A guide to state-funded care

When you're working out how to pay for care, most of the conversation tends to revolve around what you'll contribute yourself or what your local council might cover. But there's another route that's often overlooked, and for those who qualify, it's one of the most valuable forms of support available.

It's called NHS Continuing Healthcare, or CHC. It's a package of care arranged and funded entirely by the NHS, and unlike local authority funding, it isn't means-tested: your savings, income and property make no difference to whether you qualify. For families who are eligible, it can lift the financial weight of care entirely.

This guide explains what CHC is, who it's for, how the assessment works, and how to take the first step. As with all our funding guides, think of this as a clear overview rather than a substitute for personalised advice, and our Family Care Advisors are always happy to help you make sense of it.

(For the separate question of council-funded care and how the means test works, see our companion guide to local authority funding.)

What is NHS Continuing Healthcare?

NHS Continuing Healthcare is fully funded care for adults whose needs are primarily health-related rather than social. If someone is eligible, the NHS covers the full cost of meeting their assessed needs, whether that care is delivered in their own home or in a care home.

The key word is health. The system draws a line between social care (help with everyday living, which is means-tested and may be funded by your local council) and healthcare (which the NHS provides free at the point of need). CHC exists for situations where someone's day-to-day needs are mainly about managing or preventing a health condition.

Crucially, eligibility doesn't depend on a particular diagnosis or illness, and it isn't about where you live or who currently provides your care. It's about the overall nature and level of your needs, taken together.

Who is eligible? The "primary health need" test

To qualify for CHC, a person must be assessed as having what's known as a "primary health need." Rather than looking at any single condition, assessors consider all of someone's care needs together and weigh them against four key characteristics:

• Nature: the type of condition or treatment required, and the sort of support it demands
• Complexity: needs that interact with one another, making them difficult to manage
• Intensity: needs that are so severe or frequent they require regular intervention
• Unpredictability: sudden changes in condition that are hard to anticipate and may pose a risk

Circumstances that may point towards eligibility include complex or rapidly deteriorating medical conditions, significant nursing needs, severe physical disabilities, advanced dementia or other neurological conditions, and end-of-life care needs.

It's worth being honest about one thing: the bar is genuinely high, and the assessment is detailed. Most people with long-term care needs won't meet the threshold. But for those who do, CHC makes an enormous difference, so it's always worth finding out where you stand rather than assuming you won't qualify.

How the assessment works

The CHC assessment usually happens in two stages.

Stage one: the Checklist

The first step is a screening tool called the Checklist. A trained health or social care professional, such as a nurse, doctor or social worker, works through a set of care areas (covering things like breathing, nutrition, mobility, continence, cognition, behaviour and medication) and scores each one. It's a relatively quick, broad-brush check designed to decide one thing: whether a full assessment is warranted.

If the Checklist suggests a possible need, you'll be referred on to the full assessment. (A negative Checklist means you won't progress to the next stage, but if your health later deteriorates, you can ask for another.)

Stage two: the full assessment

The full assessment is carried out by a multidisciplinary team (MDT), consisting of at least two professionals from different health and social care backgrounds, usually people already involved in your care. Together, they complete a more detailed document called the Decision Support Tool, which examines your needs across 12 areas and applies the four characteristics above to reach a recommendation on whether you have a primary health need.

You should be fully involved throughout, and you're welcome to have a family member, carer or representative support you. The Integrated Care Board (ICB), the NHS body responsible for the decision, will normally let you know the outcome within 28 days of a positive Checklist or a request for a full assessment.

The fast-track route

If someone's condition is deteriorating rapidly and they may be entering the final stages of life, there's a much quicker path. A clinician can complete a Fast Track tool, which bypasses the Checklist and full assessment entirely, so that care and funding can be put in place urgently, often within a day or two. It's designed to make sure no one waits when time is short.

What happens if you're eligible

If you're awarded CHC, you'll work with your ICB to put together a care and support plan setting out exactly what your care package should include.

You also have a real say in how it's delivered. Everyone eligible for CHC should be offered the option of a personal health budget, an agreed amount you can use, with support, to arrange and tailor your own care, rather than simply receiving services chosen for you. If it isn't offered automatically, it's worth asking your ICB about it.

Because health needs change over time, your package will normally be reviewed within the first three months, and at least once a year after that. A review checks that the care still fits your needs, and, occasionally, whether CHC is still the right form of support.

What if you're not eligible?

A "not eligible" decision isn't necessarily the end of the road.

• You can ask for a review. If you disagree with the outcome of a full assessment, you have the right to request a review of the decision, usually within six months of your decision letter.
• You may still get help with nursing costs. If you're not eligible for full CHC but you're assessed as needing nursing care in a nursing home, you may qualify for NHS-funded Nursing Care (FNC), a flat weekly contribution the NHS pays towards the cost of that nursing care. From April 2026, the standard rate is £267.68 per week.
• Local authority funding may apply. If your needs are met through social care rather than the NHS, your council may be able to help, subject to a means test. Our guide to local authority funding explains how that works.

Taking the first step

If you think you or a loved one might be eligible for NHS Continuing Healthcare, the simplest starting point is to speak to a GP, social worker, community nurse or hospital team and ask for a CHC Checklist to be completed. They can begin the process, and free, fully funded care could follow for those who qualify.

We're here to help

At Edyn, our Family Care Advisors talk families through funding decisions every single day. While the CHC assessment itself is carried out by the NHS, we can help you understand whether it's worth exploring, how it fits alongside other funding routes, and what your next steps might be, with all with the warmth and patience this kind of decision deserves.

Want to talk it through?

Whether you're just beginning to explore your options or you're ready to put care in place, our expert care advisory team would love to help.

Book a family care advice call, or give us a call on 020 3970 9900.