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The Challenges of Accessing NHS Continuing Healthcare
23rd February 2026 |
When families first begin to question how care will be funded, it is often because the financial reality has become impossible to ignore. Fees are mounting, savings are diminishing, and decisions are being made under pressure. Somewhere in that process, someone may mention NHS Continuing Healthcare — usually as an afterthought rather than as a clear entitlement. It is not unusual for families to say to me, “We didn’t even know this existed.”
NHS Continuing Healthcare (CHC) is not a benefit and it is not means-tested. It is a package of care arranged and funded entirely by the NHS where a person’s needs meet the legal threshold of a primary health need. If eligibility is established, the NHS is responsible for meeting the full cost of care, whether that care is delivered in a care home or at home. The principle itself is clear. The difficulty lies in how that principle is applied in practice. 
The Gap Between Policy and Practice
The assessment framework is structured and, on paper, comprehensive. A multidisciplinary team is required to consider the totality of a person’s needs, examining their nature, intensity, complexity and unpredictability. Decisions are intended to be evidence-led and anchored in the National Framework. Yet the reality many families encounter often feels far removed from that clarity. Assessments can feel rushed. Language can appear opaque. Conclusions may not seem to reflect the lived experience of those providing day-to-day care. Recent analysis published in September 2025 by the Nuffield Trust illustrates the wider context in which these experiences sit. The number of people eligible for CHC fell from 57,216 in June 2017 to 52,008 in December 2024 . Over the same period, the proportion of individuals found eligible following full assessment declined from 31.2 per cent to 18.6 per cent . Eligibility rates also continue to vary significantly across the country, ranging from 20 to 95 per 50,000 adults depending on the area . Demographic differences account for some of this variation, but not all of it. Where someone lives can still influence the likelihood of securing funding. 
The Distinction That Determines Who Pays
CHC is described by the Nuffield Trust research paper as being an “all or nothing” model . Either the NHS accepts full responsibility for meeting assessed needs, or it does not. There is no sliding scale. That structural reality inevitably places weight on how needs are characterised and recorded. At the heart of eligibility lies a distinction that is rarely well explained. The question is not simply whether someone is unwell or requires substantial support. It is whether their needs, when viewed in their entirety, amount to a primary health need rather than a social care need. This distinction carries profound financial implications because NHS-funded care is free at the point of use, whereas social care is means-tested. In practice, families often encounter reasoning that emphasises whether needs are “well managed”, or whether care tasks appear routine because skilled staff are already in place. Risk may be minimised precisely because it is being actively mitigated. Yet the legal test concerns the nature and characteristics of the underlying need, not simply the effectiveness of its containment. 
The Assessment Process - and the Misunderstandings Surrounding it
The assessment pathway begins with a Checklist screening tool and, if that threshold is met, progresses to a full assessment using the Decision Support Tool. Families should be involved throughout and are entitled to see the documentation on which decisions are based. However, many describe feeling excluded from key stages or uncertain about how conclusions were reached. It is not uncommon for people to discover that a Checklist has been completed without their knowledge, or to feel overwhelmed by policy language at a time when they are already managing complex and emotionally demanding circumstances. There is also persistent misunderstanding about where CHC applies. Funding is not confined to care home placements. Where eligibility is established, comprehensive packages of care can be delivered at home. The Nuffield Trust analysis confirms that a substantial proportion of CHC packages support individuals outside institutional settings . Decisions about placement should follow a proper determination of eligibility, not precede it. 
Getting Clarity Before Commitment
For families, the central issue is getting some clarity about their situation before embarking on the process. Eligibility decisions are purely evidence-based and must demonstrate significantly more than the frailty or decline associated with the need for assistance with activities of daily living. Records need to reflect an complexity, intensity or unpredictability of need in a way that aligns with the legal framework. Where documentation does not accurately capture the reality of need, even strong cases can falter. Early, structured consideration of whether the threshold is realistically met can prevent both false hope and unnecessary financial loss. Next Steps Where it would be helpful to take a step back before entering the formal assessment pathway, the ARROW CHC Eligibility Review provides a structured, independent appraisal of whether the needs being described are likely, in principle, to meet the CHC threshold. It is designed to help families sense-check their position and decide, calmly and realistically, whether pursuing eligibility is justified. In some situations, the outline of need already points clearly towards eligibility and it is appropriate to move directly into ARROW’s Comprehensive Support Package, providing full representation through assessment, review or appeal. In others, particularly where someone is approaching the end of life, the more urgent question may be whether a Fast Track Pathway referral has been properly considered and acted upon. The purpose of an initial Quick Chat is simply to establish which of these routes — if any — is appropriate. Clarity at the outset protects families from unnecessary expense and prolonged uncertainty, while ensuring that where the legal criteria are met, funding is pursued in a structured and confident way. You do not have to navigate this complex system alone — and your relative should not miss out on funding to which they may be legally entitled. ARROW Continuing Healthcare Consultants offer independent, expert support to ensure families receive the funding they are legally entitled to. Contact us today for a confidential, no-pressure chat. |
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learn more about how arrow can support you with your claim
At ARROW, we provide expert guidance and hands-on support throughout the NHS Continuing Healthcare (CHC) process. We can: ✔️ Arrange an initial Checklist assessment for you or your loved one. ✔️ Fully prepare you for the Checklist and Decision Support Tool (DST) assessments. ✔️ Gain access to healthcare records (for relatives, a certified Power of Attorney or Court Deputyship Order is required). ✔️ Build strong evidence using medical and care records to support your case. ✔️ Draft evidence-based supporting statements for assessment and appeal panels. ✔️ Represent and advocate for you or your loved one at any stage of the process. ✔️ Manage appeals if you’ve been wrongly assessed as ineligible for CHC funding. 💡 If you believe you or your loved one may qualify for NHS Continuing Healthcare, don’t go through it alone--let ARROW guide you every step of the way! 📞 Contact us today for a FREE consultation! |
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