Written and reviewed by the Oath Healthcare care team · CQC-regulated provider · Last reviewed: 11 June 2026
If you’re caring for a parent, spouse, or close relative with significant health needs, the cost of care can feel overwhelming. Visiting care averages £25-£30 an hour. Live-in care runs £1,100-£1,400 a week. Over a year, those numbers add up to figures most families simply can’t sustain.
What many families don’t realise is that the NHS — not the local council — may legally be required to cover 100% of those care costs. Not means-tested. Not partially funded. Fully paid for by the NHS, indefinitely, for as long as the need exists.
This funding is called NHS Continuing Healthcare (CHC), and the eligibility criteria are stricter than people think — but also more achievable than many providers let on. Below is the practical, plain-English checklist we use to help families in Cambridge, Suffolk, Redbridge, South Essex, Nottingham, and Gateshead figure out whether to apply.
Skip ahead: Use our free 2-minute eligibility checker and we’ll send you a personalised summary of whether to pursue a CHC assessment.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (sometimes written as “NHS CHC”) is a package of fully-funded care provided by the NHS to people with complex, ongoing, primarily health-driven care needs. It can be delivered:
- In a care home or nursing home
- In the person’s own home (called “domiciliary CHC”)
- In some cases, in a hospice setting
Crucially, CHC is not means-tested. Unlike local-authority funded care, your savings, property, and income are irrelevant. The only test is the nature and severity of the person’s health needs.
If granted, the NHS commissions the care, pays the provider directly, and reviews the case annually. There is no co-payment from the family.
The 12-point Decision Support Tool checklist
Every NHS CHC assessment uses the same official form: the Decision Support Tool (DST). It scores 12 “care domains” — areas of need — on a scale from “no needs” to “priority”. Here’s a simplified version of each:
1. Behaviour
Are there challenging behaviours (aggression, self-harm, wandering, hoarding) that require regular management or skilled intervention?
2. Cognition
Is there confusion, disorientation, memory loss, or impaired decision-making that puts the person at risk if unsupervised?
3. Psychological & emotional needs
Severe anxiety, depression, withdrawal, or distress requiring specialist support?
4. Communication
Inability to express needs reliably — including effects of stroke, dementia, or sensory impairment — meaning others must interpret on their behalf?
5. Mobility
Unable to weight-bear, transfer, or reposition without help — risk of falls, pressure sores, or contractures?
6. Nutrition (food and drink)
Inability to swallow safely, need for PEG/NG feeding, severe weight loss, or risk of aspiration?
7. Continence
Doubly incontinent, requires specialist continence management, or has a catheter/stoma needing skilled care?
8. Skin (including tissue viability)
Existing pressure sores (especially Grade 3-4), repeated wound dressing, or very high risk of skin breakdown?
9. Breathing
Oxygen-dependent, severe COPD, tracheostomy, or unstable respiratory condition needing close monitoring?
10. Drug therapies and medication / symptom control
Multiple medications requiring complex management, controlled-drug pain relief, syringe drivers, or unpredictable side-effects?
11. Altered states of consciousness
Episodes of unconsciousness, seizures requiring intervention, or fluctuating awareness?
12. Other significant care needs
Any rare, complex, or unstable health issue not captured above (e.g. brittle diabetes, complex epilepsy, end-stage organ failure).
How the scoring works
Each domain is rated No needs / Low / Moderate / High / Severe / Priority (the “Priority” rating only applies to 4 domains: behaviour, breathing, drug therapies, and altered consciousness).
To be eligible for CHC, the person typically needs at least:
- One “priority” rating, OR
- Two or more “severe” ratings, OR
- A combination of severe and high ratings across multiple domains that demonstrate a “primary health need” (more on this below).
What “primary health need” actually means
This is the legal phrase that decides every CHC case — and it’s where most applications fail.
A “primary health need” exists when the person’s care needs are predominantly about healthcare, not social care. The test looks at four characteristics:
- Nature — are the needs of a kind the NHS would normally be expected to provide?
- Intensity — how severe and demanding are they?
- Complexity — how many factors interact, and how skilled does the response need to be?
- Unpredictability — how often do things change, and how quickly?
In plain English: if managing the person’s daily care requires clinical judgement, ongoing skilled intervention, or rapid response to change — it’s a health need. If it’s “personal care plus comfort” — it’s social care and the local council pays.
The DST scoring exists to provide the evidence for this judgement. A skilled MDT (multi-disciplinary team) panel reviews the scores and makes the call.
5 common myths that cause families to miss out
Myth 1: “They have to be in a care home”
Wrong. CHC can be delivered at home. In fact, “domiciliary CHC” is what families like ours specialise in supporting — and it usually delivers better outcomes than residential care. See our live-in care and complex care pages for how the model works in practice.
Myth 2: “If they have dementia, they automatically qualify”
Wrong. A dementia diagnosis is not sufficient on its own. The assessment looks at how much skilled care is needed because of the diagnosis — not the diagnosis itself.
Myth 3: “If their savings are below £23,250, the council pays — CHC doesn’t apply”
Wrong. CHC is means-test-free. Even someone with £500,000 in the bank can qualify. Savings are irrelevant to a CHC decision.
Myth 4: “You can only apply at end of life”
Wrong. NHS Fast-Track CHC is the rapid route for people with weeks to live (decisions within 48-72 hours), but standard CHC can be applied for at any stage of a long-term condition.
Myth 5: “If you’re refused, that’s the end of it”
Wrong. Around 30% of CHC refusals are overturned on appeal. Families who present clear, structured evidence — kept by a care provider who understands CHC — routinely win cases that first looked like clear refusals.
How to apply (in plain steps)
- Talk to the GP or hospital discharge team. Ask for a CHC checklist screening — they’re required to offer this when health needs are significant.
- The Initial Screening Checklist is completed — a brief 11-domain version of the DST. If two or more areas score “A”, a full assessment follows.
- A full Decision Support Tool assessment is then booked. This involves a nurse assessor and usually a social worker, with input from family.
- The MDT recommends a decision to the local Integrated Care Board (ICB), which makes the final call.
- If granted: the NHS commissions and pays for the care package.
- If refused: you have 6 months to appeal. Use the time to gather additional evidence.
Why families lose CHC claims — and how to win
Most refused applications share three weaknesses:
- Poor evidence. Vague descriptions like “needs help with washing” instead of “two-person assist for transfers due to risk of falls and aggression during personal care.”
- No clinical voice. The family present their case, but no nurse or GP letter supports it.
- No specialist provider input. Care providers who don’t know CHC don’t keep the right records. When the assessor asks “what happens overnight?” or “how often is the PRN medication used?” — there’s no clear answer.
Working with a care provider who understands CHC inside out — one that documents every incident, every clinical intervention, every change in condition — radically improves the odds. That’s the value of choosing an experienced provider, not just the cheapest one.
Use our free 2-minute CHC eligibility checker
Reading a checklist is one thing. Knowing where your specific situation actually sits is another.
We’ve built a free 12-question eligibility checker based on the same Decision Support Tool the NHS uses. It takes about 2 minutes, and at the end you’ll get:
- A traffic-light summary (likely to qualify / borderline / unlikely)
- A breakdown of which domains looked strongest
- Clear next steps tailored to your situation
- Optional: a free 20-minute follow-up call with one of our care advisors
No sign-up, no payment, no obligation. It’s a tool we built because too many families discover too late that they could have had fully-funded care for months or years.
Frequently asked questions
What is NHS Continuing Healthcare?
NHS Continuing Healthcare (CHC) is fully-funded care from the NHS for adults with complex, ongoing, primarily health-related care needs. It can be delivered at home, in a care home, or in a hospice, and is not means-tested.
Who qualifies for NHS Continuing Healthcare?
To qualify, the person must have a “primary health need” — meaning their care needs are primarily about healthcare (intensity, complexity, unpredictability) rather than social care. The assessment uses 12 Decision Support Tool domains scored from “no needs” to “priority”.
How long does a CHC assessment take?
Initial screening takes about 1-2 weeks. A full Decision Support Tool assessment is usually completed within 28 days. NHS Fast-Track CHC (for people with weeks to live) is decided within 48-72 hours.
Can NHS Continuing Healthcare be used at home?
Yes. “Domiciliary CHC” funds care delivered at home, including live-in carers, visiting carers, and overnight support. Families do not have to choose between staying at home and getting NHS funding.
What if my CHC application is refused?
You have 6 months to appeal. Around 30% of refusals are overturned with better evidence. Working with a care provider experienced in CHC documentation greatly increases the chance of success.
Is NHS Continuing Healthcare means-tested?
No. Unlike local authority-funded social care, CHC is based entirely on health needs. Your savings, income, and property are not considered.
Need help making the case?
If you’d like a confidential conversation about whether NHS Continuing Healthcare might apply to your situation — or whether to appeal a previous refusal — our team is here to help.
- 📞 Cambridge: 01223 755887
- 📞 Redbridge: 020 3949 4333
- 📞 South Essex: 01268 206550
- 🌐 Or start with the free eligibility checker
We’re CQC-regulated, family-run, and have helped families across Cambridgeshire, Suffolk, Essex, Nottinghamshire, and Tyne & Wear navigate the CHC process. Whether you choose us or not, we’d rather you knew your rights.