If someone you love needs ongoing care, the financial side of it can feel overwhelming very quickly. Care home fees, home care costs, council assessments: it is a lot to take in at a difficult time. What many families do not know is that there is a separate route entirely, one that has nothing to do with means tests or savings or the value of your home.
NHS Continuing Healthcare is a package of care arranged and paid for entirely by the NHS. It is a legal entitlement, not a charity, and it is one that many families only discover by chance, often far too late. This guide explains what it is, who qualifies, and how to ask for an assessment.
What Is NHS Continuing Healthcare?
NHS Continuing Healthcare (also known as NHS CHC or CHC funding) is a free, fully funded care package for adults aged 18 and over who have significant, ongoing health needs. The NHS arranges and pays for all of it: whether that care is provided at home, in a care home, or in a hospice.
The key word is “funded.” Not means-tested. Not a contribution. The NHS covers the entire cost, and your income, savings, and property are not assessed at any point. If you are eligible, it does not matter whether you own your home outright or have significant savings.
NHS Continuing Healthcare is available in England. Scotland replaced it in 2015 with a different system, Hospital Based Complex Clinical Care, which is restricted to patients whose needs can only be met in hospital. If you are reading this in Scotland, the rules are different and you should speak to your local health board.
How CHC Differs from Means-Tested Social Care
This distinction matters, and it is worth spelling out clearly, because the difference between NHS-funded care and council-funded care has significant financial consequences for your family.
When a local authority (council) funds social care, it applies a means test. In England, the upper capital limit is £23,250 for 2026/27. If your assets are above that threshold, you pay for your own care. And if you move into a residential care home permanently, the value of your property can be counted as part of that capital once your other assets fall below the threshold, aside from a short initial disregard in the first 12 weeks.
The practical consequence is significant. At an average of £1,535 per week for a nursing home in England, a family can exhaust substantial assets in a matter of years. In London, where nursing home costs average £1,759 per week, the arithmetic is even starker. A property that families hoped to pass on can be drawn into funding calculations and gradually disappear. For more on the different ways care can be paid for, see how live-in care is funded.
With NHS Continuing Healthcare, none of this applies. There is no means test. There is no assessment of savings, income, or property. The NHS funds the care because the person’s health needs meet the qualifying threshold, full stop. If CHC funds care at home, your family member’s home is not at risk. It is not counted. It is simply where they live.
Many families paying care home fees out of their own pocket, or watching a parent’s savings erode, are unaware that CHC exists. Healthwatch reported in October 2025 that many people only discovered the entitlement through a Facebook post or a conversation with someone in a similar situation. One family had paid over £70,000 out of pocket for care that the NHS should have been funding. This is not rare. It is, unfortunately, common.
Who Is Eligible for NHS Continuing Healthcare?
Eligibility for CHC is based entirely on whether the person has what is called a “primary health need.” This means that the main part of the care they require is focused on addressing or preventing health needs, rather than social care needs.
There is no fixed list of qualifying conditions. A diagnosis alone, whether dementia, Parkinson’s disease, or a neurological condition, does not automatically make someone eligible. What matters is the nature, intensity, complexity, and unpredictability of their needs. Someone with advanced dementia who requires constant skilled intervention to manage behaviour, risk, or medication may qualify. Someone with the same diagnosis whose day-to-day needs are primarily social may not. You can read more about how we support people living with dementia on our live-in dementia care service page.
Assessors consider needs across several domains, including cognition, behaviour, mobility, continence, skin and tissue care, breathing, nutrition, medication management, and psychological wellbeing. Each domain is given a weighting: priority, severe, high, moderate, low, or no needs. As a general guide, one priority need, or severe needs in two or more domains, usually results in eligibility. A pattern of high and moderate needs across several domains may also qualify, depending on how they interact.
If you are unsure whether your family member might qualify, the right answer is to ask for an assessment. You lose nothing by asking. Many people who do qualify are never assessed because no one tells them to ask.
The Assessment Process: Step by Step
The process has two main stages, with a faster route available for people approaching end of life.
Step 1: Request an Assessment
Anyone can trigger the process: you, your family member, their GP, a hospital discharge team, a social worker, or the care home or care agency involved in their care. Contact your local Integrated Care Board (ICB), the NHS body responsible for commissioning local health services, and ask for a CHC assessment. You can find your local ICB on the NHS website.
You do not need a formal referral form. A clear request is enough. If a healthcare professional is reluctant to refer, you can raise the request directly with the ICB.
Step 2: The Checklist
A nurse, doctor, or social worker trained in CHC will complete an initial screening tool called the Checklist. This is not the full assessment: it is a screening to decide whether a full assessment is warranted. You should be told that the Checklist is being completed and given a written copy of the result.
If the Checklist indicates that a full assessment may be appropriate, you will be referred for one. Being referred does not mean you will definitely qualify, but it means the process continues.
Step 3: The Full Multidisciplinary Assessment
A team of at least two health and social care professionals, drawn from the people already involved in the person’s care, completes a detailed assessment using the Decision Support Tool (DST). You and your family member have the right to attend this meeting and to contribute.
One important piece of practical advice from families who have been through this process: describe the person’s needs based on their worst days, not their best. If their condition fluctuates, that unpredictability is itself a relevant factor. Do not minimise or present an optimistic picture at the expense of an honest one.
Step 4: The Decision
The ICB makes the final eligibility decision, normally within 28 days of receiving the completed Checklist or the request for a full assessment. If the ICB takes longer than 28 days and the delay is not justified, it should refund care costs from day 29 until the decision date, if the person is found eligible.
You should receive the decision in writing, with clear reasons given.
The Fast-Track Pathway
If your family member’s condition is deteriorating rapidly and they are approaching end of life, there is a fast-track pathway that bypasses the standard two-stage process. A medical professional completes a fast-track referral, and the aim is to have a care package in place within 48 hours. If you believe this applies, ask the healthcare team to consider the fast-track pathway immediately. Where end-of-life care is needed at home, our palliative and end-of-life care service can provide compassionate, fully qualified support.
What Happens If You Are Eligible?
If CHC is awarded, the ICB works with you and your family member to arrange a care package. That package can include care at home, in a care home, or in a hospice. Where care at home is the right option, the NHS funds all of the care needed, including personal care such as help with washing, dressing, medication management, and more.
Your family member also has a legal right to request a Personal Health Budget. This gives more choice and control over how the care is arranged. With a direct payment, for example, you can choose a specific carer or care agency, giving you full say over who comes into the home.
Once a CHC package is in place, VersaCare can work with the ICB to provide a dedicated, fully qualified live-in carer. Our carers are employed by a fully CQC-registered agency (registration number 1-139043195), with local Care Managers on hand and an electronic care reporting system that lets family members follow care in real time. If peace of mind matters to you, and we know it does, that transparency makes a real difference.
The care package is reviewed after three months and then at least annually to ensure it continues to meet your family member’s needs.
What If Your Application Is Refused?
A refusal is not the end of the road. The eligibility rate for CHC has fallen sharply in recent years, from 31% of those assessed in 2017/18 to just 17% in 2025/26, according to NHS England data compiled by Healthwatch. Inconsistency between areas is well-documented. Families who challenge decisions often succeed.
If you are refused CHC, you have several options.
First, ask the ICB to reconsider its decision at a local resolution meeting. You can attend and present evidence. If you are still unhappy after local resolution, you can ask for an independent review through NHS England. Where families have representation at the independent review stage, whether from a solicitor, advocate, or a specialist organisation, success rates rise significantly.
We have attended many CHC assessment and appeal meetings alongside families, and the pattern we see is consistent: the single most important factor in a successful appeal is evidence. Decisions are genuinely difficult to overturn, and an appeal that simply restates the original case rarely changes the outcome. What makes the difference is fresh, concrete proof that the person’s needs meet the threshold, set out so clearly that it is hard to dispute. In our experience, that evidence usually comes from the day-to-day records kept by those providing the care: carer daily notes, medication administration record (MAR) sheets, and incident forms. These show the true nature, intensity, and unpredictability of someone’s needs over time, rather than the single snapshot captured on the day of an assessment. If you are preparing an appeal, gather this documentation and use it to demonstrate, in detail, why continuing healthcare is necessary.
As a final route of appeal, you can contact the Parliamentary and Health Service Ombudsman.
If you funded care privately during a period when you believe your family member should have been assessed for CHC, you may be able to request a retrospective assessment for that period. These are known as previously unassessed periods of care and are generally considered for care provided after April 2012.
The process can feel exhausting, particularly on top of everything else you are managing. An organisation called Beacon CHC offers up to 90 minutes of free independent advice and can help you understand your options. Call them on 0345 548 0300.
CHC and Live-in Care at Home
One of the most important things to know about NHS Continuing Healthcare is that it can fund care at home. You do not have to move into a residential or nursing home to access fully funded NHS care. The two options are available, and the choice of where care is provided should reflect what is right for your family member.
For many families, staying at home is far preferable. Familiar surroundings, a consistent carer who knows the person well, independence maintained, and family able to visit freely. The research on outcomes for people with dementia and other conditions consistently points to the benefits of continuity and familiarity.
Care at home under CHC also means that the property question simply does not arise. As set out above, CHC carries no means test, so the home is not assessed regardless. But there is an additional practical point: if your family member stays at home with a live-in carer, the home continues to be used and looked after, and your family’s plans for it remain intact.
VersaCare works with Local Authorities and NHS Trusts across England, and we understand how CHC packages operate in practice. Once eligibility is established, we can provide a highly personalised, carefully matched live-in carer to deliver that care at home. Our Area Managers cover regions across the country, and our electronic care reporting system ensures families can follow care in real time, wherever they are.
If you would like to talk through what live-in care could look like for your family, call us on 0800 0087 661 for a free care consultation. There is no obligation and no pressure: just a conversation. Or visit our contact page to get in touch at a time that suits you.