NHS Continuing Healthcare in 2026: Eligibility and Process
NHS Continuing Healthcare, usually shortened to CHC, is one of the most important and least understood entitlements in the UK care system. When someone qualifies, the NHS pays for the full cost of their care, including a care home placement. When they don't, families often face care costs of £60,000 a year or more from their own resources. This guide explains how CHC eligibility actually works in 2026, what to expect from the assessment process and how to challenge a decision you believe is wrong.
What CHC is and what it covers
CHC is a package of care arranged and funded by the NHS for adults outside hospital who have ongoing significant healthcare needs. It is not means-tested. If a person qualifies, the NHS pays for their care in full, whether at home or in a care home, including accommodation costs in a residential setting. That distinction is what makes CHC so financially significant for families.
The assessment hinges on whether the individual has a primary health need rather than primary social care needs. Diagnosis alone is not the deciding factor — two people with the same condition can reach very different outcomes depending on how their needs present and how risks are managed.
The Checklist: the first stage
Most CHC journeys start with a Checklist, a screening tool used to decide whether a full assessment is warranted. It scores 11 care domains as A, B or C — broadly high, moderate or low. The threshold for moving to a full assessment is intentionally low: two A scores, or one A plus four Bs, or six Bs is enough.
If a Checklist comes back as not meeting the threshold, you can ask for the reasoning in writing and request a review. If circumstances change — for example a hospital admission, deterioration or a new behavioural symptom — the Checklist should be revisited.
The Decision Support Tool
If the Checklist is positive, a multidisciplinary team carries out a full assessment using the Decision Support Tool, or DST. This goes deeper into the same 11 domains, plus a 12th domain for other significant care needs. Each domain is scored from no needs through to priority.
Eligibility is recommended where there is at least one priority score, or two or more severe scores, or one severe with a number of high or moderate scores that together suggest a primary health need. The team then weighs the four key indicators set out in the National Framework — nature, complexity, intensity and unpredictability of need — to reach a final recommendation.
What to do during the assessment
Families have a right to be involved. Make sure the assessor sees the person at their worst, not their best — a single good day can skew the picture. Take detailed records of incidents, medication needs, falls, behavioural episodes, continence issues and unplanned interventions for at least the previous 4 weeks.
If the person has fluctuating capacity, an attorney under a registered Lasting Power of Attorney for Health and Welfare should be involved. Where there is no LPA, a relevant person's representative, IMCA or family member should attend. Keep a written contemporaneous record of what is said and decided.
Appeals and retrospective claims
If you disagree with a not-eligible decision, you can ask the Integrated Care Board to carry out a local resolution, then escalate to NHS England's Independent Review Panel. There are time limits — typically 6 months from the date of the decision letter — so move quickly.
Retrospective claims for periods of unassessed care are still possible but increasingly difficult, with formal cut-off dates having been imposed. Specialist solicitors and not-for-profit advocates can help with complex cases, particularly where care fees were paid privately while a CHC assessment was overlooked.
Frequently asked questions
Is CHC means-tested?
No. Eligibility is based purely on assessed health needs, not income, savings or property.
Can I get CHC at home?
Yes. CHC can fund care at home as well as in a care home, although the practicalities of arranging a safe care package vary widely between areas.
How long does the process take?
From a positive Checklist to a DST decision typically 28 days, though delays are common. Appeals can take many months.