NHS continuing healthcare

If you have complex, long-term health needs, the NHS might pay for a package of care. It’s called NHS continuing healthcare.

NHS continuing healthcare (sometimes called NHS CHC) is a funding programme. If you’re eligible for NHS continuing healthcare, it pays for all your social care. This includes care home fees or carers if you’re living in your own home.

NHS continuing healthcare is not means-tested. So, getting it does not depend on how much money you have. Instead, it depends on how your illness is affecting you and the help that you need. NHS continuing healthcare is only for adults.

Having a terminal illness is not enough on its own to make you eligible for NHS continuing healthcare. To get it, the NHS says you must have ‘a complex medical condition with substantial, ongoing care needs’. You also need to be assessed for it.

NHS continuing healthcare is available in England and Wales.

It is not available in Scotland where there is a different system (see Can you get NHS CHC in Scotland? below).

In Northern Ireland, continuing healthcare is provided through social care packages. Find out about the assessment process for getting health and social care in Northern Ireland using the link below.

If you are eligible for NHS continuing healthcare, your local integrated care board (ICB) will organise your care.

After they have assessed your needs, they will arrange a care and support package. They may work together with your local council.

How each NHS integrated care board (ICB) arranges care can vary. You can ask your health and social care professionals (like your GP) how it works in your area.

If you’re staying in a care home, NHS continuing healthcare can pay the fees and other costs to do with your care (for example, personal care costs and special equipment).

If you’re in a care home where the fees are more than the NHS would normally pay, your NHS ICB may suggest that you move to a different care home. However, if a move might be bad for your health or wellbeing, the NHS should take this into account.

If you’re living in your own home, NHS continuing healthcare can pay for carers to help with daily tasks. This includes things like eating, washing and getting dressed. It can also pay for laundry and essential equipment (for example, a hoist).

NHS continuing healthcare will not pay for:

Click the button below to read a factsheet with more information about what's covered by NHS continuing healthcare.

If you are very ill or nearing the end of your life, NHS continuing healthcare can be fast-tracked (see How do I get NHS CHC fast-tracked? below).

If you do not need it to be fast-tracked, then you will first have an initial checklist assessment (see What happens at the assessments? – Initial checklist below).

If the initial check assessment shows you may be eligible, you’ll be referred for a full assessment (see What happens at the assessments? – The full assessment below).

A full assessment should take no more than 28 days to make a decision.

If your situation is complicated, the NHS says that it could take longer. But if the assessment takes more than 28 days to decide that you are eligible, you should get a refund for care costs from the 29th day onwards.

You may be able to get NHS continuing healthcare more quickly if your condition is getting worse rapidly and you may be nearing the end of your life.

A health professional such as your GP or district nurse can organise the application process for fast-tracked care. This means that you (or someone supporting you like family, friends or your carer) then do not need to do it. But you (or someone supporting you) can also ask a healthcare professional for an assessment.

To get NHS continuing healthcare fast-tracked your medical team will use an assessment called the Fast-Track Pathway Tool.

A doctor or nurse involved in your care will fill in a form to say you have a rapidly deteriorating condition and may be entering the terminal phase. This form is sent to your local NHS integrated care board (ICB).

They can do this assessment if you are staying at home, in a hospice or in a care home.

If a fast-track assessment is accepted, the NHS says a care package should be in place in two working days. But in some areas it may take longer, and could take two weeks or more.

If you want to know how long it might take, speak to your GP or nurse.

If you’ve received fast-tracked NHS continuing healthcare and your condition starts to improve, your situation may be reviewed. You may then have another assessment for NHS continuing healthcare using the usual assessment process. This will be explained to you and you will be told about any changes.

To get NHS continuing healthcare, you have to be assessed.

You can apply for an assessment if you are at home, in a care home, in a hospice or in hospital. If you apply for NHS continuing healthcare while you are in hospital and you are eligible, you will get it when you go home, to a hospice or care home.

Your health and social care professionals will also regularly review whether you need assessing for NHS continuing healthcare. The times when they may want to do an assessment include:

If a health or social care professional thinks you may need assessing, they’ll tell your local integrated care board (ICB).

You do not have to wait for a healthcare professional to recommend an assessment. You can ask your doctor, district nurse or social worker about getting one. Or someone helping to support you, like family or friends or a carer, can ask for you.

For people who are not having a fast-track assessment, the standard process is described below.

A health or social care professional with training in this area can do the initial checklist assessment.

They should ask you for your consent to having an assessment. Someone important to you like a family member or carer can be there with you. They should also give you a leaflet about NHS continuing healthcare.

The person doing the assessment will fill out a form which assesses things to do with your health. They will be things like your breathing, nutrition, continence, skin condition, mobility, communication, mental capacity, behaviour, symptom control and medication.

There are two possible outcomes:

At least two different health or social care professionals (such as a doctor and a social worker) who are involved in your care will do the assessment. If you live in Wales, someone from the local council will also be there.

They will review your needs in different areas. The areas they will look at include: behaviour, cognition (understanding), communication, psychological needs, mobility, nutrition, continence, skin, breathing, symptom control, and other needs.

For each area, they decide whether your needs are ‘priority’ (the most urgent), ‘severe’, ‘high’, ‘moderate’, ‘low’ or ‘no needs’. If you have at least one ‘priority’ need, or ‘severe’ needs in at least two areas, you may be eligible for NHS continuing healthcare. You may also be eligible if:

The health and social care professionals doing the assessment will tell your local integrated care board (ICB) if they think you are eligible for NHS continuing healthcare.

Your NHS integrated care board (ICB) will decide whether you should get NHS continuing healthcare. They will write to you as soon as possible with the decision.

Someone from the ICB will work with you to create a care and support plan. They will review it after three months to make sure it’s working properly and meets your needs. It will also be reviewed every 12 months to make sure it’s still meeting your needs.

You should be given a named person to contact about your NHS continuing healthcare.

The ICB can manage your continuing healthcare budget for you. But you can also ask for the money to be paid directly to you through a personal health budget. This allows you to have more control over how the money’s spent. Click the button below to find out more about personal health budgets.

There are some options for you (or someone supporting you) to look into if the application is rejected.

If your application is rejected at the initial checklist assessment, you can ask for it to be done again or for a full assessment.

If it’s rejected at the full assessment stage, you can ask for a review. See below to visit the Beacon website and read more about appealing NHS continuing healthcare decisions.

If you’re not eligible for NHS continuing healthcare and you’re in a care home, you may be offered NHS-funded nursing care. In this scheme, the NHS pays a contribution to the care home to help pay for your nursing care.

Or you may receive a joint package of care, where the NHS and local council share the cost. You do not need to go through another assessment for this. See below to visit the NHS website and read more about NHS-funded nursing care.

If you cannot get NHS continuing healthcare, the local council can help.

The council will do a care needs assessment. If you need help with daily living, the council will look at how to help with this. After the assessment, the council may recommend support (social care) like a paid carer, changes to your home, or equipment like a walking frame.

You can make a claim for NHS continuing healthcare on behalf of someone who’s died (if they died on or after 1 April 2012). It might mean a refund of some of their care costs (for example, care home fees). There is a backlog of cases, so it may take some time.

Click below to read more about making a claim for past periods of care.

If you’re getting NHS continuing healthcare and living in your own home, your Attendance Allowance, Disability Living Allowance and Personal Independence Payment stay the same.

If the NHS is paying your care home fees, the care component of Disability Living Allowance and the daily living component of Personal Independence Payment and Attendance Allowance will normally stop after 28 days. Your pension should not be affected.

The Disability Service Centre can provide advice or information about a claim you’ve already made for Personal Independence Payment, Disability Living Allowance or Attendance Allowance.

Scotland stopped using NHS continuing healthcare in 2015. If someone in Scotland was getting NHS continuing healthcare before it was stopped, they will carry on getting it so long as they’re eligible.

To get help with paying for social care in Scotland, including paying for a care home, you will normally need to have an assessment from your local council. You can ask your GP or nurse about this, or you can ask the council for an assessment yourself. See below to read more about getting social care.

Personal care is free if you live in Scotland. Personal care covers things like help with bathing, showering, preparing food, going to the toilet and help with medicines. It does not include all types of social care. For example, it does not include help with housework or paying for shopping. You may need to pay for these. Whether you need to pay, and how much, is decided by the local council.

If you’re in Scotland and you need to be cared for in hospital, this is free. It’s called Hospital Based Complex Clinical Care. See below to read more about this.