Last Updated: August 13, 2026

This guide explains what NHS continuing healthcare (NHS CHC) funding is, how to apply and appeal, how eligibility is determined, and the difference between NHS CHC and NHS-funded nursing care (NHS FNC). It applies to England only – arrangements differ in Scotland, Wales and Northern Ireland. It is general information, not an eligibility determination, clinical assessment or legal advice.

What is NHS continuing healthcare funding?

NHS CHC is available to those who are found to have a ‘primary health need’ during a comprehensive assessment process. It is funded entirely by the NHS and is payable whether you live at home or in a care home. Since the Health and Care Act 2022, Integrated Care Boards (ICBs) are the statutory bodies responsible for commissioning NHS continuing healthcare in each area. The governing document is the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022, revised 2023), published by the Department of Health and Social Care.

NHS CHC is not automatically awarded for any particular diagnosis – including dementia – and it is not means tested. The only criterion is that you are found to have a primary health need. All care and medical records are reviewed during the process, so they need to be detailed and accurate. Sadly, a lot of applications are not successful partly because records are incomplete.

Any package of care must meet your assessed health and associated social care needs, including accommodation where that forms part of the overall need.

The NHS continuing healthcare application process

The National Framework sets out the principles and processes for deciding eligibility in England. If a person has long-term needs, a CHC Checklist is completed first. This is a screening tool only – a positive Checklist means a full assessment is needed, but does not itself confirm eligibility. The Checklist can be completed by a social worker, GP or another health and care professional.

The Checklist and the Decision Support Tool (DST) consider 12 domains in total including:-

  • Cognition;
  • Behaviour;
  • Communication;
  • Nutrition;
  • Skin viability;
  • Psychological and emotional needs;
  • Mobility;
  • Breathing;
  • Drug therapies and medication;
  • Altered states of consciousness (ASC); and
  • Any other significant needs

The Checklist rates need in each domain as A (high), B (moderate) or C (no or low needs). If there are two or more A’s, or five or more B’s, or one A and four B’s, or an A in any domain with a priority level of need (breathing, behaviour, drug therapies and medication, or ASC), a full assessment via the DST is required.

A referral is made to your local ICB and the DST should be completed within 28 days of that referral. The DST is completed by a multidisciplinary team (MDT), which should consist of at least two health professionals from different professions, or one healthcare professional and one community care assessor. These assessors should have knowledge of your health and social care needs and have been involved in your care. Importantly, the DST levels cannot be treated as a simple numerical formula – the interaction and totality of needs must be considered.

You and your representative or attorney should be given the opportunity to attend and contribute. Your view is important to the assessment and appropriate weight should be given to it.

It is a good idea to have your own notes and records ready to contribute to the assessment. Keep details of all conversations with the various professionals, as the records relied on at assessment can fall short – carer turnover can be high and this contributes to gaps in record keeping. If the person’s behaviour is unpredictable, it needs to be recorded every time, as carers can become conditioned to difficulties and stop noting them. Spend some time preparing by reviewing the DST yourself so you understand the process and can consider what the levels of need are. Always report need as it is on the person’s worst day – the assessment focuses on what someone cannot do.

At the MDT the DST is completed and a summary of needs recorded for every domain. A rating is then recorded for each domain, covering everyone’s views. Once complete, the MDT makes a recommendation to the ICB on eligibility. In addition to the record of needs, the MDT also considers the four key characteristics which are:-

  • NATURE – the type and features of your physical, mental and psychological needs;
  • COMPLEXITY – how the needs interact to affect the management required to treat them;
  • INTENSITY – the severity of your needs and how that increases the level of support required;
  • UNPREDICTABILITY – how this affects the level of support needed to manage your needs and how it can impact on the safety of all those involved.

The MDT gives a clear recommendation of a primary health need if there is:-

  • a priority level need in any domain;
  • two or more severe levels of need in any domains.

In addition, a primary health need can be evidenced by one severe level together with needs in several other domains, or a number of domains with high or moderate needs. The needs should always be linked to the four characteristics above.

As a practical example: someone who fights during personal care, refuses medication, lashes out at carers, cannot reliably communicate their needs, takes more than 30 minutes to eat, or is disorientated in time and place at all times, might be found eligible. The level of need in behaviour might be priority or severe, and high or severe in other domains. Applying the four characteristics to these combined needs could demonstrate a primary health need.

The ICB is expected to respond to the MDT recommendation within two working days and only departs from it in exceptional circumstances. The decision will be communicated in writing along with details of the period of eligibility, or how to appeal if not found eligible. No decision is permanent and can be reviewed if your needs change. According to NHS England’s quarterly data, the standard assessment conversion rate in Q3 2025/26 was 19%.

If approved, the ICB will pay for your care from the date of the decision. If there is undue delay by the ICB beyond the 28-day period, it should reimburse for costs from day 29. A recent Local Government and Social Care Ombudsman decision highlights the impact of assessment and funding delays on families – a reminder of why following up in writing matters.

The NHS continuing healthcare appeal process

In the event of a negative response regarding NHS continuing healthcare, you have six months to appeal. The letter of appeal should carefully set out the reasons and why you believe the levels recorded are incorrect. Your own notes and records will be invaluable here – refer to specific evidence to support your position.

You should also refer to any failure to consider the four characteristics and how they apply to the overall needs. Note that a solicitor or paid representative is not required to make an appeal – Alzheimer’s Society confirms this clearly for people with dementia, and the same applies generally.

Any failure to follow the Framework should be pointed out. For example: did the MDT consist of at least two professionals, one from healthcare and one from social care? Did they refer to all care and medical records? Was adequate notice given? Were you invited to attend or spoken to? Did at least one assessor know your case sufficiently well? All of these are highly relevant and should be raised in your letter. An Ombudsman decision from 2025 found that missed CHC checklist assessments can deny families the chance to challenge outcomes – procedural failures matter.

There are two stages to the appeal process. First, a Local Resolution (LR) managed by the ICB, which will publish its own LR process. They try to resolve matters informally first; if no resolution is reached, a meeting will be arranged. According to NHS England data, as at 31 March 2024, only 13% of appeals to the Local Resolution stage were successful. If you still disagree after LR, you have a further six months to ask NHS England to arrange an independent review panel.

The independent review panel decision should be followed by NHS England and the ICB. If you still disagree, you can refer to the Parliamentary and Health Service Ombudsman within 12 months. The PHSO has investigated CHC cases where failures in planning led to reimbursements of privately paid care costs running into hundreds of thousands of pounds – though these are illustrative of what is possible, not typical outcomes.

A retrospective review can be carried out and if approved the ICB will reimburse you for the period NHS continuing healthcare funding should have been applied. Age UK describes the current system as an “extreme postcode lottery” – its December 2024 parliamentary briefing called for reform, reflecting wide variation in outcomes between ICBs.

If you are not eligible for NHS CHC, you may still be entitled to NHS-funded nursing care (NHS FNC), which is a fixed rate paid to your nursing home by the ICB. The standard rate of NHS FNC from 1 April 2026 is £267.68 per week. Find out more about NHS-funded nursing care here.

Fast track tool for NHS continuing healthcare

If you have a rapidly deteriorating condition that is entering a terminal phase, you may be eligible for fast-tracking for NHS CHC, removing the need to go through the full DST process. This pathway is intended to move quickly so that appropriate care can be put in place without delay.

Statistics

According to NHS England’s quarterly management information, as at 31 December 2025 (Q3 2025/26) there were 50,753 people eligible for NHS continuing healthcare in England: 34,117 Standard and 16,636 Fast Track. Note that from May 2026 NHS England discontinued formal CHC statistical report PDFs, while continuing to publish underlying quarterly data.

Summary

Neither NHS CHC nor NHS FNC is means tested – both can be applied for even if you own your own home and have savings. A common misconception is that you must have a specific diagnosis or that you must live in a care home; neither is true. Approved packages are normally reviewed after three months and then at least annually, so eligibility should be revisited if needs change.

The statistics show that the process is difficult and NHS CHC is awarded to those with the greatest health need. Keeping thorough records, understanding the four key characteristics, and challenging procedural failures at every stage gives you the best chance of a fair outcome.

For further information, contact Associate Lucie Glover, Furley Page Solicitors: Tel 01227 763939 or email [email protected]. Visit www.furleypage.co.uk

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Frequently Asked Questions

Is NHS continuing healthcare means-tested?

No, eligibility is based entirely on your assessed needs, not your financial situation. Your income, savings, or whether you own a home are not considered during the assessment process. For more details, see the official National Framework guidance.

Does dementia automatically qualify someone for NHS continuing healthcare funding?

A specific diagnosis like dementia does not automatically mean you will receive funding. The assessment looks at your total day-to-day needs and determines if they amount to a primary health need. If you are navigating this, read our guide on obtaining CHC for a person with dementia.

Can NHS continuing healthcare pay for care at home?

Yes, it can be provided in your own home, as well as in a care home or hospice. If you choose to receive care in your own home, the NHS will arrange a package to meet your assessed health and social care needs.

What happens if I am not eligible for full NHS continuing healthcare funding?

If you do not qualify, the Integrated Care Board may refer you to your local authority for a standard care assessment. If you live in a registered nursing home, you might still qualify for NHS-funded nursing care as a contribution towards your fees. Read more about paying for care options.

Do I need to pay a solicitor to apply for NHS continuing healthcare?

You do not need to pay a claims company or solicitor to access the assessment process. You can be supported by a family member or choose independent advocacy if your case is complex. You can learn more about the vital role of advocacy on our website.