NHS Continuing Healthcare, or CHC, is fully funded NHS care for adults with significant ongoing health needs. It is not means-tested. If your family member is eligible, the NHS pays for all reasonable care costs, whether that care is delivered at home or in a care home. Helping at Home works with NHS Integrated Care Boards to deliver care for CHC clients at home.
What CHC actually is
CHC isn’t a benefit and it isn’t a council service. It’s an NHS funding decision, made by your local NHS Integrated Care Board (ICB), based on a single test: does your family member have a “primary health need” as defined by the National Framework for NHS Continuing Healthcare?
If the answer is yes, the NHS funds the entire cost of care. There’s no income or savings assessment, no contribution from the family, no top-up to negotiate. The NHS pays the provider directly.
If the answer is no, your family member may still be eligible for other forms of support, including council-funded care, NHS-funded Nursing Care if they’re in a nursing home, or self-funded care arranged privately.
Who qualifies
The CHC decision turns on whether your family member’s needs are primarily about their health, rather than primarily about social care. The National Framework lays out twelve “care domains” the assessment looks at:
- Behaviour
- Cognition
- Psychological and emotional needs
- Communication
- Mobility
- Nutrition (food and drink)
- Continence
- Skin (including tissue viability)
- Breathing
- Drug therapies and medication
- Altered states of consciousness
- Other significant care needs
For each domain, the assessor rates the level of need (priority, severe, high, moderate, low, no needs). The pattern of those scores, combined with the nature, intensity, complexity and unpredictability of the needs, drives the eligibility decision.
People with advanced dementia, complex neurological conditions, end-of-life needs, and combinations of significant long-term conditions are among those most likely to be assessed as eligible. But eligibility is about the specific pattern of needs at the point of assessment, not about a diagnosis on its own.
How the assessment works
There are two stages.
The Checklist. An initial screening by a nurse, social worker or other qualified professional. It’s a quick filter. If the Checklist suggests CHC might be appropriate, your family member moves to the full assessment.
The Decision Support Tool (DST). A full multidisciplinary assessment led by the local ICB. A nurse assessor, social worker, and other professionals involved in your family member’s care meet (often with you present, or with you contributing) and go through the twelve domains. The DST is the document that drives the eligibility decision.
Hospital discharge is one of the common moments when a Checklist is done, often before someone leaves an acute ward. CHC assessments can also happen in a care home, in someone’s own home, or as part of an end-of-life Fast Track assessment.
The Fast Track route is for people with a rapidly deteriorating condition that may be entering its terminal phase. It bypasses the Checklist and triggers urgent CHC funding so care can start without delay.
Why top-ups are not permitted on CHC
Families occasionally ask whether they can pay extra to get a particular provider, a higher-rate carer, or longer visits than the CHC commissioner has agreed. The answer for the core CHC package is no.
Under the National Framework, the NHS is responsible for meeting the full reasonable cost of meeting the assessed needs. A person’s care cannot be partly CHC-funded and partly family-funded for the same assessed need. If the package the ICB is offering doesn’t meet your family member’s assessed needs, the route is to challenge the package, not to top it up.
What families can do is pay separately for things that are not part of the assessed CHC care, such as private hairdressing, social activities outside the care plan, or specific equipment that hasn’t been agreed as part of the package. These have to be genuinely separate. If you’re not sure where the line falls, ask the ICB.
CHC at home: practical considerations
CHC packages at home are common but they’re not automatic. The ICB has to be satisfied that the care can be delivered safely at home with the level of staffing the assessed needs require. Some of the things that influence whether home-based CHC is workable:
- Whether the home can be adapted for safe care delivery (hoists, hospital beds, accessible bathroom)
- Whether overnight care is needed, and whether that’s sleeping nights or waking nights
- Whether a single carer is enough for safe handling, or two carers are needed for some tasks
- Whether specialist clinical skills are required (PEG feeding, suctioning, ventilator management) and how those are met
We deliver CHC packages at home that include complex care competencies, overnight care, and end-of-life care where appropriate. Our team works to the standards set in the commissioning agreement with the ICB.
How we work with NHS CHC
When an ICB commissions Helping at Home to deliver a CHC package, we agree the scope, the staffing pattern, the competency requirements, and the review cycle. The ICB pays us directly. You and your family see no invoice and you make no contribution.
Reviews happen at three months from the start of the package, and then annually, or sooner if there’s a significant change. Reviews can confirm continued eligibility, change the package, or in some cases lead to a CHC decision being withdrawn (rare, and you have rights of appeal if it happens).
If your family member is being assessed for CHC and you’d like to know how a package would work with us, call 01636 646915. We can talk through what we deliver, the kinds of CHC packages we run currently, and how the commissioning conversation usually unfolds.
Where to get more help on CHC itself
The CHC process can feel opaque if you’re going through it for the first time. Three resources we’d point families towards:
- The Age UK CHC factsheet, written for families
- The Beacon CHC information service, which offers free information and lower-cost paid advocacy
- Your family member’s GP, district nurse, or hospital discharge team, who can request a Checklist if they think CHC might be appropriate
