NHS Continuing Healthcare: Free Care for Complex Health Needs
Care fully funded by the NHS, with no means test
NHS continuing healthcare, often shortened to CHC, is free health and social care arranged and funded solely by the NHS, for adults with long-term complex health needs. It is not means-tested: savings, income and property play no part in the decision, and it can fund care in your own home as well as in a care home.
It is also one of the least understood parts of the care system. Eligibility rests on the nature of someone’s needs, not on their diagnosis, and the assessment process has several stages. This guide explains how it works, based on the current NHS guidance, and what to do at each step.
Continuing Healthcare at a Glance
The essentials:
- Free care arranged and funded solely by the NHS, for adults with long-term complex health needs
- Not means-tested: your money and home are irrelevant to the decision
- Eligibility is based on needs, not diagnosis: what matters is the complexity, intensity and unpredictability of the help someone needs
- Assessment has two stages: an initial checklist, then a full assessment by a multidisciplinary team
- A fast track route exists for people nearing the end of life, with care usually in place within 48 hours
- It can fund care at home, including through a personal health budget
Figures on this page were checked on 13 August 2026 against the NHS continuing healthcare guidance. Rates can change, usually each April, and the NHS website always has the most up to date figures.
Who Qualifies, and How the Decision Is Made
What counts as a “primary health need”?
The NHS funds continuing healthcare where someone’s main need for care arises from their health. The assessment looks at four things: how complex the needs are, how intense, how unpredictable, and what the risks would be if the right care were not provided at the right time.
In practice, someone typically qualifies with at least one priority-level need, or severe needs in at least two areas, across domains that include breathing, nutrition, continence, mobility, communication and psychological needs. No diagnosis qualifies automatically, including dementia, and no diagnosis rules anyone out.
Who decides?
Integrated Care Boards decide eligibility. For our area that is the Hertfordshire and West Essex Integrated Care Board. A decision should usually be made within 28 days of the initial assessment or request, and where an unjustified delay goes beyond that, the NHS should refund care costs from day 29 until the decision.
The first stage is a checklist assessment, which can be completed by a nurse, doctor, other healthcare professional or social worker. Its job is only to decide whether someone should go forward for full assessment, so the threshold is deliberately low. Ask for it in writing, and keep a copy.
The full assessment is carried out by a multidisciplinary team of at least two professionals from different healthcare professions, using a national Decision Support Tool. Family carers can and should contribute: nobody knows the day-to-day reality better.
Once in place, the package is reviewed within three months and then at least annually. If you disagree with a decision, you can ask the Integrated Care Board to review it, and the NHS guidance at nhs.uk explains the appeal route.
Where someone is nearing the end of life and their condition is deteriorating quickly, the fast track pathway exists so that funded care can be in place quickly, usually within 48 hours. A clinician completes the fast track tool, and the care package follows without the full assessment process.
Families are often not told this route exists. If your family member is approaching the end of life and needs care at home quickly, ask the GP, district nurse or hospital team directly about fast track continuing healthcare. Our end of life care at home page explains how we support families through this time.
CHC is not only for care homes. The NHS guidance is explicit that care can be provided in a variety of settings outside hospital, including your own home, and funding can be taken as a personal health budget, which works in a similar way to a direct payment for healthcare.
That means someone with complex needs can have NHS-funded support in the place they know best. In our experience the practical questions are about how the package is shaped: the hours, the continuity, and how health and personal care fit together. We are glad to talk any of that through, whether or not Starling is the right provider for the package.
If the decision goes the other way, care is then arranged through the council route with a means test, and our care funding guide explains what that involves, including Attendance Allowance and direct payments.
Common Questions About NHS Continuing Healthcare
Is NHS continuing healthcare means-tested?
No. It is funded entirely by the NHS and your savings, income and property play no part in the decision. Eligibility rests only on the nature of your health needs.
Does a dementia diagnosis qualify someone automatically?
No diagnosis qualifies automatically, and none rules anyone out. The assessment looks at the complexity, intensity and unpredictability of the needs themselves, whatever their cause.
Can continuing healthcare pay for care in my own home?
Yes. The NHS guidance is explicit that care can be provided in a variety of settings outside hospital, including your own home, and funding can be taken as a personal health budget.
How long should a decision take?
A decision should usually be made within 28 days of the initial assessment or request. Where an unjustified delay goes beyond that, the NHS should refund care costs from day 29 until the date of the decision.
What is the fast track pathway?
A quicker route for people nearing the end of life whose condition is deteriorating rapidly. A clinician completes the fast track tool and funded care is usually in place within 48 hours, without the full assessment process.
What happens if the answer is no?
Care is then arranged through the council route, with a financial assessment. You can also ask the Integrated Care Board to review the decision. Our care funding guide explains the council route, including direct payments and Attendance Allowance.
How to Get Started
- Ask the GP, hospital team or social worker for a continuing healthcare checklist assessment, and keep a copy of the result
- Contribute to the full assessment as a family: real, specific detail about needs, especially on the hardest days
- Talk to us about how a funded package could work at home. Call 01727 324 127