NHS Continuing Healthcare: free NHS-funded care — who qualifies and how the assessment works

NHS Continuing Healthcare (CHC) is care that is arranged and funded entirely by the NHS for adults with complex, long-term health needs. Unlike council social care, which the person usually has to pay for, CHC is free: the NHS covers the full cost. It can be provided in your own home or in a care home.

Who is eligible for NHS Continuing Healthcare?

Eligibility depends on your assessed care needs, not on a specific diagnosis. As the NHS explains, the nature, complexity, intensity and unpredictability of your needs are all weighed. If your main need is for healthcare, you may qualify for CHC. Eligibility is not permanent and is reviewed if your needs change.

How does the assessment work?

First, a professional (a nurse, doctor or social worker) completes an initial Checklist to decide whether a full assessment is needed. The reasons are recorded in writing and you should get a copy. If the Checklist is passed, a multidisciplinary team of at least two professionals carries out a full assessment using the Decision Support Tool. They look at 12 areas — including breathing, nutrition, mobility, and psychological and emotional needs — and rate each from "no needs" up to "priority". Usually at least one "priority" need, or "severe" needs in at least two areas, means eligibility is expected.

What if health is getting worse quickly?

If your health is deteriorating rapidly and you are nearing the end of life, you should be considered under the fast-track pathway. In that case a care package should usually be in place within 48 hours, without a long full assessment.

Who arranges it, and how fast?

Your integrated care board (ICB) must assess you and agree the care package. An eligibility decision should usually be made within 28 days of a full assessment or request. If the ICB takes longer without good reason, it should refund care costs from day 29 until its decision. Once eligibility is confirmed, your care is reviewed within 3 months and then at least once a year.

What if CHC is refused?

A refusal does not mean there is no help. You may be referred to your local council, given a joint NHS-and-council package, or — if you need nursing care in a care home — awarded NHS-funded nursing care, where the NHS pays for the nursing part. You can request an assessment through your ICB, and you can ask for a previously unassessed period of care (PUPoC) to be reviewed, usually for care after April 2012. Free independent advice is available from Beacon on 0345 548 0300.