NHS Continuing Healthcare (CHC)

When someone needs a lot of support, families often assume they must pay for care themselves or go through social services.

But that is not always true.

Some people may qualify for NHS Continuing Healthcare (CHC), which is a package of care arranged and funded entirely by the NHS for adults aged 18 or over with a primary health need. Eligibility is not based on diagnosis, disability label, or income. It is based on the nature, intensity, complexity, and unpredictability of the person’s needs.

That means two people with the same diagnosis may be treated differently depending on how their needs actually present day to day.

NHS Continuing Healthcare is funding for people whose care needs are mainly health-related rather than purely social care-related. If someone is found eligible, the NHS pays for their assessed care package. This can sometimes be provided in their own home, a care home, or another suitable setting.

This is different from:

• Local authority social care funding, which is usually means-tested

• NHS-funded Nursing Care (FNC), which is only a contribution toward nursing care in a nursing home and only applies if the person is not eligible for full CHC

A person may be considered for CHC if they have substantial ongoing needs due to illness, disability, accident, frailty, neurological condition, dementia, or another serious health condition.

It is not awarded just because someone is elderly, has dementia, or needs a carer. The key question is whether they have a primary health need. NHS decision-making looks at the overall picture, including the interaction of needs and the risks involved.

There are usually two main stages.

1. The Checklist

This is the initial screening tool. It does not decide final eligibility. It is used to decide whether the person should go forward for a full assessment.

2. Full assessment using the Decision Support Tool

If the Checklist indicates it, a multidisciplinary team carries out a fuller assessment using the Decision Support Tool (DST). This looks at a range of care domains and the evidence behind them.

The person and/or their representative should be involved, their views should be taken into account, and they should be given copies of the decision documents and reasons for the decision.

There is also a fast-track pathway for people whose condition is rapidly deteriorating and who may be entering an end-of-life phase. In those cases, funding should be arranged urgently, often within 48 hours.

If someone does not qualify for full CHC but does need care from a registered nurse and lives in a nursing home, they may qualify for NHS-funded Nursing Care (FNC) instead. This is a flat-rate payment made by the NHS directly to the nursing home toward the nursing element of the fees.

So, in simple terms:

• CHC = full package funded by NHS

• FNC = nursing contribution only, usually in a nursing home

Because families are often never clearly told it exists.

People may be discharged from hospital, pushed toward private fees, or told to arrange care urgently without anyone properly explaining that an NHS Continuing Healthcare assessment may be relevant.

This matters because:

• some people may be paying for care they should not be paying for

• families often confuse social care funding with NHS responsibility

• carers may be supporting clients with very high health needs without understanding the funding route behind the care package

• poor records and vague descriptions of need can weaken the real picture of what the person actually requires

A CHC decision is not based on:

• the diagnosis alone

• whether someone lives at home or in a care home

• whether their family is wealthy

• whether they “seem settled” because good carers are holding everything together

In fact, one of the biggest problems is that well-managed needs can sometimes be underestimated. A person may look stable only because someone is constantly monitoring, prompting, repositioning, supervising, managing risk, or preventing deterioration.

That is exactly why accurate notes matter.

It matters because “needs care” and “should privately pay for care” are not the same thing.

NHS Continuing Healthcare exists for people whose needs are primarily health needs, but many families have never heard of it until they are already exhausted, frightened, and paying large bills.

For carers, this matters too.

If you are documenting severe confusion, double incontinence, skin risks, falls, unpredictable behaviours, swallowing concerns, medication complexity, or the need for frequent monitoring, you may be recording the very evidence that shows the person’s needs are more than “just social care.”

CHC does not apply to everyone.
But when it does apply, missing it can cost families dearly.

If you think someone may have substantial ongoing health needs, ask whether they should be considered for an NHS Continuing Healthcare Checklist assessment.

That request may be raised through professionals involved in their care, such as hospital discharge teams, social workers, GPs, community nurses, or care home staff.

Keep notes factual, specific, and detailed.

Instead of writing:
“Needs lots of help”

Record:

• what support was needed

• how often

• what risks were present

• what happened when support was delayed, refused, or ineffective

• what monitoring or intervention was needed to keep the person safe

That kind of evidence matters.