What is NHS Continuing Healthcare?

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (revised July 2022) defines health care needs as those related to the treatment, control, management, or prevention of a disease, illness, injury, or disability, and the care or after-care of a person with these needs, regardless of whether a health professional must carry out the tasks.

Key Points about CHC:
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•     Available for individuals over 18 with needs from disability, illness, or injury.
•     Eligibility is based on care needs, not specific diagnoses or conditions.
•     CHC is free at the point of delivery, covering all care fees.
•    Covers care in various settings, including care homes, hospices, or at home.
•     In care homes, CHC covers all care fees, including accommodation.
•     At home, CHC covers nursing and personal care, plus related household costs.
•     Not means-tested; financial status does not affect eligibility.
•     CHC prioritises health needs over financial status or living arrangements.

Each individual case should be considered on its own facts, and in accordance with the NHS Continuing Healthcare principles, as set out in the National Framework for NHS Continuing Care and NHS-funded Nursing Care (you can download a copy below).

How is it assessed?

When someone is discharged from the hospital, placed into care, receives care at home, or experiences a change in their needs, an initial screening assessment called the Checklist should be completed by a health or social care professional. A document known as the Checklist Tool helps establish the complexity of the patient's health needs.

If the Checklist outcome is positive, the individual is referred for a full assessment of needs, conducted by a multidisciplinary team. The full assessment uses the Decision Support Tool to examine key characteristics of the patient's needs across twelve domains or areas of care, and evaluates the impact these have on their day-to-day care requirements.

The assessment team also consider the key characteristics of eligibility for NHS CHC, which are whether nature, intensity, complexity and unpredictability of an individual’s needs, indicates that, primarily, the care they are receiving focuses on addressing or preventing these needs. These four key characteristics should be applied to the totality of an individual’s needs. The outcome of the assessment processes will determine whether the individual has a primary health need and thus qualifies for NHS Continuing Healthcare.

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Who is Eligible for CHC?

Anyone receiving full-time care with healthcare needs should be assessed for CHC funding. However, many people are unaware of this free NHS funding and are often wrongly told they must pay for their own care, leading to means-testing.

To qualify for CHC funding, an individual must have a primary health need, meaning their care is primarily driven by health needs rather than social needs. The term “primary health need” helps differentiate between healthcare and social care needs, guiding the level and type of care required.

What's the difference between healthcare needs and social care needs?

• Healthcare needs are provided free by the NHS.
• Social care needs are provided by Local Authorities and are means-tested.

The boundary between healthcare and social care can be unclear, often leading to disputes over payment responsibility. The 1999 Pamela Coughlan case clarified that Local Authorities can only provide nursing care if it’s incidental to accommodation and within their social services remit; if care needs exceed this, the NHS is responsible.

To determine CHC eligibility, an assessment evaluates the individual’s day-to-day nursing and healthcare needs using four key indicators: Nature, Intensity, Complexity, and Unpredictability. Meeting any of these indicators may qualify someone for CHC funding.
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The Care Act 2014 reinforced the primary health needs approach from the Coughlan case, clearly distinguishing social care from healthcare. If an individual may be eligible for CHC, they should be referred to their local ICB for assessment.

Despite these guidelines, the boundary remains unclear, sometimes allowing the NHS to avoid funding care.

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The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care

The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care outlines the principles and processes assessors must follow when determining eligibility for NHS Continuing Healthcare, as well as the procedure for challenging eligibility decisions. It ensures that individuals with a primary health need receive the appropriate NHS-funded care and support.

The Framework includes numbered Practice Guidance to support assessors and staff delivering NHS Continuing Healthcare, along with key assessment tools to guide decision-making. These tools include the Fast Track Tool, the Checklist Tool, and the Decision Support Tool.

​Download a copy of the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care below:

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