NHS Funding and Continuing Healthcare Explained

What is NHS Continuing Healthcare (CHC)?

When facing the prospect of long-term care for an elderly family member, one crucial question is: Who pays for that care? Many people assume all elderly care is self-funded or means-tested by the council, but there’s an often overlooked avenue of funding: the NHS. In particular, something called NHS Continuing Healthcare (CHC) can cover the full cost of care for individuals with significant health needs, regardless of their finances. In this article, we’ll demystify NHS Continuing Healthcare – what it is, who’s eligible, and how to get assessed. We’ll also touch on other NHS-related funding, such as NHS-funded nursing care and intermediate care, that can help support older adults outside of hospital. Understanding these options could potentially save your family thousands of pounds and ensure your loved one gets the care they need without the stress of funding it.

NHS Continuing Healthcare is a package of care arranged and funded entirely by the NHS for individuals who have been assessed as having a primary health need . In simpler terms, if a person’s care requirements are primarily due to health issues (rather than just general frailty or social care needs), they may qualify for CHC. Importantly, CHC is not means-tested – it doesn’t matter how much money you have; if you meet the criteria, the NHS will pay for all your care .

CHC can fund care in various settings:

In your own home, covering things like a caregiver to assist you, therapy services, nursing visits, etc. (It will pay for care and support needed to meet health and personal care needs, but not room and board since you’re living at home).

In a care home (residential or nursing home), covering your accommodation, meals, and care home fees in full.

This funding is intended for adults (over 18) with long-term complex health needs or disabilities. For example, someone who has had a severe stroke with complex nursing requirements, or advanced dementia with challenging health-related needs, or a progressive neurological condition might qualify. In a care home (residential or nursing home), covering your accommodation, meals, and care home fees in full.

The key distinction: Most people requiring care have what are considered “social care needs” – help with daily living, which is the kind of care councils assist with and means-test. CHC is for when someone’s needs go beyond that, into the realm where healthcare (nursing, monitoring, managing severe symptoms) is the dominant part.

CHC Eligibility Criteria

Eligibility for NHS Continuing Healthcare is determined by an assessment process using a framework set by the NHS. Here’s an overview of how it works:

1. Checklist Screening: Usually, if someone might need CHC, a health or social care professional will first do a Checklist – a short screening tool to see if the full assessment is warranted. If the checklist score is high enough, they move to step 2. If it’s not, CHC is unlikely (though you can request a full assessment if you strongly feel it’s needed, or they’ll refer to council for other support).

2. Full Assessment by a Multidisciplinary Team: This is a comprehensive assessment using a form called the Decision Support Tool (DST). A team (often including a nurse, doctor, and social worker) looks at various domains of need: things like mobility, nutrition, breathing, medication needs, cognition, behavior, psychological needs, communication, continence, skin integrity, etc. Each is scored (No needs, Low, Moderate, High, Severe, or Priority) based on the intensity, complexity, and unpredictability of the need.

3. Primary Health Need Decision: They consider the totality of the needs – their nature, intensity (how severe), complexity (how they interrelate and require skilled care), and unpredictability (how suddenly needs can change or crises occur). If it’s found that the care required is beyond what a local authority could legally provide (social care), and is primarily health-focused, the person is deemed to have a primary health need and thus eligible for CHC.

It’s not tied to specific diagnoses or conditions. But some examples where people often get CHC:

End-of-life (palliative) situations: there’s a fast-track pathway for CHC if someone is rapidly deteriorating or terminally ill to ensure they can have care funded quickly at home or hospice to facilitate their final wishes.

Severe advanced dementia where behavior is very challenging or health complications are numerous.

Neurological conditions like advanced MS, motor neurone disease, later stages of Parkinson’s with complex symptoms.

After serious injury (e.g. brain injury) resulting in complex care needs.

Or someone who has complex combinations of needs – say moderate needs in many domains that altogether make their care very intensive.

It’s important to note, eligibility is about the needs, not the diagnosis, location, or who’s currently paying. So you might already be in a care home or receiving care at home – if your needs are health-dominated, you could qualify and then NHS would take over funding.

The assessment process should involve the individual and family – you can provide input and evidence of the needs. It can be a bit complex, and sometimes contentious, because CHC decisions are occasionally subjective and many people get turned down initially and appeal.

How to Get Assessed for NHS Continuing Healthcare

To start the ball rolling for CHC, you usually need to be referred for a CHC assessment. Here’s what to do:

Ask healthcare professionals involved: If your loved one is in hospital, the discharge team might do a CHC checklist automatically for patients with significant needs. If not, you can ask the hospital discharge planner or ward staff about CHC if you believe your relative may qualify. If your loved one is at home or in a care home already, you can ask their GP, district nurse, or social worker to arrange a CHC assessment. You can also approach the local Integrated Care Board (ICB) – these replaced CCGs – that administers CHC in your area, to request an assessment, explaining why you think it’s warranted .

Prepare information: It helps to have recent care notes, any incident logs, and input from nurses or carers about the person’s needs. When the assessment happens, ensure you or someone who knows the person well is present. Be very clear about the worst-case scenarios and the day-to-day reality; this is not the time to be modest or optimistic. You want the assessment to reflect true needs, even on the bad days. For example, if your dad sometimes can’t swallow properly and chokes, that’s crucial to mention under nutrition domain, even if other times he’s okay – unpredictability matters.

Fast Track: If a health professional (like a doctor or specialist nurse) believes the person is entering a terminal phase or their condition is rapidly worsening, they can complete a Fast Track Tool, which bypasses the longer assessment and grants CHC quickly (usually within 48 hours) so care can be put in place urgently. Keep this in mind if your loved one’s condition deteriorates – ask about fast-track CHC for end-of-life care, which could fund hospice care or more care at home.

After the assessment, the decision is usually made by a panel at the ICB. You should be notified in writing. If CHC is granted, a care package will be arranged and paid for by the NHS. If it’s denied and you disagree, you can appeal – first ask for a local review, and if needed, escalate to an independent review panel. Many families do appeal CHC decisions and sometimes succeed, since the criteria can be interpreted differently. It’s worth noting charities like Beacon CHC (a social enterprise) offer free advice on CHC and can assist with appeals .

What Does CHC Cover?

If your loved one is approved for CHC, the NHS basically takes over funding what’s needed as per the care plan:

If they live at home: The NHS might fund carers to come in multiple times a day or even a full-time live-in carer or nursing care at home if needed. They might provide specialist therapy visits (physio, occupational therapy) and any necessary equipment (hospital bed, hoist, etc.). Essentially, whatever is assessed as needed to meet the health and associated care needs will be funded. It can include help with personal care, since that’s part of the holistic need, even though personal care alone isn’t a health need, but under CHC it’s bundled in because it’s
part of the care package.

If in a care home: The NHS will pay the care home fees in full (including the room, food, care – everything).

If in a nursing home: Prior to CHC, some may get a smaller benefit called FNC (Funded Nursing Care) which is a flat contribution for nursing needs. But if CHC kicks in, it supersedes that with full funding.

One great relief with CHC is it removes the financial burden. We’ve seen clients go from paying ~£1,500 a week for a nursing home to having it all paid by CHC after they qualified – a huge weight off the family’s shoulders.

Remember, CHC is reviewed regularly (usually annually, or sooner if condition changes). If needs decrease, it can be withdrawn (or if needs increase, someone not previously eligible might become eligible).

NHS-Funded Nursing Care (FNC)

This is a partial NHS funding that applies if someone is in a nursing home (a care home registered to provide nursing care) but doesn’t qualify for CHC. It’s much more limited – basically a contribution towards the nursing component of care. As of 2025, it’s around £219 per week in England (the rate can change each year). The nursing home should deduct this from the fees you pay, as the NHS pays it directly to the home.

You don’t have to apply for FNC separately; it’s assessed as part of if someone has nursing needs. Often, if a person was assessed for CHC and found not eligible for full CHC but they are in a nursing home, they’ll be granted FNC automatically. It’s not a huge amount, but it’s something

Other NHS Support:
Intermediate Care and Reablement

While CHC and FNC are for long-term, ongoing situations, it’s worth noting short-term NHS-funded care that can help after hospital stays or during recovery:

Intermediate Care / Reablement: The NHS and councils jointly often provide up to 6 weeks of care for free to help someone recover after a hospital discharge or to prevent hospital admission. For example, your mum breaks her hip, goes to hospital, and when she’s ready to come home, they might arrange a reablement team (could be NHS therapists and council carers) to visit for a few weeks to get her back on her feet, all free of charge to her. This is mandated – typically up to 6 weeks is free (some areas might do less). It’s meant for short-term rehabilitation. If ongoing care is needed after that, then they’ll do the normal means-tested arrangements.

NHS Continuing Care in a hospice or end-of-life setting: Sometimes people get care in a hospice funded by NHS or charities, separate from CHC. Also, if someone’s in hospital and essentially needs long-term care, sometimes they can stay in certain NHS community hospitals or units without charge, but that’s less common now – more is pushed to either CHC or social care.

How Prime Eldercare Can Help if You Have NHS Funding

At Prime Eldercare, we occasionally work with clients who have CHC funding but want a say in which caregiver is with them. Typically, if you get CHC, the NHS will commission an agency or a team to provide care. However, you can express a preference. Some areas offer personal health budgets, meaning you get the money to arrange your own care (similar to direct payments but from NHS). This could allow using an introductory service like ours to find a carer you love, and the NHS funds it. It requires coordination with the NHS team, but it’s an avenue to maintain choice.

Even without a personal budget, you can still be involved. For example, if your loved one in a care home gets CHC, but you’d rather bring them home with a live-in carer, you could discuss that with the CHC team – if it’s cost-neutral or cheaper than the care home, they might agree. We could then help you find a suitable live-in carer and the NHS CHC would pay for it.

Also, if CHC is not granted, we understand the frustration families feel. We sometimes guide families on getting thorough documentation of care needs (our carers keep detailed notes that can serve as evidence in CHC assessments). If a client of ours seems like they should be CHC-eligible, we will flag that and suggest the family pursue an assessment, possibly helping them articulate the needs.

Conclusion: Don’t Overlook NHS Funding

In summary, while social care funding (through councils) is means-tested and limited to those with lower assets, NHS Continuing Healthcare is unique in being free and based on health needs alone. It’s essentially like the NHS covering care in the community just as it would in a hospital.

If your loved one has very complex needs, do explore this route. Many people only find out about CHC late in the game (sometimes even care homes don’t inform families because the application process is laborious), but it can be a game-changer.

Always ask medical professionals, “Does my relative qualify for NHS Continuing Healthcare?” especially if they have multiple health issues. The worst that happens is they say no; the best is you get a huge financial relief.

For those who don’t qualify for CHC, remember to still claim things like Attendance Allowance (a benefit, separate from NHS, but important) and utilize any intermediate care after hospital to maximize recovery.

Finally, while the process can be bureaucratic, don’t be intimidated. You are allowed to be persistent. Many families have had to push to get an assessment or appeal a decision. It can help to read up on the National Framework for CHC (if you want to go deep) or get advice from specialist charities.

Call to Action

If you need guidance on navigating NHS care funding vs. local authority funding, Prime Eldercare is here for you. We have experience supporting clients through the continuum of care – from privately arranging help to transitioning onto NHS-funded packages when eligible. We can provide general advice and share resources that might assist you in the CHC application process.

And of course, if you do secure NHS funding and want to explore having a consistent, high-quality carer at home (perhaps through a personal health budget or other arrangement), we can work with you and the NHS to make that happen.

Contact us for a free consultation about your situation. Our team is knowledgeable about the UK care system and can help you understand all your options, ensuring you don’t miss out on any entitlements.

Remember: the NHS isn’t just for hospitals and GP visits – it may also cover long-term care for those most in need. Make sure to investigate this option, as it could dramatically change your care planning for the better.

(For broader information on paying for care and combining various funding sources, see Guide 3: Funding Care in the UK – A Comprehensive Guide, which covers council funding, NHS
funding, and benefits in one place.)