Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. Mental Capacity Act 2005, c. 9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
Copywright
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Abstract
This guide addresses NHS Continuing Healthcare from the perspective of local authority and independent social workers. It covers the legal limit on local authority provision, when a Checklist should be triggered, the social work contribution to a multidisciplinary assessment, the interface with Care Act assessment and charging, disputes between the authority and the Board, and professional considerations where the two are in conflict.
NHS Continuing Healthcare for social workers
The primary health need test exists because there is a legal limit on what a local authority may lawfully provide. Social workers work on the other side of that boundary daily, which makes the CHC question a core part of the role rather than a health matter to be referred on.
The limit is legal, not budgetary
Coughlan established that nursing care beyond what is merely incidental or ancillary to accommodation falls to the NHS. That is a limit on what a local authority may lawfully do, not a matter of local policy or resource. Arranging a package that exceeds the boundary is not a generous interpretation of duty, it is provision outside the authority's functions.
When to trigger a Checklist
On any material increase in health-related need. Following hospital discharge with new clinical needs. Where a package requires clinical intervention, skilled monitoring or significant overnight support. Where placement is becoming difficult because of the complexity of need. Where a person is being assessed for a nursing placement. Any of these should prompt the question.
The social work contribution to the assessment
The Framework expects multidisciplinary input including social care. That contribution is not a formality. Social work brings the analysis of what social care can and cannot properly meet, the assessment of risk and daily living need, and frequently the longest relationship with the person and family. A team without social care input is incomplete.
Well-managed need in practice
Social workers see this directly, because the package the authority has commissioned is often precisely what produces the person's apparent stability. Where a multidisciplinary team is recording a settled presentation, the social work contribution is well placed to say what maintains it and what happened before it was in place.
The Care Act interface
Where a person is not eligible, Care Act assessment and charging follow. Where they are, NHS responsibility displaces it for the assessed needs. Where a joint package applies, only the local authority element is means tested. Getting the sequence right matters, since charging a person for care the NHS should be funding creates a recoverable position later.
Disputes between authority and Board
These are common and they can stall packages. Care should not be interrupted while responsibility is resolved, and interim arrangements should be made. Where a dispute is running, document what was proposed, by whom and when, since the record matters if the funding position is revisited afterwards.
Professional considerations
Social workers sometimes find themselves under pressure where the authority's financial interest and the person's interests appear to diverge. The professional obligation runs to the person. Recording the assessed needs accurately, and recording that the CHC question was raised, is both the professional and the practical course.
Key takeaway
The boundary is a legal limit on local authority provision, so the CHC question is core social work business. Trigger a Checklist on material change, contribute substantively to the multidisciplinary assessment, and record accurately where the authority's interest and the person's diverge.
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Frequently asked questions
Whose job is it to raise CHC?
Any professional involved can, and social workers are frequently best placed to notice the trigger. The boundary is a legal limit on local authority provision, so it is core social work business rather than a health matter.
When should a Checklist be triggered?
On material increase in health-related need, after hospital discharge with new clinical needs, where a package requires clinical intervention or significant overnight support, or where placement is becoming difficult due to complexity.
Is social care input required at the assessment?
The Framework expects multidisciplinary input including social care. A team without it is incomplete, and that is a specific procedural point where it is absent.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.