What Is Continuing Healthcare (CHC) Funding and Who Qualifies? A Complete Guide for Families
Navigating the UK's healthcare and social care system can feel overwhelming, especially when you're trying to understand how to fund care for a loved one. One of the most important—and often misunderstood—funding options available is NHS Continuing Healthcare (CHC) funding.
If you or a family member requires ongoing, complex care, CHC could potentially cover the full cost of that care without any means-testing. This could mean the difference between financial security and depleting your savings to pay for care.
In this comprehensive guide, we'll break down exactly what CHC funding is, who qualifies, how the assessment process works, and what steps you need to take to access it. Whether you're exploring care options for the first time or you've been told your loved one might be eligible, this guide will give you the clarity you need to make informed decisions.
What Is NHS Continuing Healthcare (CHC) Funding?
NHS Continuing Healthcare is a fully-funded care package provided by the NHS for adults with complex health needs. Unlike social care, which is means-tested and often requires significant personal contributions, CHC is completely free to those who qualify.
The key principle behind CHC is simple: if your primary need is healthcare rather than social care, the NHS will pay for it in full.
This distinction is crucial. Social care—such as help with washing, dressing, or household tasks—is typically funded by local authorities and is means-tested based on your savings and income. Healthcare—such as nursing care, complex medical management, or treatment of ongoing health conditions—falls under the NHS's responsibility.
When someone qualifies for CHC, the NHS funds:
Residential or nursing home care
Home care services
Specialist equipment and adaptations
Medications and medical treatments
Nursing support and clinical interventions
Personal care related to health conditions
The crucial point: there is no means-testing, no capital limits, and no requirement to contribute from your own savings or income.
Who Qualifies for CHC Funding?
Eligibility for CHC is not based on a specific diagnosis, age, or financial circumstances. Instead, it depends on whether you have a "primary health need"—meaning your care requirements are primarily health-focused rather than social care-focused.
Key Eligibility Criteria
To qualify for CHC, your care needs must centre on treating or preventing health conditions. This typically includes:
Complex Medical Conditions
Terminal illnesses
Rapidly deteriorating health conditions
Multiple chronic health problems requiring ongoing medical management
Significant Health-Related Needs in Areas Such As:
Mobility: Severe restrictions requiring specialist equipment or constant support
Breathing: Conditions requiring oxygen therapy, ventilation support, or respiratory management
Continence: Complex continence issues requiring specialist nursing care
Communication: Severe difficulties requiring specialist intervention
Psychological or Emotional Needs: Complex mental health conditions requiring intensive support
Nutrition: Conditions requiring tube feeding, parenteral nutrition, or specialist dietary management
Skin Integrity: Pressure ulcers, complex wounds, or dermatological conditions requiring specialist care
Cognition: Severe cognitive impairment affecting daily functioning
Behaviour: Complex behavioural issues requiring specialist management
Drug Therapies: Complex medication regimens requiring specialist nursing administration
Altered States of Consciousness: Conditions affecting awareness or responsiveness
Who CHC Applies To
CHC can apply to adults with:
Physical disabilities
Learning disabilities
Mental health conditions
Neurological conditions (including dementia, though a dementia diagnosis alone doesn't guarantee eligibility)
Long-term conditions requiring complex management
Young people transitioning to adult services at age 18
End-of-life care needs
Important: A diagnosis alone does not determine eligibility. For example, someone with dementia may or may not qualify for CHC depending on the complexity and nature of their overall health needs.
What CHC Does NOT Cover
CHC is specifically for health needs. It does not cover:
General social care (help with housework, shopping, or personal care unrelated to health conditions)
Accommodation costs (though care provided in that accommodation is covered)
Meals (unless part of a care package)
Leisure activities or social support
The CHC Assessment Process: Step by Step
Understanding the assessment process is essential if you believe you or a loved one might qualify for CHC. The process is standardized across England and uses specific tools to ensure fair and consistent decisions.
Stage 1: The Checklist (Initial Screening)
The first step is the CHC Checklist, completed by a healthcare professional such as:
A GP
A nurse
A social worker
Care home staff
Hospital discharge planners
This checklist covers 12 care domains and asks whether the person has needs in any of these areas. It's a screening tool designed to identify whether a full assessment is warranted.
If the checklist indicates potential eligibility, the process moves to the full assessment.
If the checklist suggests the person is unlikely to qualify, they may be signposted to other funding options, such as NHS-Funded Nursing Care (FNC) or local authority social care.
Stage 2: The Full Multidisciplinary Team (MDT) Assessment
If the checklist is positive, the local Integrated Care Board (ICB) must arrange a full assessment within 28 days.
This assessment involves a multidisciplinary team of healthcare professionals who evaluate:
The nature of needs: What specific health conditions and care requirements does the person have?
The complexity of needs: How intricate and interconnected are these needs?
The intensity of needs: How much care and support is required?
The unpredictability of needs: How often do needs change or require urgent intervention?
The team uses the Decision Support Tool (DST) to systematically evaluate whether the person has a primary health need. This tool helps ensure that decisions are based on consistent criteria rather than subjective judgment.
Stage 3: The Decision
Following the full assessment, the ICB makes a decision:
Eligible for CHC: The NHS will fund a personalized care package based on assessed needs.
Not Eligible for CHC but Eligible for NHS-Funded Nursing Care (FNC): If the person lives in a registered nursing home and has nursing needs but doesn't meet the criteria for full CHC, they may qualify for FNC, which covers nursing costs only.
Not Eligible: The person may be directed to local authority social care (means-tested) or private funding options.
The Fast-Track Pathway
For people with terminal illness or rapidly deteriorating health, there's a faster route. A clinician can complete a fast-track tool, which is sent directly to the ICB. A funding decision should be made within 48 hours.
This pathway ensures that people at the end of life don't face delays in accessing funding.
How to Access CHC: Getting Started
Who Can Refer?
A referral for CHC assessment can come from:
A healthcare professional (GP, nurse, hospital doctor, social worker)
Care home staff
You or your family member (self-referral)
Local authority social services
Where to Start
Contact your local Integrated Care Board (ICB) directly. You can find your local ICB on the NHS England website or by asking your GP.
Provide information about:
Current health conditions
Care needs and support required
Current care arrangements
Any recent hospital admissions or health changes
What Happens Next
Initial Assessment: A healthcare professional will complete the CHC Checklist
Full Assessment (if indicated): The ICB will arrange a multidisciplinary team assessment within 28 days
Decision: You'll receive a written decision explaining whether CHC funding has been approved
Care Planning (if approved): The ICB will work with you to develop a personalized care package
Ongoing Reviews: Your care package will be reviewed at 3 months, then annually
Important Points About CHC Funding
It's Not Means-Tested
Your savings, income, property, or financial circumstances have no bearing on CHC eligibility. This is fundamentally different from local authority social care, where a capital threshold of £14,250 applies.
It Covers the Full Cost
If you're eligible, the NHS covers 100% of the cost of your care package. You won't be asked to contribute from your own resources.
It's Reviewed Regularly
Your CHC funding isn't a one-time decision. It's reviewed:
At 3 months after initial approval
Annually thereafter
Whenever your health or care needs change significantly
If your needs change, your care package can be adjusted accordingly.
You Have Rights
If you disagree with a CHC decision, you have the right to:
Request a review
Appeal the decision
Seek independent advocacy support
Organizations like Age UK, Dementia UK, and local advocacy services can help you challenge a decision if you believe it's incorrect.
CHC vs. Other Funding Options
Understanding how CHC compares to other care funding options can help you determine which route is right for you.
CHC vs. Local Authority Social Care
AspectCHCLocal Authority Social CareMeans-TestedNoYes (capital threshold £14,250)Cost to UserFreeMeans-tested contributionsEligibility BasisPrimary health needSocial care needsWho FundsNHSLocal authorityAssessmentHealth-focusedSocial care-focused
CHC vs. NHS-Funded Nursing Care (FNC)
If someone doesn't qualify for full CHC but lives in a registered nursing home, they may qualify for FNC, which covers nursing costs only. Social care costs would still need to be funded through local authority or private means.
CHC vs. Private Funding
Some people choose to fund care privately. However, if you qualify for CHC, accepting NHS funding is usually the better option, as it:
Costs you nothing
Provides a comprehensive care package
Includes regular reviews and adjustments
Offers protection if your needs change
Common Misconceptions About CHC
"My loved one has dementia, so they automatically qualify"
False. Dementia alone doesn't guarantee CHC eligibility. The assessment focuses on the overall complexity and nature of health needs, not the diagnosis.
"CHC only applies to nursing homes"
False. CHC can fund care in residential homes, nursing homes, or at home. The setting doesn't determine eligibility—the nature of health needs does.
"If we have savings, we won't qualify"
False. CHC is not means-tested. Your savings, property, or income have no impact on eligibility.
"The assessment is just a formality"
False. The assessment is thorough and rigorous. It's important to provide detailed information about health needs and how they affect daily life.
"Once approved, CHC funding never changes"
False. CHC is reviewed regularly, and funding can be adjusted if needs change.
What to Do If You Think Someone Qualifies
If you believe you or a loved one might be eligible for CHC, here are the steps to take:
1. Gather Information
Document:
Current health conditions and diagnoses
Daily care needs and support required
Medications and treatments
Recent hospital admissions or health changes
Current care arrangements and costs
2. Speak to Your GP or Healthcare Professional
Discuss CHC eligibility with your GP or current healthcare provider. They can provide initial guidance and may initiate a referral.
3. Contact Your Local ICB
If your healthcare provider doesn't initiate a referral, contact your local ICB directly and request a CHC assessment.
4. Request the Checklist
Ask for the CHC Checklist to be completed. This is your right, and healthcare professionals should complete it if you request it.
5. Prepare for the Full Assessment
If the checklist is positive, prepare for the full MDT assessment by:
Gathering medical records and documentation
Preparing a detailed account of daily care needs
Identifying key healthcare professionals involved in care
Considering what questions you want to ask
6. Seek Support if Needed
Consider working with:
An independent advocate
A care advisor
A solicitor specializing in care funding
Organizations like Sylvian Care, which can provide expert guidance on navigating the CHC process
How Sylvian Care Can Help
At Sylvian Care, we understand that navigating CHC funding can be complex and confusing. Our team of care experts can help you:
Understand your eligibility: We'll review your situation and advise whether CHC might apply
Prepare for assessment: We'll help you gather information and prepare for the CHC assessment process
Navigate the system: We'll guide you through each stage of the assessment and decision-making process
Arrange appropriate care: Once CHC is approved, we can help arrange the right care package to meet your needs
Ongoing support: We provide continued support to ensure your care package remains appropriate as needs change
Whether you're exploring CHC for the first time or you're already in the assessment process, Sylvian Care is here to help you access the funding and care you deserve.
Conclusion
NHS Continuing Healthcare (CHC) funding is a vital resource for people with complex health needs, offering the potential for fully-funded care without means-testing or financial contributions. Understanding whether you or a loved one qualifies is the first step toward accessing this support.
The key takeaway: CHC eligibility is based on having a primary health need, not on diagnosis, age, or financial circumstances. If your care requirements are primarily health-focused and complex, you may be eligible for this life-changing funding.
The assessment process is thorough but fair, designed to ensure that those with genuine health needs receive the support they deserve. While it can feel daunting, you don't have to navigate it alone.
Take Action Today
If you think CHC might apply to you or a loved one:
Speak to your GP or healthcare provider about CHC eligibility
Contact your local ICB to request an assessment
Reach out to Sylvian Care for expert guidance and support throughout the process
Don't leave funding on the table. If you qualify for CHC, accessing it could transform your care experience and provide peace of mind for you and your family.
Contact Sylvian Care Today for a free consultation about how we can help you access the care and support you deserve.