If someone receives care arranged by their local council, there may come a point when their health needs qualify them for NHS Continuing Healthcare (CHC).
CHC can make a significant difference to how care is funded because, unlike council-funded social care, it isn't means-tested.
But who qualifies, how is eligibility assessed, and can NHS funding be withdrawn if someone's needs change?
The answers below explain the process in England, with differences across the rest of the UK covered at the end.
1. What is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults aged 18 or over whose assessed needs amount to what's called a primary health need.
It can cover care provided at home, in a care home or in another appropriate setting.
CHC isn't means-tested, so someone's savings, income or property don't affect whether they qualify.
2. Who qualifies for NHS Continuing Healthcare?
Eligibility depends on the person's overall care needs, rather than their age, diagnosis or financial circumstances.
Professionals consider four characteristics:
Nature: What care is needed, and what does it involve?
Intensity: How severe are the needs, and how much care is required?
Complexity: How difficult are the needs to manage, particularly when several conditions interact?
Unpredictability: How likely are needs to change unexpectedly, and what are the risks if care isn't provided promptly?
These characteristics help determine whether the person has a primary health need.
Having dementia, Parkinson's disease or another serious condition doesn't automatically mean someone qualifies. Equally, a person doesn't need a particular diagnosis to be eligible.
3. How does someone move from council-funded care to NHS funding?
The process usually involves three stages.
Stage 1: Initial screening
A healthcare professional or social worker completes a CHC Checklist to establish whether a full assessment is needed.
A positive Checklist doesn't mean the person automatically qualifies. It means their needs should be examined in more detail.
Stage 2: Full assessment
A multidisciplinary team of health and social care professionals assesses the person's needs using a Decision Support Tool (DST).
This covers 12 areas, including mobility, breathing, nutrition, cognition, behaviour, medication and skin care.
The team considers the person's needs as a whole and makes a recommendation about eligibility.
Stage 3: Eligibility decision
The local NHS Integrated Care Board (ICB) normally makes the final decision.
If CHC is awarded, the NHS becomes responsible for arranging and funding the agreed care package.
The eligibility decision should normally be made within 28 calendar days of the ICB receiving notification that a full assessment is required.
4. How can someone request a CHC assessment?
You can ask a GP, social worker, district nurse or another healthcare professional involved in the person's care whether a CHC Checklist should be completed.
Explain why you believe the person's needs may qualify, particularly if their condition has changed or they now require more complex care.
You can also contact the local ICB's Continuing Healthcare team directly.
If the person is in hospital, ask the discharge team about the appropriate assessment arrangements. A full CHC assessment will not usually take place in an acute hospital while the person still has immediate treatment or recovery needs.
5. What happens if someone's health deteriorates?
A deterioration in health may mean the person should be screened or reassessed for CHC.
For example, they might develop additional nursing needs, experience significant changes in cognition or require increasingly complex care.
However, deterioration alone doesn't guarantee eligibility.
The assessment must establish whether their overall needs amount to a primary health need.
If someone previously didn't qualify but their needs have changed, you can ask for a new Checklist.
6. Once CHC is awarded, can the NHS withdraw funding?
Yes. CHC eligibility isn't necessarily permanent.
A review of the care package should normally take place within three months of the initial eligibility decision, followed by reviews at least annually.
These reviews primarily check whether the existing care arrangements are still meeting the person's needs.
A routine care review doesn't automatically mean eligibility must be reassessed.
If there is evidence of a significant change in needs that could affect eligibility, the ICB may arrange a full reassessment.
If that reassessment establishes that the person no longer has a primary health need, CHC funding may end.
7. What if someone's condition is stable because they're receiving good care?
This is an important distinction.
A condition being well managed doesn't mean the underlying care needs have disappeared.
For example, someone may experience fewer medical incidents because skilled carers are successfully managing their condition.
Assessors must still consider the underlying needs and the care required to manage them.
The fact that someone is receiving effective care should not, by itself, be used as evidence that they no longer qualify.
8. Can NHS funding stop immediately after a reassessment?
The NHS shouldn't simply withdraw funding without appropriate arrangements for ongoing care.
Before changing responsibility for care, the NHS and local authority should jointly reassess the person's needs, consult with the person and each other, and ensure alternative funding or services are in place.
If the person is no longer eligible for CHC, the local authority may become responsible for arranging some or all of their social care.
Unlike CHC, local authority social care is generally subject to a financial assessment, so the person may have to contribute towards the cost.
Some people may also qualify for NHS-funded nursing care or a jointly funded package of NHS and local authority support.
9. What can families do if they disagree with a CHC decision?
You can challenge a decision that someone doesn't qualify for CHC, including a decision to withdraw existing funding.
Start by asking for:
• The written eligibility decision and reasons.
• Copies of the Checklist, Decision Support Tool and relevant assessments.
• Information about how to request a review.
You can then ask the ICB to reconsider the decision through its local resolution process.
If the disagreement remains unresolved, you may be able to request an independent review through NHS England.
The ICB should explain the applicable deadlines and procedures. It's best to act promptly rather than wait.
10. How can families prepare for an assessment?
Keeping a record of someone's care needs can be helpful, particularly when their condition fluctuates.
Record:
• Changes in mobility, cognition, behaviour, eating or swallowing.
• Medication needs and any difficulties managing them.
• Falls, infections, hospital admissions or other significant incidents.
• How often help is required, including overnight.
• What happens when care is delayed or not provided.
• The support needed to keep the person safe and their condition stable.
• Ask carers and healthcare professionals to document significant changes.
Family members can also contribute information during the assessment, where appropriate.
11. What if someone's condition is deteriorating rapidly?
There is a separate CHC fast-track pathway for people with a rapidly deteriorating condition who may be entering the final stage of life.
It allows an appropriate clinician to recommend urgent NHS-funded care without going through the usual full assessment process.
There is no requirement for the person to have a particular diagnosis or a specified number of weeks left to live.
We explain how the fast-track pathway works and how to access it in a separate PodAnswer.
12. Do the same NHS Continuing Healthcare rules apply throughout the UK?
No. Although NHS-funded care is available across the UK, the eligibility rules and assessment processes differ.
England
NHS Continuing Healthcare is assessed using national eligibility criteria. Local Integrated Care Boards are responsible for decisions.
The assessment, review and appeals procedures described above apply to England.
Wales
Wales also has Continuing NHS Healthcare, based on whether someone has a primary health need.
However, it operates under a separate Welsh framework, and local health boards are responsible for eligibility decisions.
The assessment and appeals arrangements differ from those in England. For example, people wishing to appeal an eligibility decision should normally notify their local health board within 28 days and submit their written appeal within six months, subject to exceptions.
Scotland
Scotland replaced NHS Continuing Healthcare with Hospital Based Complex Clinical Care in 2015.
The central question is whether someone's clinical care needs can be properly met in a setting other than a hospital.
If their needs can be met at home or in a care home, different care funding arrangements apply. Scotland also provides free personal and nursing care for eligible adults, subject to its rules.
Northern Ireland
Northern Ireland operates a separate Continuing Healthcare policy through its Health and Social Care Trusts.
The eligibility and decision-making arrangements differ from those in England.
If you live in Northern Ireland, contact your local Trust for information about assessments, funding and reviews.