Are you or a loved one facing significant, ongoing health needs? You may be entitled to NHS Continuing Healthcare (CHC) – a crucial, fully-funded package of care provided by the NHS. Unlike social care, CHC is not means-tested, meaning the NHS covers all assessed care costs, including accommodation in a care home, if a "primary health need" is identified. This means your care requirements are primarily health-related, not social.

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However, navigating the CHC assessment process can be incredibly complex and often overwhelming. It involves detailed Checklist and Multi-Disciplinary Team (MDT) assessments using a Decision Support Tool (DST) to evaluate the nature, intensity, complexity, and unpredictability of needs.  "Continuing Healthcare" (often abbreviated to NHS CHC or just CHC) in the UK refers to a package of care for adults aged 18 or over that is arranged and funded solely by the NHS (National Health Service).

 

This means that if someone is eligible for NHS CHC, the NHS pays 100% of their care costs, regardless of their income or assets. This is a significant distinction from local authority (social services) funding for care, which is usually means-tested (meaning you contribute to the cost based on your financial situation).

Here's a breakdown of what "Continuing Healthcare" means, its implications, and how eligibility is determined:

What is NHS Continuing Healthcare (CHC)?

• Full NHS Funding: It covers all assessed care needs, whether that care is provided in your own home, in a care home, or in another care setting. If care is in a care home, it covers accommodation, personal care, and nursing care.

• Primary Health Need: The key criterion for eligibility is that an individual must have a "primary health need." This means that the main reason for their care is due to their health needs, rather than social or personal care needs. The definition of a "primary health need" is crucial and often misunderstood. It's not about a specific diagnosis (e.g., dementia or Parkinson's doesn't automatically qualify), but about the nature, complexity, intensity, and unpredictability of the care required.

• Complex, Intense, Unpredictable Needs: Individuals who qualify typically have complex, substantial, and ongoing health needs that require sophisticated, skilled, or frequent interventions to manage. This can include needs related to:

  • ​Behaviour

  • Cognition (e.g., severe memory problems affecting daily safety)

  • Psychological and emotional needs

  • Communication

  • Mobility

  • Nutrition (e.g., requiring tube feeding)

  • Continence (e.g., complex catheter care)

  • Skin and tissue viability (e.g., severe pressure sores)

  • Breathing (e.g., requiring oxygen or ventilator)

  • Drug therapies and medication (e.g., complex medication regimes requiring skilled administration)

  • Altered states of consciousness

  • Other significant care needs

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Implications of "Continuing Healthcare":

• Financial Relief: For those who qualify, it means complete financial relief from care costs, which can be substantial and otherwise deplete savings and assets.

• Comprehensive Care Package: The NHS is responsible for arranging and funding a comprehensive care package that meets all identified health and associated social care needs.

• Personal Health Budgets: If care is provided at home, eligible individuals may be offered a Personal Health Budget (PHB), which gives them more control over how their care is planned and delivered.

• Reviews: Eligibility for CHC is not necessarily permanent. It is reviewed regularly (typically after three months and then annually) to ensure that the individual's needs still meet the criteria. This means funding can potentially be withdrawn if needs reduce.

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The Assessment Process:

The process for determining eligibility for NHS CHC is detailed and follows a national framework. It typically involves two stages:

• The Checklist: This is an initial screening tool completed by a health or social care professional (e.g., nurse, social worker, GP). It helps determine if a full assessment for CHC is required. A positive Checklist does not mean you are eligible for CHC, only that you should proceed to a full assessment.

• The Full Assessment (Decision Support Tool - DST): If the Checklist is positive, a Multi-Disciplinary Team (MDT) of health and social care professionals (who are involved in the individual's care) will conduct a comprehensive assessment using the Decision Support Tool (DST). They gather evidence from all relevant records and typically hold a meeting with the individual and/or their representative. The MDT makes a recommendation on eligibility to the Integrated Care Board (ICB), which makes the final decision.

• Fast Track Pathway: For individuals with a rapidly deteriorating condition, especially those who are nearing the end of life, there is a "Fast Track" process to ensure care is put in place quickly (often within 48 hours) without needing to go through the full DST process.

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Why is it complex and why might you need professional help?

The process for assessing CHC is notoriously complex and can be inconsistent across different areas. Many families find it confusing, lengthy, and challenging to navigate. Professionals, such as specialist solicitors or advocates (like Beacon CHC), often assist individuals and families to:

• Understand the eligibility criteria.

• Gather the necessary evidence.

• Present a strong case during the assessment.

• Challenge negative decisions through the appeals process (which can go through local resolution and then to an Independent Review Panel if necessary).

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In summary, "Continuing Healthcare" is a vital form of NHS funding for individuals with significant ongoing health needs. While it provides immense financial and practical support, the assessment process to secure it is rigorous and often requires careful preparation and perseverance.