NHS Continuing Healthcare is one of the most significant and most frequently misunderstood funding entitlements in the English health and social care system. It pays the full cost of care for adults aged 18 and over whose primary need arises from a health condition. It requires no means test and no individual contribution. It is a legal entitlement under the National Health Service Act 2006, supported by the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care, last updated in July 2022.

It is not being phased out. Only 19 per cent of people who go through a standard assessment are found eligible, a rate that has fallen from 27 per cent in 2017 despite no change to the eligibility criteria. For the people in your care and the families supporting them, understanding how CHC works is one of the most practically useful things a care provider can offer, and demonstrating that understanding in a tender is one of the clearest ways to signal that your organisation operates at a clinical and systemic level, not just a service delivery level.

What CHC Covers and Who It Is For

CHC is available to any adult aged 18 or over with ongoing, complex care needs arising from disability, accident, or illness. Eligibility is not determined by diagnosis. It is determined by the nature, intensity, complexity, and unpredictability of the individual’s day-to-day care needs. Two people with the same diagnosis can receive different CHC outcomes because what matters is the profile of care required, not the clinical label attached to the underlying condition.

Where CHC is awarded, the Integrated Care Board (ICB) is responsible for arranging and funding the full care package at no cost to the individual. This covers:

• Care home fees, whether residential or nursing
• Domiciliary care and live-in care in the person’s own home
• Associated clinical support, therapy, and specialist nursing input
• All assessed health and social care needs arising from the condition, including those that would otherwise be met by local authority social care

Common conditions among CHC recipients include advanced dementia, acquired brain injury, motor neurone disease, multiple sclerosis, complex physical disabilities, Huntington’s disease, and terminal illness. However, any condition can in principle give rise to eligibility if the resulting care needs meet the primary health need threshold as defined by the National Framework. Providers delivering nursing care services will most frequently encounter CHC as the funding route for their most complex long-term placements.

The Assessment Process

The standard CHC process follows two stages. First, a Checklist screening tool is completed by a health or social care professional involved in the individual’s care, often triggered by a hospital discharge review, a care home admission, or a review of an existing care plan. If the Checklist outcome is positive, the ICB arranges a full assessment using the Decision Support Tool (DST), conducted by a multi-disciplinary team of at least two professionals from health and social care. The individual and their representative must be invited to attend and participate in the MDT meeting.

Key facts about the assessment process:

• The National Framework sets a target of 28 calendar days from a positive Checklist to an eligibility decision, though in practice this is frequently exceeded.
• As at Q3 2024/25, 52,008 people in England were eligible for CHC: 34,469 via the standard route and 17,539 via Fast Track.
• The standard assessment conversion rate was 19 per cent in Q3 2024/25, meaning 81 per cent of people who underwent a full DST assessment were found ineligible.
• The ICB ratifies the MDT’s recommendation and should depart from it only in exceptional, documented circumstances.
• Reviews must take place within three months of the initial eligibility decision, then at least annually thereafter.

The Fast Track Pathway

The Fast Track pathway is available for people with a rapidly deteriorating condition that may be entering a terminal phase. It bypasses the Checklist and DST entirely. A single clinician, typically a GP, consultant, or senior nurse with knowledge of the individual’s condition, completes the Fast Track Pathway Tool. The ICB must arrange immediate CHC provision upon receipt, without waiting for a standard assessment.

Fast Track cases may subsequently be moved to standard CHC review if the individual’s condition stabilises. This is a transition that families and providers should be prepared for. The move from Fast Track to standard CHC does not mean the individual has lost entitlement. It means the ICB is required to conduct a full assessment to determine ongoing eligibility through the standard process, with all the same rights to participate, challenge, and appeal. In Q3 2024/25, Fast Track accounted for 63 per cent of all new CHC referrals, reflecting the extent to which the pathway is used for people receiving care in the community in their final months of life. Providers delivering domiciliary care services are increasingly asked to support Fast Track CHC packages in community settings as the NHS shifts care closer to home.

The Decision Support Tool: 12 Domains

The DST assesses the individual’s needs across 12 care domains. The MDT then applies four key characteristics to the overall picture: Nature, Intensity, Complexity, and Unpredictability. A CHC eligibility recommendation is normally indicated in the following circumstances:

• A Priority level of need in any one of the four domains that carry this level: Behaviour, Nutrition, Breathing, or Altered States of Consciousness.
• Two or more Severe findings across any combination of the six domains that carry a Severe level: Behaviour, Cognition, Nutrition, Skin and Tissue Viability, Mobility, and Drug Therapies and Medication.
• A pattern of High and Moderate findings across multiple domains that together demonstrate a primary health need even in the absence of a Priority or double Severe finding.

Two domains, Communication and Psychological and Emotional Needs, do not carry Priority or Severe levels. This is a recognised limitation of the DST for people with dementia, acquired brain injury, and mental health conditions, where some of the most complex care needs fall within these domains but cannot be scored at the levels that trigger automatic eligibility recommendations. In these cases, the four key characteristics of the primary health need test become particularly important, and the overall clinical narrative presented to the MDT matters as much as individual domain scores.

A critical point for providers and families: the DST must reflect the level of need that would exist without the skilled care currently in place. Well-managed needs must still be recorded at the level they represent in reality. A person whose challenging behaviour is successfully managed by expert staff is a high-need person whose needs are being well met, not a low-need person. If the MDT underweights managed needs, the eligibility recommendation will not accurately reflect the individual’s true care profile and the decision may be wrong.

Geographic Variation, Appeals, and NHS-Funded Nursing Care

The degree to which CHC outcomes depend on geography rather than clinical need is a documented systemic failure. The Nuffield Trust found that standard CHC eligibility rates in Q4 2023/24 ranged from 7.3 per cent in Gloucestershire to 42.5 per cent in Leicester, Leicestershire and Rutland, a sixfold difference. The number of people found eligible per 50,000 population ranged from 36.9 in Cornwall to 301.0 in Lincolnshire. This variation is not explained by any difference in the prevalence of complex health need. It reflects inconsistency in how ICBs apply the primary health need test, despite the National Framework being legally binding across all ICBs.

Decisions can be challenged through a three-stage process:

1. Local resolution: a written request to the ICB to review its decision, setting out the specific grounds on which the assessment or decision is disputed.
2. Independent Review Panel: arranged through NHS England, reviewing the decision on grounds of process or application of the eligibility criteria, not on the basis of fresh clinical assessment.
3. Parliamentary and Health Service Ombudsman: the final avenue, which has documented systemic failings in CHC decision-making and can require ICBs to fund care retrospectively.

Retrospective claims for Previously Unassessed Periods of Care can be submitted for historic periods, including after a person has died, and can result in significant refunds of care costs previously paid privately or through local authority means-tested funding. For people in nursing homes who are not eligible for CHC, NHS-Funded Nursing Care contributes £254.06 per week at the standard rate or £349.50 per week at the higher rate in England for 2025/26. It is also not means-tested and cannot be received simultaneously with CHC. Free independent CHC advice is available from the Beacon service at beaconchc.co.uk or on 0345 548 0300, funded by NHS England, providing up to 90 minutes of personalised guidance.

For wider context on how CHC intersects with the adult social care system, see our guide to social services adult care: what it means, who it’s for, and how it works in 2026.

Providers bidding for CHC-commissioned services, whether nursing home placements, specialist home care, or community health services, are assessed against criteria that go beyond standard care quality. ICBs expect to see clinical governance frameworks, evidence of managing complex and unpredictable need, familiarity with the National Framework, and a demonstrable understanding of how CHC intersects with the broader care funding landscape. Our bid management services help you build that case clearly, credibly, and compliantly.

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