NHS Continuing Healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults whose needs are primarily health-related. It is not means-tested, so your savings and house are irrelevant, and it can be delivered in a care home or in your own home. Eligibility is decided by assessment, not diagnosis.
It is also, in our experience, the best-kept secret in the entire care system. Fifteen years and 2,000-plus Surrey families in, the sentence we hear most often at kitchen tables is “nobody ever mentioned this to us”. So consider this article us mentioning it, loudly, with the kettle on.
What is NHS Continuing Healthcare, in plain English?
Strip away the jargon and CHC is a simple idea: if what someone needs is really healthcare, the NHS should pay for it, the same way it pays for a hospital bed. The care itself might look like social care, help with washing, medication, moving safely, but if the driving force behind it is a health need, the NHS picks up the whole bill.
That word “whole” is doing serious work. CHC is not a contribution, a top-up or a voucher. It covers the full assessed package of care, and there is no means test anywhere in the process. Savings do not count. Income does not count. The house does not count. The official overview lives on the NHS website, and it is worth a read, though we would gently note it was written by people who have never had to explain a Decision Support Tool to their mum over Sunday lunch.
What is CHC actually worth in pounds?
Here is the part almost every guide skips, and it is the part families actually need. Care is expensive. As at July 2026, the UK average nursing home fee is £1,535 a week, roughly £79,820 a year (carehome.co.uk, updated 30 July 2026). Full-time care at home is a serious commitment too: our own live-in care starts from £225 per full 24 hours, which works out from about £1,575 a week.
If someone qualifies for CHC, the NHS funds their assessed care package in full. Not a slice of it. All of it, whether that is a nursing home place or round-the-clock care in their own bed, with their own garden, and their own particular opinions about how tea should be made. Over a year, that is a five-figure sum staying in the family instead of leaving it, which is why the assessment is always worth pursuing properly rather than shrugging at.
Compare that with the alternatives:
| Funding route | Who pays, and how much |
|---|---|
| NHS Continuing Healthcare | NHS pays the full assessed package, at home or in a care home. No means test at all |
| NHS-funded Nursing Care | NHS pays £267.68 a week (standard rate from 1 April 2026) towards the nursing element, in care homes with nursing only, never at home |
| Council support | Means-tested: full cost yourself above £23,250 in assets, sliding-scale help between £14,250 and £23,250, most income still goes to fees below that (2026/27 thresholds) |
| Self-funding | You pay the lot, at whatever the market charges |
The means-test thresholds and the mechanics behind that third row are set out in the 2026/27 local authority circular, and we have written a fuller guide to the whole landscape in our article on the (cancelled) care fees cap.
Who is eligible for NHS Continuing Healthcare?
Eligibility turns on one phrase: a primary health need. Decoded, that means the main reason someone needs care is their health, not simply the ordinary business of getting older and needing a hand.
Crucially, no diagnosis qualifies or disqualifies you on its own. Two people with the same condition can get different decisions, because the assessment looks at the nature, intensity, complexity and unpredictability of their needs, not the label on the medical notes. That feels unfair until you realise it also means nobody can wave you away with “oh, dementia doesn’t count”. It might. It depends on the needs.
Which brings us to how the deciding actually happens.
How does the CHC assessment work?
There are two stages, plus a fast lane, and the whole thing is free. You do not need a solicitor, a subscription or a magic phrase. You do need patience and a folder for paperwork, ideally a cheerful one.
- Stage one: the checklist. A screening tool completed by a nurse, doctor or social care professional to see whether a full assessment is warranted. It is deliberately generous, designed to let people through rather than filter them out. Anyone can ask for one: ask the GP, the hospital discharge team, or Surrey adult social care on 0300 200 1005.
- Stage two: the full assessment. A multidisciplinary team of professionals looks at the person’s needs using something called the Decision Support Tool. More on that below, because it deserves its own section.
- The decision then usually arrives within 28 days of the referral.
- The fast track. Where someone has a terminal illness and their condition is deteriorating quickly, a clinician can use the fast-track route and funding is usually in place within 48 hours. If this is your family’s situation, say the words “fast track” out loud to the doctor or nurse. It exists precisely so that nobody spends their last weeks in a funding queue.
What is the Decision Support Tool, and what are the 12 domains?
The Decision Support Tool (DST) sounds like something that assembles flat-pack furniture. It is actually a structured form the assessment team uses to look at a person’s needs across 12 care domains, areas of daily life and health, and to weigh how severe, complex and unpredictable the needs are in each.
The domains cover things like behaviour (for example, distress or agitation that needs skilled management), cognition (memory, understanding, decision-making), mobility (moving, transferring, risk of falls) and medication (how complex the regime is and what happens if it goes wrong), alongside other areas of physical and mental health need.
The team weighs the picture across all 12 domains to answer the primary health need question. We will not pretend to explain the scoring mechanics here, partly because the official guidance does it properly and partly because we have watched families disappear into that rabbit hole for whole weekends. What matters at your end is evidence.
So, two pieces of hard-won practical advice. First, be honest about the worst days, not the best ones. Families are lovely and loyal and have a habit of telling assessors “oh, she manages”, when the truthful answer involves three phone calls a night. The assessment needs the unvarnished picture. Second, attend the assessment if you possibly can, with notes and dates. You know the reality of the needs better than any file does.
Can CHC pay for care in your own home?
Yes, and this is the point most websites bury. CHC is not a care home scheme. The package can be delivered wherever the person lives, including their own home, and for many families that is the whole prize: staying put, fully funded. Given that 97% of people say they would prefer to stay in their own home rather than move into a care facility, it is odd how rarely anyone says this out loud.
In practice, an NHS-funded package at home can look very much like the care we provide every day: visiting care, overnight care, or full live-in care with a trained professional living in the house. If your family is exploring CHC and wants to understand what a home-based package could look like before the assessment, our free home assessment is a sensible, pressure-free place to start, and our funding support team fills in forms for a living. We even bring biscuits.
What should you do if you are turned down?
Plenty of families are refused, and plenty of refusals do not survive a second look. If the answer is no:
- Ask for the decision in writing, including the completed assessment paperwork, so you can see exactly how each domain was weighed rather than arguing with a summary.
- Use the local resolution and appeal process. You are entitled to challenge the decision, first locally with the NHS body that made it, and beyond that through the NHS complaints route if you remain unhappy.
- Know that retrospective claims exist. Families who believe someone should have been receiving CHC during a past period of care can pursue a retrospective claim. Nobody enjoys re-opening old paperwork, but the sums involved can be substantial.
- Get free specialist help. Beacon CHC is an independent charity offering free advice specifically on Continuing Healthcare, including refusals and appeals. Talk to them before paying anyone who advertises during the daytime quiz shows.
- Check the fallbacks. If CHC genuinely is not appropriate, someone in a care home with nursing should still get NHS-funded Nursing Care of £267.68 a week, and the council means test may help too. A refusal is not the end of the funding conversation, just the end of one branch of it.
What should you do next?
- Request a CHC checklist screening. Ask the GP, hospital team or Surrey adult social care (0300 200 1005). It is free and commits you to nothing.
- Get a council needs assessment in parallel. Also free, regardless of wealth, via gov.uk. The two processes feed each other.
- Gather the evidence now. A simple diary of needs, incidents and night-time disruption is worth more at an assessment than a beautifully worded letter.
- Plan the care you would actually want. Whatever the funding outcome, knowing whether home care could work, and what it costs, puts you in charge. Our pricing is published and our assessment is free.
Frequently asked questions.
Is NHS Continuing Healthcare means-tested?
No. CHC is the one major care funding route with no means test at all. Your savings, income and house are never assessed. Eligibility depends entirely on whether your needs are primarily health-related, decided through the checklist and full assessment process described above.
Can CHC pay for care in my own home?
Yes. CHC packages can be delivered at home as well as in care homes, and that can include full live-in care. Given most people would rather stay home, it is always worth asking the assessment team to consider a home-based package first.
Does dementia automatically qualify someone for CHC?
No condition automatically qualifies, and none automatically disqualifies. The assessment looks at the person’s actual needs across 12 domains, including cognition and behaviour, rather than the diagnosis. Some people living with dementia qualify, many do not, so the checklist is always worth requesting.
What if we are turned down for CHC?
Ask for the decision and paperwork in writing, then use the local resolution and appeal process, with the NHS complaints route beyond that. Retrospective claims exist for past care periods. Beacon CHC (beaconchc.co.uk) gives free independent advice on refusals and appeals.
If you are weighing up care and wondering whether CHC, the council or your own pocket ends up paying, come and think it through with people who do this every week. Call our Leatherhead team on 01372 386222 or book a free assessment. No obligation, no jargon, and we will happily translate any letter the NHS has sent you.
Sources and references.
- NHS, NHS Continuing Healthcare (process, Decision Support Tool, 28-day and 48-hour timescales)
- GOV.UK, NHS-funded Nursing Care rate from 1 April 2026 (£267.68 a week standard rate)
- GOV.UK, Social care charging for 2026/27, local authority circular, 17 February 2026 (means-test thresholds)
- carehome.co.uk, care home fees and costs, updated 30 July 2026 (average weekly fees)
- Beacon CHC, free independent advice on Continuing Healthcare
- GOV.UK, apply for a needs assessment
- Aims Homecare price sheet, July 2026, at aimshomecare.co.uk/pricing