NHS continuing healthcare: who qualifies and how the checklist works
How NHS continuing healthcare is decided in England, from the checklist and full assessment to Fast Track, nursing care funding and appeals.
What is NHS continuing healthcare?
NHS continuing healthcare (usually shortened to CHC) is a package of ongoing care arranged and paid for solely by the NHS for an adult assessed as having a "primary health need". The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, the Department of Health and Social Care guidance that sets out the process in England (in the revised version that took effect on 1 July 2022, last corrected in July 2023), says the package covers both health needs and the associated social care needs, and Age UK's July 2026 factsheet notes that this includes the accommodation where a care home is part of the overall need.
It is not means-tested, because the Framework says financial issues should not be considered when deciding eligibility, and once someone is eligible they cannot be asked to pay towards their assessed needs. It can be provided in any setting, including your own home or a care home, and integrated care boards (ICBs), the NHS bodies that commission local health services, carry out the assessments and make the decisions.
Who qualifies for NHS continuing healthcare?
You qualify if the ICB decides that you have a primary health need, which broadly means that the nursing and other health care you need goes beyond what a council could be expected to provide within the limits set by section 22 of the Care Act 2014. Assessors look at four characteristics of your needs (their nature, intensity, complexity and unpredictability), and the Framework says any one of these, alone or in combination, can show a primary health need.
A diagnosis does not settle the question either way. The Framework also says that well-managed needs are still needs, which means a need is not discounted just because good care is keeping it under control, and that a decision should not rest on the setting of care or on whether a particular provider can manage it.
How does the continuing healthcare checklist work?
The checklist is a short screening tool that decides whether you need a full assessment, and its threshold is deliberately low so that anyone who might be eligible gets that opportunity. It covers 11 areas of need, such as breathing, mobility, cognition and behaviour, each rated A, B or C, where A is the highest level of need. Under the DHSC checklist guidance, updated in October 2026, a full assessment is required if two or more areas are rated A, if five or more are rated B (or one A and four B), or if one of the areas marked on the form as a priority is rated A.
A trained nurse, GP, other clinician or social worker can complete it, and the Framework expects one whenever someone needs a long-term place in a care home with nursing or has significant support needs. You should normally be given the chance to be present, and although you cannot refer yourself by filling one in, you can ask your ICB for one. The outcome should be given to you in writing, normally as a copy of the checklist, and if it is negative you can ask the ICB to reconsider, although it does not have to carry out a new one.
What happens at the full CHC assessment?
A full assessment is carried out by a multidisciplinary team of at least two professionals from different health professions (or one health professional and one person who carries out Care Act assessments), who record the evidence about your needs in the Decision Support Tool. The Decision Support Tool guidance sets out 12 care domains: breathing, nutrition, continence, skin and tissue viability, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, altered states of consciousness and other significant care needs. Each domain has levels of need from no needs upwards, with a severe level in most domains and a priority level in four of them.
The guidance says a clear recommendation of eligibility would be expected where there is a priority need in any of those four domains, or two or more severe needs in total, whilst a severe need alongside needs in several other domains, or several high or moderate needs, may also indicate a primary health need. The ratings guide rather than decide, so the team still has to explain its recommendation against the four characteristics, and it should give appropriate weight to your own view of your needs.
The ICB makes the decision and, according to the Framework, should depart from the team's recommendation only in exceptional circumstances and should decide independently of budgets. The process should not usually take more than 28 calendar days from the ICB receiving a positive checklist, and NHS.uk says that if an unjustified delay beyond that ends with you being found eligible, the ICB should refund care costs from the 29th day. The written decision should give the reasons and include a copy of the completed tool.
What is the Fast Track Pathway for continuing healthcare?
The Fast Track Pathway is a quicker route for someone whose condition is deteriorating rapidly and who may be entering a terminal phase, and it replaces both the checklist and the full assessment. It is completed by an "appropriate clinician", meaning a registered nurse or doctor responsible for the person's care (which can include hospice clinicians), and a properly completed form is enough on its own to establish eligibility, so the ICB must accept it and act on it immediately.
The Framework says the care package should not usually take more than 48 hours to arrange, and it warns against strict time limits based on life expectancy, because the pathway is not restricted to situations where death is imminent. It can be used at home or in a care home, and because eligibility may be reviewed later, the clinician should explain at the outset that the funding could change. If you have views on where you would want to be cared for towards the end of life, our guide to living wills and advance decisions explains how to record them in an advance statement.
What happens if you are not eligible?
If you are not eligible but need a care home that provides nursing, the NHS may still pay towards the nursing part of the fees through NHS-funded nursing care. You may qualify where you need care from a registered nurse and your needs are best met in a nursing home, and because CHC is always considered first, NHS.uk says most people do not need a separate assessment. The ICB pays a flat weekly rate straight to the home, which NHS.uk's page on NHS-funded nursing care gives as £267.68 a week from 1 April 2026, or £368.24 for residents who moved in before 1 October 2007 and were on the previous high band. It is paid whoever funds the rest of the fees, but it covers only registered nursing time, not personal care or accommodation.
The rest of your care falls to the council, which assesses your needs and finances separately, as our guide to care needs assessments and how a care home is paid for explains, whilst our guide to deprivation of assets and care home fees covers the capital limits. Where some health needs remain, the NHS and the council can share the cost through a joint package of care.
How often is NHS continuing healthcare reviewed?
The Framework expects a review within three months of the decision and then at least once a year, because eligibility is not indefinite, and reviews mainly check that the care plan still meets your needs. A full reassessment with a new Decision Support Tool is needed only where there is clear evidence that your needs have changed enough to affect eligibility.
CHC funding can affect benefits, because Age UK's factsheet says Attendance Allowance, and the care or daily living parts of Disability Living Allowance and Personal Independence Payment, are suspended 28 days after NHS funding begins in a care home (and in a nursing home where its nurses treat you, the mobility parts can stop as well), although they can continue with CHC at home. Our guide to Attendance Allowance explains how that benefit works. Anyone eligible for CHC has also had a right to a personal health budget since October 2014, which can be paid as a direct payment and gives you more say in how the money is spent.
How do you challenge a continuing healthcare decision?
You start by asking the ICB to review its decision under its local resolution procedure, which every ICB must have and which normally begins with a discussion of how the decision was reached before moving to a formal meeting. Age UK's factsheet says you have six months from receiving the written decision to ask, and suggests relating your reasons to particular domains in the Decision Support Tool.
If that does not settle it, you can ask NHS England for an independent review, which Age UK says should be requested in writing within six months of the local resolution outcome. NHS England's page on independent review panels says each panel has an independent chair, with ICB and council representatives who are not involved in the case, and the Framework says its recommendations are advisory but should be accepted in all but exceptional circumstances. Nobody needs to be legally represented, although a relative or advocate can speak for you. The final stage is the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman), which expects you to complain to the organisation first and to come to it within 12 months of knowing about the problem.
Where a relative asks for a review without a lasting power of attorney or deputyship, the Framework says the person's own agreement is sought, or a best interests process used if they lack capacity, so a registered LPA makes it clearer who can act, as our guide to setting up a lasting power of attorney explains. Separately, if you paid for care during a past period when you should have been considered for CHC but were not, GOV.UK guidance allows a request for an assessment of that "previously unassessed period of care", generally only for care from 1 April 2012.
How is it different in Wales, Scotland and Northern Ireland?
Wales: Continuing NHS Healthcare is assessed by local health boards under the Welsh Government's own 2021 national framework, updated by an interim policy statement on direct payments from 1 April 2026.
Scotland: CHC was replaced on 1 June 2015 by Hospital Based Complex Clinical Care, which turns on whether your care needs can be properly met in any setting other than a hospital, a question answered by a consultant with the multidisciplinary team. If they can, you move to a community setting where council charging and free personal and nursing care apply, although people already receiving CHC before that date keep it while they remain eligible.
Northern Ireland: The Department of Health's 2021 policy asks a similar single question, and the Commissioner for Older People for Northern Ireland reports that it remains in force since the UK Supreme Court refused permission for a further appeal in 2025, so your Health and Social Care Trust is the place to ask.
What to do next if continuing healthcare might apply
Ask for a checklist when needs become significant, particularly before a long-term move into a nursing home, through the GP, the hospital ward, the social worker or the ICB.
Gather evidence such as care notes and a record of the help needed by day and by night, since the Framework lists a 24 or 48-hour diary of needs and interventions, along with carers' views, among the evidence an assessment can draw on.
Ask to take part in each assessment, and ask for copies with the written reasons.
If health is deteriorating quickly, ask the treating nurse or doctor whether the Fast Track Pathway applies.
Note the 28-day expectation for a decision and the deadline for asking the ICB to review it.
Read Age UK's free factsheet on continuing healthcare if you are unsure, and make sure someone has legal authority to act if capacity may become an issue.
Keeping a clear note of the accounts and benefits someone holds alongside their care paperwork makes life easier for whoever deals with their affairs later, and if that work falls to your family after a death, Legacy Trail's free notification service can contact the banks, utilities and other private-sector companies for them.
Frequently asked questions
No. Continuing healthcare is not means-tested, so your home and savings play no part in the decision, and the NHS pays for your assessed care, including a care home place, for as long as you remain eligible. If a later review finds you are no longer eligible, the council's means test would then apply to any care it arranges, and that is when the value of a home can become relevant.
No. NHS.uk says a continuing healthcare package cannot be topped up in the way a council-funded care home place can. You can pay privately for extra services on top of what the NHS provides, but these should come from different staff and preferably be provided in a different setting.
Not on its own, because a diagnosis does not decide eligibility. Someone with dementia may qualify if the nature and intensity of their needs, for example around cognition and behaviour, amount to a primary health need, and needs that are being well managed by good care still count.
You or a relative can ask the integrated care board, a GP, a hospital team or a social worker to arrange a checklist. Nobody can qualify by completing a checklist themselves, and personal information can be shared with family only with the person's consent, or through a best interests decision if they lack capacity.
Yes. Continuing healthcare can be provided in your own home, and the eligibility test is the same whatever the setting. At home the integrated care board pays for all your assessed health and associated care needs, although not everyday living costs such as rent and food, and a personal health budget can give you more control over how that care is arranged.
This article is for general information only and does not constitute legal advice. Individual circumstances vary. If you are dealing with an estate, consider taking advice from a solicitor who specialises in probate. For other guidance specific to your circumstances, speak to a funeral director, Citizens Advice, or a regulated financial adviser.