NHS continuing healthcare (CHC)

What is continuing healthcare?

NHS continuing healthcare, also known as CHC, is a package of ongoing health and social care which is arranged and paid for solely by the NHS. It is available if you live in England or Wales and are assessed as having a ‘primary health need’ – which is defined as having long-term complex health needs which cannot be met by social services. Eligibility is based on an assessment of your overall day-to-day care needs rather than on a particular diagnosis or condition, such as MS. Continuing healthcare, unlike funding from a local authority, is not means tested.

Continuing healthcare is only available for adults, there is a different system in place for children and young people known as continuing care.

NHS continuing healthcare can be provided in a variety of settings outside hospital, for example, it might be in your own home in the form of nursing visits or could cover care home fees. The care package provided is reviewed regularly to make sure it still meets your needs. If your needs change, your eligibility may change.

The criteria for accessing CHC are very strict, and funding varies by region. If you think you might be eligible for CHC you will need to check with your local integrated care board (England) or health board (Wales). If you have an urgent clinical need, such as at the end of life, your clinician should be able to do a fast-track application for CHC so you can move quickly and comfortably onto an appropriate care package.

If you’re not eligible for CHC you may be referred to social services who will assess your care and support needs and determine how much you should contribute to your care.

Continuing healthcare is also available in Northern Ireland, but historically access has been inconsistent across the region due to a lack of clear eligibility criteria. Following a consultation period, a new process is currently being implemented and new guidance is being developed.

In Scotland, there are different care arrangements, known as Hospital Based Complex Clinical Care (HBCCC).

Eligibility for care in the individual nations


Assessments for continuing healthcare are carried out by your local integrated care board (ICB) which is responsible for commissioning local health services. There is a legally prescribed decision-making process which must be followed. It can be a difficult and complex process for both individuals and health professionals to navigate.

Often an admission into hospital or other circumstances will be the trigger that indicates you may need longer-term care and support. Most people will undergo an initial ‘checklist’ assessment, which is carried out by a nurse, doctor or social worker. This will be used to determine if you need a full assessment. Eligibility for a full assessment should be made within 28 days of the request or initial assessment. However, being referred for a full assessment doesn’t guarantee that you’ll be eligible for CHC. If your health is deteriorating rapidly, or you are nearing the end of life, there is a fast-track pathway for assessment.

A full assessment is carried out by a multidisciplinary team (MDT), involving at least two individuals from different professions who are already involved in your care. This could include health or social care professionals such as your GP, nurse, physiotherapist, occupational therapist, or social worker. The MDT will look at:

  • what help you need
  • how complex your needs are
  • how intense your needs are
  • how unpredictable your needs are. 

Your needs will be assessed in 12 different areas, including:

  • breathing
  • nutrition
  • continence
  • mobility
  • cognition.

Each area assessed will be scored on a scale from priority > severe > high > moderate > low > no needs. Typically, to be eligible you must have at least one area scored priority, or two severe needs. However, you may also be eligible if you have one severe need and several other needs.

If you’re assessed as eligible to receive CHC, a care and support package will be put together to meet your needs. Your ICB should work with you and consider your views about your package and where it might be provided. However, the ICB can also consider the cost and value for money of the different options. This might be:

  • support in your own home – the cost of care and support for your health and care needs including personal care such as help with washing and dressing would be covered, but it doesn’t include costs of food, accommodation or any general household support
  • a care home – the NHS will cover the cost of your care home fees
  • other supported care, for example a hospice.

If you are awarded NHS continuing healthcare in England, you will also have the right to ask for a personal health budget (PHB). This is NHS money you can use to meet your health and wellbeing needs. Health professionals can provide support to help you plan and agree what your needs might be. A personal health budget gives you more choice over what care you receive, but it can’t be used to pay for care home fees.

The care and support package will be reviewed within three months of it being implemented and then annually. 


In Scotland, eligibility for Hospital Based Complex Clinical Care (HBCCC) is based on a single question: “Can your care needs be properly met in a setting other than hospital?”

If the answer is no, the NHS will fund your care and treatment, but only in a hospital setting or a specialist NHS unit. HBCCC is provided free of charge if a multidisciplinary team (MDT) has assessed your nursing and other daily healthcare needs to be complex, specialist, unpredictable and intense, and that the level of care you need cannot be met in another setting. Your needs should be reviewed at least every three months to see if you still require HBCCC.

However, if the answer is yes, you will not be eligible for HBCCC and will be discharged from NHS care into a community setting. This could be your own home or a setting such as a care home. The NHS will continue to fund your medical needs following discharge, but your local council’s charging policy will apply for any care needs and you may have to contribute towards these costs. For example, you might be asked to contribute towards the cost of accommodation if you are discharged to a care home.

Personal care costs are free in Scotland to individuals who’ve been assessed by their local authority as having personal care needs. So, if you’re not eligible for HBCCC but are entitled to personal care costs, you wouldn’t be expected to pay for services relating to personal hygiene, help at mealtimes, mobility issues, medication, or your general wellbeing. However, help with housework, laundry, shopping, or costs for attending a day care centre may be chargeable depending on the outcome of a financial assessment by your local authority.


In Wales, continuing healthcare is assessed, arranged, and funded by your local health board (LHB). The process followed is the same as in England.

Northern Ireland

Until recently, there was no guidance on NHS continuing healthcare in Northern Ireland, which made it difficult to determine eligibility for the service. Although some people were able to access a similar package of care to that offered in England and Wales, in practice provision wasn’t consistent on a regional basis. It was only offered to a very limited number of individuals within certain health and social care (HSC) trusts.

So, in 2017, the Department of Health launched a consultation on continuing healthcare in Northern Ireland to try and make access more equitable. Several options were explored, but the preferred option that emerged was to introduce a single eligibility criteria question: “Can your care needs be properly met in any other setting than a hospital?” This is the same question as is used in Scotland.

The new policy of the single eligibility criteria question has been applied since February 2021. However, the implementation process and associated guidance is still in development. So, if you think you might be eligible for continuing healthcare you should contact your local HSC Trust for further advice on the process.

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