NHS Continuing Healthcare UK (2026): Full NHS Funding for Care — How to Claim and Challenge

NHS Continuing Healthcare (CHC) is a package of ongoing care funded entirely and exclusively by the NHS for adults in England who have a 'primary health need' arising from illness, disability, or injury. Key characteristics: (1) FULLY FUNDED BY THE NHS — NOT MEANS-TESTED: unlike the local authority means test (which only funds care if capital is below £23,250), NHS CHC is not means-tested. It does not depend on the person's savings, income, or property. Anyone who meets the clinical eligibility criteria receives full NHS funding regardless of wealth; (2) THE CORE ELIGIBILITY CRITERION — 'PRIMARY HEALTH NEED': a person has a primary health need when, looking at all their care needs and their interaction with each other, it can be said that the main or primary reason they need care is a health need, rather than a social care need. This is a holistic judgment — not just whether they have medical problems, but whether the nature, intensity, complexity, and unpredictability of their needs are primarily health-related. The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022) sets out the national criteria; (3) WHAT IT COVERS: care at home; in nursing homes; in residential care homes; in hospice-like settings. The NHS pays the full cost of the care package — there is no local authority or family contribution. Where the person moves to a care home under CHC, the NHS can specify which care homes meet the required standard — the person can choose but the NHS is not obliged to fund a premium-rate home if a suitable home at a lower rate is available; (4) FUNDED NURSING CARE (FNC) — THE LOWER TIER: FNC (£235.88/week as of April 2026) is a separate, lower-level NHS contribution paid DIRECTLY to nursing homes for residents who have registered nursing needs but do not meet the full CHC threshold. FNC reduces the privately-funded care costs but does NOT remove the means test — the resident still pays the balance above FNC from their own assets; (5) WHO IS LIKELY TO QUALIFY FOR CHC: CHC is most commonly awarded to people with: advanced dementia with severe behavioural problems, swallowing difficulties, or frequent infections; motor neurone disease; multiple sclerosis with complex needs; severe stroke; complex mental health conditions; Parkinson's disease at advanced stage; terminal cancer on the Fast Track pathway; complex wound care, challenging behaviour, or high-dependency nursing needs. Being in a care home or having medical problems does not automatically qualify — the key question is whether the NATURE of the care need is primarily health-based.

NHS CHC eligibility is assessed using a structured national framework with two stages: (1) STAGE 1 — CHECKLIST ASSESSMENT: the initial screening stage. Any healthcare professional (nurse, GP, social worker, occupational therapist) can complete a CHC Checklist when they believe someone may have CHC-eligible needs. The checklist assesses care needs across broad domains. If the person meets the threshold on the checklist, a full DST assessment is arranged. The checklist can be completed as part of a hospital discharge review, a care home review, or at the request of a GP or family member; (2) STAGE 2 — DECISION SUPPORT TOOL (DST): the full multi-disciplinary assessment. A healthcare professional and a local authority social care representative jointly complete the DST. The DST has 12 care need domains: (a) Behaviour; (b) Cognition; (c) Psychological/Emotional Needs; (d) Communication; (e) Mobility; (f) Nutrition — food and drink; (g) Continence; (h) Skin (and tissue viability); (i) Breathing; (j) Drug Therapies and Medication (symptom management); (k) Altered States of Consciousness; (l) Other Significant Care Needs. Each domain is scored across need levels: Priority / Severe / High / Moderate / Low / No Needs; (3) WHAT SCORES INDICATE ELIGIBILITY: (a) A single PRIORITY score in any domain strongly indicates CHC eligibility ('Priority' represents needs so severe, complex, or unpredictable that the person requires skilled nursing/care 24 hours a day); (b) A SEVERE score in one domain and HIGH or SEVERE scores in others can indicate eligibility; (c) Multiple HIGH scores across domains taken together can indicate eligibility — the holistic test applies; (4) MULTIDISCIPLINARY TEAM (MDT): the full DST should be completed by a MDT including: a healthcare professional who knows the person (GP, district nurse, care home nurse); a social care representative; the person themselves or their advocate; a carer. The person has the right to have an advocate or family member present; (5) THE RECOMMENDATION: the MDT completes the DST and makes a recommendation to the NHS Continuing Healthcare coordinator. The final decision is made by a senior NHS clinician. The recommendation must be evidence-based — not based on budget pressures; (6) TIMEFRAMES: the NHS has 28 days to complete a full CHC assessment from the date of a positive checklist. Urgent Fast Track assessments must begin within 48 hours.

Fast Track CHC is a simplified, urgent pathway that can establish full NHS CHC funding within 48 hours for people who are rapidly deteriorating and may be nearing the end of life: (1) WHEN FAST TRACK APPLIES: Fast Track is appropriate when a person has a rapidly deteriorating condition that may be entering a terminal phase and they require CHC urgently — they do not have time for the full multi-week DST process. The National Framework specifies that Fast Track should be used where a person's need for CHC is urgent and the complexity of need justifies it; (2) WHO CAN REFER: any doctor (GP, hospital consultant, or other doctor) can complete a Fast Track referral form (CF1). A specialist nurse in specific conditions (e.g. a Marie Curie nurse) may also be able to refer. The doctor must confirm the person's prognosis and clinical needs; (3) WHAT HAPPENS: the CHC coordinator receives the Fast Track form; must arrange CHC within 48 hours; the person can move to an appropriate care setting within days; if already in a care home, the NHS takes over funding immediately; (4) CRITICAL POINT — MANY FAMILIES DO NOT KNOW TO ASK: Fast Track CHC is used far less than it should be, often because: (a) The GP or specialist does not initiate it automatically; (b) Families are not aware it exists; (c) The person has been assessed as 'not meeting CHC criteria' previously (even prior refusal does not prevent Fast Track if their condition has deteriorated); (d) Hospital staff focus on discharge without arranging continuing care; (5) WHAT FAMILIES SHOULD DO: if a person with serious illness is in hospital and likely to need a care home on discharge — or is already in a care home but deteriorating rapidly — a family member or the person's solicitor/advocate should explicitly ask the GP or hospital consultant: 'Is this person eligible for Fast Track CHC?' If the clinical team does not initiate this, the family can write formally to the NHS Continuing Healthcare coordinator for the local Integrated Care Board (ICB); (6) IF FAST TRACK IS REFUSED: a GP's refusal to complete a Fast Track referral can be challenged — seek advice from a CHC specialist solicitor. The ICB has obligations to assess needs urgently. The Parliamentary and Health Service Ombudsman can investigate delays.

Yes — if a person received care that should have been funded by the NHS under CHC, but was not assessed at the time, a retrospective claim can be made for a refund of care costs that the NHS should have paid: (1) THE LEGAL BASIS: retrospective CHC claims are based on the principle that a person who had a primary health need at the time of receiving care was entitled to NHS funding, even if no assessment was carried out. The leading cases include: R(Grogan) v Bexley NHS Care Trust [2006] EWHC 44 (Admin) — established that the NHS cannot delegate its CHC obligation to local authorities; R v North and East Devon HA ex p Coughlan [1999] Lloyd's Rep Med 306 — established the lawfulness of NHS CHC and the threshold for a 'primary health need'; (2) WHO CAN CLAIM: a retrospective claim can be made by the person themselves; their LPA attorney (under a registered P&FA LPA); the executor of the estate if the person has died; a family member acting in the person's interests with appropriate authority; (3) TIME LIMIT: the NHS guidance and case law establish that retrospective claims should be considered up to 6 years back (Limitation Act 1980 — 6 years for unjust enrichment / breach of NHS duties). In practice, NHS Integrated Care Boards will consider claims going back 1990 or further if documentation is available, but most claims are for the preceding 3-6 years; (4) HOW TO CLAIM: write to the NHS Integrated Care Board (ICB) for the area where the care was provided (the ICB has taken over the former Clinical Commissioning Group functions); provide medical records, care home invoices, and care records; request a backdated CHC assessment against the National Framework; (5) SUCCESSFUL CLAIMS CAN RECOVER SIGNIFICANT SUMS: care home fees averaging £1,000-1,500/week over 2-3 years = £100,000-250,000+ refund. Professional CHC solicitors typically work on a conditional fee/no-win-no-fee basis; (6) CHALLENGE PROCESS FOR REFUSED CLAIMS: initial review within the ICB; if refused: Independent Review Panel (IRP) at NHS England; if still refused: Parliamentary and Health Service Ombudsman (PHSO); judicial review as a final resort.

CHC has significant estate planning implications for people who are paying care costs from their own assets or who expect to: (1) CHC PREVENTS ESTATE DEPLETION: care costs of £50,000-80,000/year or more rapidly deplete savings and assets. If CHC applies, the person retains their estate intact — there is no depletion of capital for IHT planning purposes. For a person with a £500,000 estate, receiving CHC rather than self-funding for 3 years preserves roughly £150,000-240,000 that would otherwise have been spent on care; (2) CHC AND RETROSPECTIVE CLAIMS: a successful retrospective CHC claim returns previously spent care costs to the estate. If those funds were already distributed to beneficiaries or spent, the refund is paid directly to the estate/executor; (3) IHT PLANNING WITH CARE: for many people, the timing of a possible CHC assessment changes the IHT picture significantly. A person who is likely to receive CHC funding in the future should: (a) Not rush to deploy assets in IHT planning in anticipation of care costs that may not materialise; (b) Not make lifetime gifts of large sums specifically to 'fund care' if CHC may cover those costs — any reduction of the estate by gifts could be subject to IHT PET analysis; (4) WILL AND LPA PLANNING ALONGSIDE CHC: a registered Property and Financial Affairs LPA (LP1F) is essential: the attorney can: (a) Request a CHC assessment; (b) Challenge a refusal; (c) Make a retrospective CHC claim on behalf of the person (or on behalf of the estate, post-death); (d) Ensure the person is not being means-tested for care that the NHS should fund. Without an LPA, these steps require a Court of Protection order; (5) CARE HOME FEES AND THE WILL: if a person receives CHC, their estate at death should not have been significantly depleted by care costs. The full estate — including the family home, savings, and investments — is available to pass under the will. This makes will planning (RNRB eligibility; trust structures; spouse exemption) fully relevant. The assumption that care costs will consume the estate may be wrong if CHC is properly claimed; (6) ADVICE: if a family member currently in care may have CHC-eligible needs, consult a specialist CHC solicitor or adviser before assuming self-funding continues. A CHC assessment may transform the financial position entirely.