
• Complexity of the needs. Are several interacting conditions involved?
• Unpredictability. How likely are the needs to change suddenly and require fast response?

When the answers to those questions add up to needs that go beyond what a local authority can reasonably be expected to commission, the test of primary health need is met. The 12-domain Decision Support Tool is the structured way assessors record this.

The process, in steps

1. Someone identifies the person may need CHC. Often a hospital discharge planner, district nurse, GP or family member raises it. There is no formal way to apply yourself, but you can ask any healthcare professional involved with your relative to start the process.
2. A Checklist is completed. This is a short pre-screen across 11 care domains. If the Checklist score passes the threshold, the person moves on to a full assessment. If it does not, they can ask for one anyway and should do so if they believe it is wrong.
3. A full assessment using the Decision Support Tool. This is the 12-domain document used to record the level of need in each area. Levels run from No needs to Priority. Two Severe scores or one Priority score generally indicate eligibility, though the four characteristics above are weighed alongside.
4. A Multi-Disciplinary Team meeting. The DST is reviewed by a team that usually includes a nurse assessor, a social worker, and clinicians who know the person. They make a recommendation.
5. The ICB decides. The Integrated Care Board responsible for the area reviews the recommendation and confirms or rejects eligibility. National data shows the share of standard assessments that result in eligibility was 16.7% across England in 2025-26 Q4, ranging from 2.3% in Gloucestershire to 35.4% in Cambridgeshire and Peterborough. See your local ICB’s figures.
6. The decision is communicated. If eligible, the NHS commissions and pays for care from that point. If ineligible, the family is informed of the right to request a review.

Standard timelines target 28 days from referral to decision but in practice many cases take longer. NHS England’s quarterly data tracks the share completed within 28 days as one of its metrics.

Who is most likely to qualify

There are no fixed diagnoses that qualify automatically. The test is the overall picture of need, not the label. That said, certain conditions are more likely to produce the kind of NICU (nature, intensity, complexity, unpredictability) profile that supports CHC eligibility:

• Advanced dementia with significant behavioural disturbance or risk to self/others
• Motor neurone disease, multiple sclerosis at advanced stages, Huntington’s disease
• Late-stage Parkinson’s with complex symptom management
• Stroke survivors with significant residual deficits and risk of further events
• Complex respiratory conditions requiring tracheostomy or ventilator support
• End-stage organ failure requiring intensive symptom management
• Severe pressure damage with ongoing tissue viability needs
• Multiple serious comorbidities producing an unstable overall picture

Stable conditions, even severe ones, are harder to argue. A person with end-stage dementia who is calm, eats with assistance and sleeps through the night may score lower than a person with moderate dementia who is unpredictable and challenging to manage safely.

What CHC pays for if granted

• The full cost of an appropriate care home placement, including the “hotel” element (room, food)
• Nursing input
• Personal care
• Equipment, including specialist beds and lifting equipment
• Continence products
• Medication and prescriptions
• Therapy input (physiotherapy, speech and language, occupational therapy)

If your relative is at home, CHC can also fund domiciliary care, live-in care, or other community-based packages where appropriate. The choice of placement is made jointly between the ICB and the family but the ICB is not obliged to fund any care home regardless of cost. They must commission an option that meets the assessed needs.

What CHC does not pay for

• Care that does not arise from the assessed primary health need
• Top-up payments if a family wants a more expensive care home than the ICB has agreed to commission. These come from the family.
• Items that are not part of the care package (private therapies, hairdressing, newspapers, etc.)

If your relative does not qualify

Most people referred for full CHC assessment are not found eligible. National data for the most recent quarter on this site is 16.7%. The right next step depends on whether the decision is sound, where your ICB sits on the variation curve, and the household’s financial picture.

• If you have been refused: the appeal route, self-funding, and equity release options
• Fast-track CHC: a separate process for people with terminal illness
• Who pays for care: the broader picture of healthcare vs social care funding
• The means test: when the local authority pays and how the savings threshold works