NHS continuing healthcare (CHC)

A need that is related to a condition or impairment can either be a:

• social care need
• health need

Social services meet social care needs. NHS continuing healthcare must be for primary health needs.

You will have a primary health need if the main reason you have care is to support your health needs or prevent them getting worse.

During your application process, the assessor must follow the national framework for NHS continuing healthcare and NHS-funded nursing care.

Guidance for the national framework for NHS continuing healthcare (GOV.UK)

If the assessor does not follow the framework, you can make a complaint.  

Challenging or complaining about CHC

You are more likely to qualify for CHC if your medical needs are:

• complex or severe
• multi-disciplinary (a range of medical professionals involved)
• unpredictable
• currently not managed
• going to get worse if not supported by medical professionals

If you are in hospital and have a primary health need, speak with a health care professional before you are discharged.

Letter template to request an assessment for continuing healthcare (Access Social Care)

If they agree, they will start the application and complete the checklist.

CHC checklist

If they do not agree, you can contact your local integrated care board and ask them to complete the checklist.

Find your local integrated care board (NHS)

If you already get social care support, you might be eligible for continuing healthcare if:

• your needs are getting more medical
• you have got worse, especially if this is because lack of medical care
• your needs are seen as too complicated and are unmet

Social care should only meet social care needs. Continuing healthcare must fund a primary health need.

If you think your needs are medical, ask your local authority for a social care review. Say that you have a primary health need and ask for a CHC checklist assessment.

Letter template to request an assessment for continuing healthcare (Access Social Care)

You can go to your local integrated care board (ICB) for an assessment. But you’re more likely to get continuing healthcare if a social worker or your GP thinks your needs are medical. They will support your CHC application.

Unlike social care, continuing healthcare:

• is not means-tested
• does not have a financial assessment

This means you do not contribute money towards CHC.

If you’ve been in hospital and come out with long-term health needs, the CHC process would start. You might need to ask a healthcare professional to complete the checklist if this is not done automatically.

If you have been in hospital because of your mental health, the support you receive might be different.

Leaving hospital (Mind)

You might get section 117 aftercare, which is free care similar to CHC.

If section 117 aftercare does not meet all your needs, you can get CHC at the same time.

To apply for continuing healthcare, you need to ask for an assessment. You can ask:

• your social worker
• healthcare professional
• your local integrated care board (ICB)

The assessment has 2 parts:

1. the eligibility checklist
2. a full assessment using the decision support tool (DST)

Most people will need to have the checklist assessment before they can ask for a full assessment.

If your condition is getting worse very quickly or might become terminal, you do not need the checklist assessment.

Terminally ill people and benefits

You can go straight to the full assessment. Ask your social worker or a healthcare professional if you qualify for the fast-track CHC assessment.

Fast-track pathway tool for NHS continuing healthcare guidance (GOV.UK)

Letter template to request a fast-track CHC assessment (Access Social Care)

A health professional or social worker fills out the checklist. This is to see if you qualify for a full continuing healthcare assessment. The checklist looks at:

• breathing, such as nebulisers, oxygen or tracheostomy
• nutrition, such as needing support to have food and drink or being unable to take food or drink by mouth
• continence, such as needing a stoma or catheter
• skin and tissue viability, such as pressure sores
• mobility, such as being unable to bear weight, being a fall risk or having involuntary spasms
• communication, such as needing support to communicate, being non-verbal or being unable to express your needs
• psychological and emotional needs, such as anxiety that means you’re unable to look after yourself
• cognition, such as being unable to make decisions about basic care needs and daily living activities
• behaviour that can put you or others at risk
• drug therapy, such as prompting to take medication or high pain levels that needs a registered nurse to give medication
• altered states of consciousness, such as frequent seizures or fainting that needs specialist intervention

NHS continuing healthcare checklist and guidance (GOV.UK)

The checklist assessment should take 30 minutes to complete. The health professional will look at each area and score your needs as A, B or C:

• A: significant medical need
• B: moderate medical need
• C: mild or no medical need

Getting the results

After you have had the checklist assessment, you will receive a letter. This will say if you are eligible for the full assessment for continuing healthcare.

• A positive checklist means you qualify for the full assessment: you might be eligible for CHC.
• A negative checklist means you do not qualify for the full assessment: you are not eligible for CHC.

Positive checklist

To get a positive checklist, you need:

• 2 or more A scores
• or 5 or more B scores
• or an A score and 4 B scores
• or an A score if it’s a priority need

Priority needs are:

• breathing
• behaviour
• drug therapy
• altered states of consciousness

If you have a positive checklist, you are eligible for the full assessment. Your letter should say what the next steps are and how to book your assessment.

A full assessment

Negative checklist

A negative checklist means you will not have a full assessment and you are not eligible for continuing healthcare.

If your health is due to get worse, you can ask for another checklist assessment in 3 months.

If you get worse quickly or are terminally ill, ask for a fast-track assessment.

Fast-track pathway tool for continuing healthcare

If you feel your needs were not assessed correctly, you can challenge the decision.

Challenging or complaining

After an initial assessment by a healthcare professional, your NHS local integrated care board (ICB) will do an assessment.

Find your local integrated care board (NHS)

This is called the full assessment for continuing healthcare. The full assessment:

• has at least 2 healthcare professionals
• can include your social worker
• looks at the same health needs as the checklist
• takes much longer to complete and can have multiple assessments
• can look at other evidence about your health needs
• might include speaking to health professionals who understand your health needs

Independent advocates are trained professionals or volunteers. They work with you to get your voice heard and stand up for your rights.  

An advocate can: 

• listen to you and your concerns 
• give you information about your options to help you make choices 
• help you express what you want 
• go to meetings to support you to say what you want 
• empower you to advocate for yourself 

Find an independent advocate 

To find an advocate in your area, search for ‘advocacy’ on your local council’s website. 

Find your local council (GOV.UK) 

You can then contact the advocacy service in your area.  

Not all councils provide all types of advocates. It depends on where you live. Find local advocacy services from Citizens Advice or Disability Rights UK. 

Find your local Citizens Advice 

Advocacy (Disability Rights UK) 

Getting the information you need

The assessment should be accessible to you. It can be in person or over the phone. The assessment can take a few hours to get all the information.

If you have evidence of health needs, have them with you during the assessment or email them to your ICB.

Evidence can include:

• care plans
• treatment plans
• letters from specialists
• hospital admissions
• discharge reports

Making it accessible

If there is anything that would make assessments more accessible, ask your assessor.

For example, you can ask:

• for a rest break
• for several shorter assessments
• to have the assessment at home, over video call or in a place you feel comfortable
• to have all the questions written down or in advance
• to have a copy of the decision support tool before your assessment so you know how they will assess you
• to have someone speak on your behalf

Some people find it hard to talk about their health needs. You might it upsetting or stressful. You’re not alone.

The national framework states that the process should be accessible and person-centred. You should be fully involved in the assessment and decision-making process.

Guidance for the national framework for NHS continuing healthcare (GOV.UK)

If you have any communication needs, these should be met.

After your assessment the ICB will normally speak with health professionals who manage your condition.

The ICB might look at your health records. They will ask for permission before doing this.

After this, the assessors might do another assessment. They should let you know.

The decision support tool (DST)

When they have all the information, the decision support tool (DST) will assess your health needs and decide if they are:

• priority
• severe
• high
• moderate
• low or no needs

It is a similar form to the checklist and looks at the same things, but goes into more detail.

NHS continuing healthcare decision support tool guidance (GOV.UK)

While you’re waiting for a result, ask your ICB who will provide your care and support.

Letter template to request for support while waiting for a CHC eligibility decision (Access Social Care)

You should be eligible for CHC if you have:

• at least one priority need
• or at least 2 severe needs
• or a severe need and other high or moderate needs

You will receive a decision letter within 28 days of your last assessment. You will get a copy of the decision documents. This will explain if you are eligible for continuing healthcare.

Not eligible for CHC

If you are not eligible for continuing healthcare, the assessment says you do not have a primary health need.

If your condition is getting worse, you might have a 3-month review. You can ask the ICB for this.

If your medical condition is getting worse quickly or you’re terminally ill, you might qualify for a CHC fast-track assessment.

Fast-track pathway tool for continuing healthcare

If you do not agree with the decision, you can challenge it.

Challenging or complaining

Eligible for CHC

If you are eligible for continuing healthcare, you will work with your ICB to make a care and support plan.

The plan will be detailed and say:

• what your health needs are
• how the plan will meet these needs
• what the next steps are

The care and support plan says what your care package should have in it. This will include:

• what type of care you need
• what hours of support you get
• how your care will be managed

If you do not agree with the care and support plan or your care package, you can challenge the decision.

Challenging or complaining

When you have continuing healthcare, you decide who will manage the money.

You can ask the NHS to:

• decide and organise your care and support
• put the money in a personal health budget

If the NHS organises your care, they will let you know what support you receive.

You can have a combination of NHS organised care and a personal health budget.

Personal health budget

Everyone with a continuing healthcare plan should have the option of a personal health budget. You might have to ask your ICB if this was not offered after your assessment or you’d like to try it.

If they think you can manage your own care, you can have a personal health budget. It does involve paperwork, but you can get support to do this.

Personal health budget

A personal health budget gives you more control over your care. This can mean your care is more personalised and helps you achieve your goals. When you have a personal health budget, the CHC still funds your care.

A personal health budget can pay for:

• a personal assistant (PA) to help with everyday care
• equipment not provided as standard by the NHS
• leisure or educational activities and transport costs to meet a medical need
• respite care to spend time away from your carer or do an activity with them
• anything that has been agreed and will help you manage your condition

When you first get CHC, you have an initial review after 3 months. After that, you normally have a review every year.

Your local integrated care board (ICB) will have a policy on how often you will have a review. When you get a CHC award, the letter should say when your next review is.

You should have a key contact. This is the person who is in charge of your CHC funding. Contact them if you want to know when your next review is.

Your ICB can tell you who your key contact is.

Find your local integrated care board (NHS)

You can ask your local integrated care board (ICB) for an appeal if you:

• did not qualify for continuing healthcare
• do not agree with your care and support plan
• were not offered a personal health budget
• your needs have changed
• your ‘well-managed needs’ were not included in the assessment

Challenging or complaining about continuing healthcare

If you want to complain, follow the NHS complaints procedure.

How to complain to the NHS