NHS Continuing Healthcare (CHC) Explained

Navigating the complexities of care funding for a loved one can be incredibly challenging and often emotionally draining. As families, you want the best possible care, but understanding who pays for what, especially when complex health needs are involved, can feel like an uphill battle. This guide aims to demystify NHS Continuing Healthcare (CHC), a crucial funding pathway that many families are unaware of, or find difficult to access.

NHS Continuing Healthcare (CHC) is a package of care arranged and funded solely by the National Health Service (NHS) for individuals with a 'primary health need'. This means that if your loved one's primary need for care is due to their health condition, rather than social care needs, the NHS should cover the full cost of their care, regardless of their income or assets. This can include care in their own home, a care home, or a hospice.

Understanding if your loved one might be eligible, and how to apply, is a vital first step in ensuring they receive the appropriate care without the added financial strain on your family. We'll walk you through the process, explain the key criteria, and provide practical advice on how to navigate this often-complex system.

NHS Continuing Healthcare (CHC) is a specialised funding package provided by the NHS for adults who have a significant and complex health need. Unlike local authority funding for social care, CHC is not means-tested, meaning your loved one's income, savings, or property will not be taken into account when determining eligibility. If eligible, the NHS covers 100% of the costs of their care, whether they are receiving care at home, in a nursing home, or other residential settings.

The key principle behind CHC is that if an individual's primary need for care is due to their health needs, the NHS is responsible for funding that care. This is distinct from 'social care needs', which local authorities are generally responsible for, often subject to a means-test.

Eligibility for CHC is based on whether an individual has a 'primary health need'. This is determined through a comprehensive assessment process, not by a specific diagnosis or condition, but by the nature, complexity, intensity, and unpredictability of their care needs. The assessment looks at various domains of care, such as mobility, communication, nutrition, continence, skin integrity, behaviour, and more.

The CHC assessment process can feel daunting, but understanding each stage can help you prepare. It typically involves two main stages:

This is a quick screening tool to identify individuals who might need a full assessment. It can be completed by a healthcare professional (e.g., GP, nurse, social worker) or a multidisciplinary team. The Checklist looks at 12 care domains and if your loved one meets certain criteria in a specified number of these, they should be referred for a full assessment.

If your loved one passes the Checklist, they will be referred for a full assessment using the Decision Support Tool (DST). This is a comprehensive assessment conducted by a multidisciplinary team (MDT) of healthcare professionals, such as nurses, doctors, and social workers, who are familiar with your loved one's needs.

The concept of a 'primary health need' is central to CHC eligibility. It's not about having a specific illness, but about the type and level of care required to manage that illness. The four key characteristics are:

A 'primary health need' is usually identified when an individual has high levels of need in several domains, or a 'priority' or 'severe' level of need in at least one domain, alongside other high needs.

It can be incredibly disheartening if your loved one's application for CHC is denied. However, it's important to know that you have the right to appeal the decision. The appeal process typically involves:

It's possible to make a retrospective claim for CHC funding if you believe your loved one should have been eligible for CHC at a previous point in time, and you have been paying for their care privately or through local authority funding. This can be complex, often requiring detailed medical records from the period in question.

Retrospective claims are typically made when there's evidence that an assessment should have taken place, or that an assessment was flawed, leading to an incorrect decision about eligibility. It's advisable to seek specialist legal advice if considering a retrospective claim, as the process can be lengthy and requires substantial evidence.

Navigating the CHC process can be emotionally and practically demanding. Here are some key tips:

Understanding NHS Continuing Healthcare can be a significant step towards securing the appropriate funding for your loved one's care. While the process requires persistence and detailed preparation, the potential benefits of full NHS funding can alleviate immense financial pressure and ensure your loved one receives the specialised care they need.