How NHS Continuing Healthcare works

NHS Continuing Healthcare (CHC) is care that the NHS arranges and pays for in full. It is for adults whose care is mainly about health needs. The official guide calls this a "primary health need".

The rules come from a government guide called the National Framework. Our guidance and sources page links to it, and to the other official guides.

Use the stage tracker on this page to note where you are. It saves on this device only.

Step 1: Before the checklist

Most people start with a short screening form called the checklist.

What you can do

• Ask for a checklist if you think the person may need CHC. You can't fill it in yourself, but you can ask for one.
• Ask a nurse, doctor or social worker who knows the person. Or contact the CHC team at the local ICB (the NHS body that plans care in your area).
• In most cases the checklist should be done within 14 days of asking.
• If the person is in hospital, the checklist is usually done after they leave and have had time to recover.

Step 2: The checklist

The checklist is a quick screen. The bar is set low on purpose, so that people who need a full assessment get one.

A positive checklist means a full assessment comes next. It does not mean the person will get CHC.

What you can do

• Ask to be there. The person should get notice and the chance to be present, with anyone who supports them.
• Ask for the result in writing, with the reasons. This is usually a copy of the checklist.
• If the checklist says no full assessment is needed, you can ask the ICB to think again.

Step 3: The full assessment

A team of at least two professionals looks at all of the person's needs. This is the multidisciplinary team (MDT). They use a form called the Decision Support Tool (DST).

The DST looks at 12 areas of need, called domains. Our evidence guide explains each one.

Care that is already in place should carry on while you wait for the decision.

What you can do

• Take part. The person and their family should have a central role.
• Say what daily life is really like. The person's own view of their needs should count alongside the professionals' views.
• You are not part of the team that makes the recommendation, but you should get every chance to add to the discussion.
• If you disagree with a level in any domain, ask for your view and your reasons to be written in the DST.
• If you have concerns about how it was done, raise them with the coordinator. If they can't be settled, ask for them to be noted in the DST.

Step 4: The decision

The MDT makes a recommendation. The ICB makes the decision.

The ICB should only go against the recommendation in exceptional cases, with clear reasons. Money should play no part in the decision.

In most cases the whole process should take no more than 28 days from the positive checklist.

What you can do

• Expect a letter with the decision, the reasons, a copy of the DST, who to contact and how to ask for a review.
• If it is taking longer than 28 days, ask the ICB why and when it expects to decide. It should tell you.

Step 5: If the person is found eligible

The ICB plans and pays for a care package to meet the person's assessed needs. The person should not be asked to pay towards those needs.

There should be a review within three months, then at least once a year.

What you can do

• Share what the person wants from their care. Their wishes should be taken into account.
• Ask about a personal health budget if care is at home.

Step 6: If you disagree with the decision

First, local resolution. Ask the ICB to review the decision. This starts with a talk with the ICB, and can move to a formal meeting. Each ICB must publish its process, with timescales, so ask for a copy.

Next, an independent review. If that does not settle it, you can ask NHS England for an independent review. You do not need a lawyer for the panel hearing. Family or an advocate can support the person.

Last, the Ombudsman. If the decision still stands, you can complain to the Parliamentary and Health Service Ombudsman.

If the ICB took too long. Where a decision was unreasonably late and the family paid for care in the meantime, the ICB should make a payment for that period.

What you can do

• Ask the ICB to explain its decision, using the DST.
• Bring any information that was not looked at before.
• Get free advice before you start. See free help.

If the person's health is getting worse quickly

There is a faster route, called Fast Track, for people whose condition is getting worse quickly and who may be near the end of life. See Fast Track. Prepare is not for that route: talk to the person's doctor or nurse today.

This page explains the process. It is not legal or clinical advice.