NHS Continuing Healthcare: Eligibility, Checklist, Appeals

Some people with long-term complex health needs qualify for free health and social care arranged and funded solely by the NHS. This is known as NHS continuing healthcare. It can be provided in a variety of settings outside hospital, such as in your own home or in a care home. It is for adults aged 18 or over. Children and young people may receive a "continuing care package" instead.

CHC is free, unlike support provided by local authorities, which may involve a financial contribution depending on income and savings. If you are found eligible in your own home, the NHS pays for your package of care and support. If you are found eligible in a care home, the NHS pays your care home fees, including board and accommodation.

You are eligible if you are assessed as having a primary health need. Your eligibility depends on your assessed needs, not on any particular diagnosis or condition, and if your needs change then your eligibility may change. The assessment looks at the whole of your relevant needs against 4 characteristics:

• ✓Yes: nature: the type of your needs and the overall effect they have on you
• ✓Yes: intensity: how extensive and severe your needs are, including any need for sustained or ongoing care
• ✓Yes: complexity: how your needs present and interact, and the skill needed to manage them
• ✓Yes: unpredictability: how much your needs fluctuate, including the risks to your health if care is not provided at the right time

The full assessment records your needs under 12 headings: breathing, nutrition, continence, skin, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medicine, altered states of consciousness, and other significant care needs. Each is given a weighting of priority, severe, high, moderate, low or no needs. If you have at least 1 priority need, or severe needs in at least 2 areas, you can usually expect to be eligible. You may also be eligible with a severe need in 1 area plus a number of other needs, or a number of high or moderate needs.

You should be fully involved and have your views taken into account, and carers and family should be consulted where appropriate. The ICB must assess you if it seems you may need CHC. A decision about eligibility for a full assessment should usually be made within 28 days of an initial assessment or request for a full assessment, and the decision on eligibility should normally be made within 28 days of the ICB getting a completed checklist or request for a full assessment.

Consent is not needed to complete the assessments or to share information with care teams and health and social care staff. Consent is needed to share personal information from the assessments with third parties such as family, friends or representatives.

If your health is deteriorating quickly and you are nearing the end of your life, you should be considered for the fast-track pathway so that care and support can be put in place as soon as possible, usually within 48 hours. There is no need for a checklist or the decision support tool. An appropriate clinician completes a fast track pathway tool and sends it to the ICB.

If the ICB decides you are eligible but takes longer than 28 days to decide this and the delay is unjustifiable, it should refund any care costs from the 29th day until the date of its decision.

The ICB arranges a care and support package that meets your assessed needs, and should work with you and consider your views on the package and setting. It can also take cost and value for money into account. You have had a right to a personal health budget since October 2014, and the ICB should offer one, including a direct payment for healthcare.

Your needs and package are normally reviewed within 3 months and then at least annually. If your needs have changed, the review will consider whether you are still eligible. Neither the NHS nor the local authority should withdraw from an existing care or funding arrangement without a joint reassessment of your needs, and without first consulting each other and you.

You cannot top up an NHS continuing healthcare package the way you can with a council care package. The only way to pay privately on top is to buy additional private services on top of what you are assessed as needing from the NHS, ideally from different staff and in a different setting.

The ICB can, with your permission, refer you to your local authority to discuss whether you may be eligible for support from them. If you still have some health needs, the NHS may pay for part of the package, known as a joint package of care. There is no charge for the NHS elements of a joint package, but the council may charge a contribution towards its part depending on your income and savings.

If you are assessed as needing nursing care in a care home that is registered to provide nursing care, you are eligible for NHS-funded nursing care. The NHS pays a flat rate directly to the care home towards the cost of registered nursing care, whoever funds the rest of the fees. The NHS website says the rate set on 1 April 2026 is £267.68 a week, and that people who moved into a care home before 1 October 2007 on the previous high band get a higher rate of £368.24 a week.

An organisation called Beacon gives free independent advice on NHS continuing healthcare. You can call its free helpline on 0345 548 0300.

You may be able to ask for your eligibility to be considered for a previously unassessed period of care if you should have been considered for CHC at the time but were not, and you fully or part-funded your care. These requests are usually only considered for periods of care after April 2012.

The national framework described here applies in England. Wales has its own national framework for Continuing NHS Healthcare, where local health boards assess your health-based needs, and an interim policy statement on direct payments took effect on 1 April 2026.

Under the Welsh framework the sole criterion for eligibility is whether your primary need is a health need. A checklist is not mandatory, but if one is used it must be completed by at least 2 practitioners. Care packages must be in place no later than 8 weeks from the point it was considered you may have a primary health need, and fast track assessments should be completed within two days. The first review of a care plan should be within 3 months of services starting, then at least annually.

To challenge a decision on CHC or NHS-funded nursing care, tell your local health board in writing within 28 days of receiving the decision letter that you intend to appeal, then submit a written appeal within 6 months of being told the decision. Once local procedures are exhausted, referral to the Independent Review Panel should be considered, and if the panel upholds the decision you can go to the Public Services Ombudsman for Wales.

If you paid towards your care and think you were eligible, you can ask for a retrospective review. The period reviewed will be no longer than 12 months before the date of application, and you must provide evidence of the fees you paid within 5 months of registering the claim.

Scotland has its own arrangement for long-term complex clinical care, called hospital based complex clinical care, and its assessment is built around a single eligibility question: can the individual's care needs be properly met in any setting other than a hospital? The assessment is carried out by the responsible consultant or equivalent specialist, informed by the multi-disciplinary team, in partnership with you and your family or carer.

If you do not meet that question you are discharged from NHS care to a community setting such as home with support, a care home or supported accommodation. At that point the council's charging policies apply and you may have to contribute towards the cost of your care. If you have a health need, the NHS is still responsible for meeting it free of charge, although people in care homes are asked to contribute towards their social care and accommodation costs depending on their financial circumstances.

Separately, Scotland has free personal and nursing care. You can get personal care for free from your local council if your care needs assessment shows you need it, regardless of your age, income, savings or relationship status, and nursing care from the NHS in your own home is free. For care home fees, the personal and nursing care payment rates from 1 April 2026 are £260.30 a week for personal care and £117.10 a week for nursing care. You can only get these payments after an assessment of your care needs.

nidirect says that if you live in a nursing home and have assessed nursing needs, your Health and Social Care Trust will pay £100 per week towards the fees to cover the cost of the nursing element. Some people have their care fully paid for by their Trust, which is called continuing health care. Hospital staff, your GP or a social worker can help arrange an assessment if you think you qualify.

The Department of Health's guidance, effective from 11 February 2021, sets a single eligibility question for continuing healthcare: can your care needs be properly met in any other setting other than a hospital? The decision is a specialist judgement following assessment by a multidisciplinary team, and everyone in hospital care three months (90 days) after admission should be considered against it unless they are deemed medically fit. If the answer is yes, you are discharged to the appropriate care setting and the relevant charging policy applies.

Where your need is met in a residential or nursing home, the law requires the Trust to levy a means-tested charge. If your own home is the right setting, there is currently no charge for services there, and you may be eligible for up to 6 weeks uncharged placement through the intermediate care pathway after hospital.

If you are dissatisfied with the outcome of an assessment you can seek a review. If disagreement persists, you can use the formal HSC complaints procedure through your Trust, and if you are still dissatisfied you can refer your complaint to the Northern Ireland Public Services Ombudsman. The Patient and Client Council gives free, independent and confidential help and advice about the complaints procedure on Freephone 0800 917 0222.