Anyone who is identified as having a primary health need because of an accident, injury, disability or condition will be offered a ‘Continuing Healthcare Assessment’ to assess their eligibility for NHS continuing healthcare. Â
NHS continuing healthcare is a package of care that is arranged and funded solely by the NHS where the individual has been found to have a ‘primary health need’ as set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (last updated 30 May 2022).  Â
The assessment process is in two stages, with an initial checklist assessment first being completed by a health professional, usually a Clinical Nurse Specialist (CNS) Assessor in hospital or from your local Clinical Commissioning Group (CCG) or Integrated Care Board (ICB). If the checklist assessment highlights a need for a more in-depth assessment, patients are often discharged with appropriate healthcare under the ‘Discharge to Assess’ process prior to a full in-depth assessment being completed at home or
in a Nursing home setting by the Continuing Healthcare Team from your local Integrated Care Board (previously your local Clinical Commissioning Group). This is usually completed within 4 – 6 weeks following discharge.
Such care is provided to an individual aged eighteen or over, to meet needs that have arisen as a result of disability, accident or illness. People who are eligible for NHS Continuing Healthcare (CHC) do not pay anything towards the cost of their care.  NHS Continuing Healthcare can be provided at home or in a care home with nursing services. 
If you feel you or the person you care for may be eligible, please speak with the health or social care professionals involved in their care or contact your local Integrated Commissioning Board to request an assessment.  Here you will find out about NHS Continuing Health Care, the assessment process and how to apply if you feel the person you care for is eligible.
NHS continuing healthcare is a package of ongoing care and support that is arranged and funded solely by the National Health Service (NHS) specifically for individuals with very high levels of need, who are found to have a ‘primary health need’. An individual has a primary health need if, having taken into account all their health and social care needs, it can be said that the main aspects or majority of the care they require is focused on addressing or preventing health needs.
Such care is provided to an individual aged 18 or over to meet health and associated social care needs that have arisen as a result of disability, accident or illness.
NHS continuing healthcare is free, unlike support provided by local authorities, which may involve the person with care needs making a financial contribution towards the cost of care, depending on income and savings. Your local Clinical Commissioning Group (CCG) or Integrated Care Board (ICB) will be responsible for deciding the appropriate package of support for someone who is eligible for NHS continuing healthcare.
NHS Continuing Healthcare is for people with significant care needs. Eligibility for NHS continuing healthcare isn’t based on whether the person you care for has a specific health condition, nor on who provides the care or where the care is being provided, but rather on whether they have varying complex care needs as a result of an ongoing physical or mental health condition, disease, or diagnosis.
To get NHS continuing healthcare an individual must have ongoing significant physical and, or mental health needs, and having taken into account of all their needs, it can be said that the main aspects or majority part of the care they need is focused on addressing and, or preventing health needs.
Eligibility for NHS continuing healthcare is assessed in two stages, in most cases:
- a screening process using the ‘NHS Continuing Healthcare checklist’ is used
- where the checklist is positive, and highlights the need for a more in-depth assessment, the next stage involves a multidisciplinary team of health and social care professionals (MDT) undertaking a comprehensive assessment and evaluation of an individual’s health and social care needs and reviewing evidence such as medical records, examinations, assessments etc, to make an assessment of eligibility for CHC using a standardised tool called a ‘decision support tool’ (DST) to help inform the decision.
If you feel that the person you care for has a primary health need, where the main aspects or majority part of the care they need is focused on addressing and, or preventing health needs, and you think you might be eligible for NHS continuing healthcare, the first step is to speak to your doctor or social worker.
They can make a referral to the relevant Clinical Commissioning Group (CCG) or Integrated Care Board (ICB). You can also approach your local CCG or ICB and explain why you believe the person you care for should be considered for NHS Continuing Healthcare.
To find your local Clinical Commissioning Group (CCG) visit the NHS website and enter your postcode or town to find the relevant CCG to contact.
To find your local Integrated Care Board (ICB) visit the NHS website and enter your postcode or town to find the relevant ICB to contact.Â
The assessment process for NHS Continuing Healthcare is carried out in two stages:
1. The first stage involves a screening process using the NHS Continuing Healthcare checklist. This is usually completed by a Clinical Nurse Specialist (CNS) Assessor in hospital or from your local Clinical Commissioning Group (CCG) or Integrated Care Board (ICB).Â
2. Where the first stage checklist is positive, and highlights the need for a more in-depth assessment, the next stage involves a multi-disciplinary team of health and social care professionals (MDT) undertaking a comprehensive assessment and evaluation of an individual’s health and social care needs and reviewing evidence such as medical records, examinations, assessments etc, to make an assessment of eligibility for CHC using a standardised tool called a ‘decision support tool’ (DST) assessment to help inform the decision.
The CHC assessment is divided into 12 care domains including behaviour,  cognition, psychological and emotional needs, communication, mobility,  nutrition,  skin integrity (including wounds, ulcers, tissue viability) drug therapies and medication: symptom control, altered states of consciousness and any other significant care needs which need to be taken into account.
Domains are then judged on a six point scale of need of no need, low need, low need, medium need, high need, severe need and priority need. However, not all domains are rated across the full range of options.
The domains for behaviour, breathing, drug therapy and altered states of consciousness include levels of need that are so great that they could reach the ‘priority’ level (which would indicate a primary health need) on their own.
The needs in other domains are not considered ever to be at a level on their own that could trigger eligibility. Needs in relation to cognition, psychological/emotional needs, communication, mobility, nutrition, continence and tissue viability can form part of a range of needs which taken together could constitute a primary health need.
If a need is being well-managed, for example where psychological interventions are meeting behavioural or emotional needs and therefore minimising their impact, then this should still be recorded at the level of need that would be present if the ongoing intervention was withdrawn.Â
A recommendation of eligibility to NHS continuing healthcare would be expected when there is an identified priority need in any one of the four domains that carry this level (behaviour, breathing, drug therapy and consciousness
A decision about eligibility for a full assessment for NHS continuing healthcare should usually be made within 28 days of an initial assessment or request for a full assessment.
If the person you care for is not eligible for NHS continuing healthcare, they can be referred to their local council who can discuss whether they may be eligible for Social Care support.
What is Advocacy?
Because of disability, illness, social exclusion and other challenges, some people find it difficult to express their views or get the support they need. An advocate is always on your side and will advocate to support you to have the rights and services that you are entitled to.
Advocacy support is there to empower people to have a voice and make a real difference to their lives;Â speaking on someone's else's behalf, when they can't or supporting them to speak for themselves when they can. Advocacy support is independent of Social Care and the NHS.
What is an advocate?
An advocate is someone who can help the person with care needs to understand processes like assessments, safeguarding or Continuing Healthcare (CHC) applications. They can help them to communicate their views and wishes, or they can speak on their behalf, if appropriate.
Carers and family members will be invited to share information to inform the assessment and advocate on their friend or relative's behalf. However, a paid carer cannot act as an advocate.
Types of advocacy
There are different types of advocacy, including:
- Care Act 2014 advocacyÂ
- Issues-based advocacyÂ
- Independent Mental Capacity Advocacy (IMCA)
- Carers Advocacy
- Continuing Health Care (CHC) Advocacy
- NHS complaints AdvocacyÂ
- Mental health advocacy
- Advocacy for the armed forces community (AFC) under the Armed Forces Covenant
If you feel that your friend or relative needs an advocate to ensure their views relating to how their condition affects them, contact your local Adult Social Care at the council and ask about advocacy services. Find your local social services here.
POhWER is a charity that helps people to be involved in decisions being made about their care. You can call POhWER's support centre on 0300 456 2370 for advice.
The Advocacy People gives advocacy support. Call 0330 440 9000 for advice or text PEOPLE to 80800 and someone will get back to you.
VoiceAbility also provide advocacy support. Call their helpline on 0300 303 1660 for advice or use VoiceAbility's online referral form.
You can also contact your local Age UK branch to see if they have advocates in your area. You can contact Age UK online or call 0800 055 6112.
The NHS Continuing Healthcare has a Fast Track Assessment for patients who have palliative care needs and are at the end of life. The Fastrack assessment is unlike the usual continuing healthcare assessment process as it can be provided without an assessment, and with confirmation of a prognosis, from an appropriate clinician - a registered nurse or a registered medical practitioner NHS Continuing Healthcare can usually be provided straight away. Â
If you would like to request an assessment you can ask an appropriate clinician to complete the Fast Track document for you. This would need to be then sent to your local Integrated Care Board (ICB) or your local Clinical Commissioning Group (CCG) depending on where you live. Integrated care boards (ICBs) began replacing clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022. You can find details on your local Integrated Care Board on the NHS website.
If you disagree with the outcome of either a screening Checklist or Full Assessment for NHS Continuing Healthcare, decision for the person you care for, you have the right to challenge it as their advocate. Here we explain how to appeal against a Continuing Healthcare decision.
Challenging a Checklist decisionÂ
If at the initial screening, or Checklist stage (stage 1) the criteria for a Full Assessment is not met, you can ask the Integrated Care Board (ICB) to reconsider its decision.
If the decision remains the same, you have the right to access the NHS complaint procedure which consists of a written complaint to the ICB Complaint Manager and then the option to refer your complaint to the Parliamentary and Health Service Ombudsman.
Appealing a Full Assessment decision
If the person you care for has had a Full Assessment for NHS Continuing Healthcare and you disagree with the outcome, you have the right to appeal as their carer and advocate.
Appeals can be quite stressful and can take many months to resolve. We advise you to take the time to understand why the assessment was unsuccessful before deciding whether or not to pursue an appeal.
However, while appeals can be draining, a positive outcome can make a huge difference. Perseverance in making an appeal could make the difference in avoiding selling the family home. For others, the simple recognition that your friend or relative should have been eligible is the main priority.
The NHS Continuing Healthcare Appeal Process
The appeal process normally consists of three stages:
- Stage 1 is the local resolution procedure adopted by your ICB. It varies, but should involve an informal stage such as a meeting potentially followed by a panel review.
- Stage 2 is an Independent Review (IR) convened by NHS England which, if accepted, may lead to a formal review of the ICB’s decision by an independent panel of experienced health and social care professionals and a lay Chair. You will be invited to attend part of the panel hearing.
- Stage 3 is referral of your case to the Parliamentary and Health Service Ombudsman for a full independent investigation. Depending on this outcome there may be further stages involved.
Appeal Timescales
You should be given six months to request local resolution (stage 1) from the date on your eligibility decision letter. In practice, ICBs range from two weeks to six months. However, national guidance states it should be six months, so it’s worth challenging your ICB on this point if you’re given less time.
You have six months to request an Independent Review, but you have just six weeks to submit all of your written evidence (including any supporting statements) after you have made that request. For those who wish to seek representation to help you through Independent Review, it is now vital that you get in touch with your chosen representative as soon as possible after receiving the local resolution decision, and before you notify NHS England of your wish to request an Independent Review.
After you have requested Independent Review, it should not normally take longer than three months to complete. In reality, however, it’s common for all of the appeal processes to take well over a year or require multiple panels before all available appeal options have been exhausted.
If the person you care for is entitled to NHS continuing healthcare, their local Clinical Commissioning Group (CG ) or Integrated Care Board (ICB) will discuss options with them as to how their care and support needs will best be provided for, and managed, and their preferred setting in which they would like to be cared for. This may be at home, in a Nursing Home or a Residential Care Home with nursing.
When deciding on how your friend or relatives needs are met, your wishes and expectations of how and where the care is delivered should be documented and taken into account
If you're eligible for NHS continuing healthcare, necessary care and support will be arranged and will normally be reviewed within 3 months and thereafter at annually.
This review will consider whether your existing care and support package meets your assessed needs. If your needs have changed, the review will also consider whether you're still eligible for NHS continuing healthcare.
Clinical commissioning groups (CCGs) are clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. CCG's were created following the Health and Social Care Act in 2012, and replaced primary care trusts on 1 April 2013.
Integrated care boards (ICBs) began replacing clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022. You can find details on your local Integrated Care Board on the NHS website.
From July 2022 CCG's will be dissolved and their duties taken on by the new integrated care systems (ICSs), once the Health and Care Bill receives Royal Assent.Â
CCG functions will be subsumed into integrated care systems, with CCGs ceasing to exist as statutory organisations by July 2022. Until then they remain the organisations that are responsible for getting the best possible health outcomes for their local population.Â
This involves assessing local needs, deciding priorities and strategies, and then buying services on behalf of the population from providers such as hospitals, clinics, community health bodies, etc. It is an ongoing process. CCGs must constantly respond and adapt to changing local circumstances. They are responsible for the health of their entire population and measured by how much they improve outcomes.
Online Help and Advice
Visit our online support section where we have provided advice and guidance on a range of relevant topics to help you in your caring role.