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.
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.
Where CHC is awarded, the Integrated Care Board is responsible for arranging and funding the full care package at no cost to the individual, covering domiciliary care and live-in care, care home fees, specialist nursing care, and all associated clinical support arising from the condition. Common conditions among CHC recipients include advanced dementia, acquired brain injury, motor neurone disease, multiple sclerosis, complex physical disabilities, and terminal illness. Any condition can in principle give rise to eligibility if the resulting care needs meet the primary health need threshold.
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. If the outcome is positive, the ICB arranges a full assessment using the Decision Support Tool, conducted by a multi-disciplinary team of at least two professionals. The individual and their representative must be invited to attend and participate.
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 National Framework sets a target of 28 calendar days from a positive Checklist to an eligibility decision, though in practice this is frequently exceeded. The ICB ratifies the MDT recommendation and should depart from it only in exceptional, documented circumstances.
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, with a single clinician completing the Fast Track Pathway Tool and the ICB arranging immediate provision. In Q3 2024/25, Fast Track accounted for 63 per cent of all new CHC referrals.
The Decision Support Tool: 12 Domains
The DST assesses needs across 12 care domains, with the MDT applying four key characteristics to the overall picture: Nature, Intensity, Complexity, and Unpredictability. Eligibility is normally indicated by a Priority level of need in any one of four domains — Behaviour, Nutrition, Breathing, or Altered States of Consciousness — or two or more Severe findings across the six domains that carry a Severe level.
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 and Appeals
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. 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 across England.
Decisions can be challenged through local resolution first, then an Independent Review Panel through NHS England, and finally the Parliamentary and Health Service Ombudsman. Retrospective claims for Previously Unassessed Periods of Care can be submitted for historic periods, including after a person has died. For people in nursing homes not eligible for CHC, NHS-Funded Nursing Care contributes £254.06 per week at the standard rate or £349.50 at the higher rate in England for 2025/26. Free independent CHC advice is available from the Beacon service at beaconchc.co.uk or on 0345 548 0300.
For wider context on how CHC sits within the adult social care funding landscape, our guide to social services adult care: what it means, who it’s for, and how it works in 2026 is worth reading alongside this piece.
What This Means for Providers
Understanding CHC is contextually important beyond the providers directly commissioned to deliver CHC packages. If you deliver supported living services to people with complex health needs, some of your current service users may be eligible for CHC and not know it. Identifying that eligibility and supporting a family through the assessment process is part of what person-centred, outcomes-focused care looks like in practice and is exactly the kind of evidence commissioners want to see in method statements.
Providers bidding for CHC-commissioned 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, and genuine familiarity with the National Framework. The providers who score consistently well in these tenders are not those with the longest policies. They are those who can demonstrate they understand what CHC-eligible need actually looks like and have built their service model around it.
AssuredBID
CHC rewards providers who understand the system deeply and evidence their clinical governance rigorously. Our bid management services help you build that case clearly, credibly, and compliantly, from method statements to pricing to pre-submission review.
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