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. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. National Institute for Health and Care Excellence. Clinical guidance. Available at: https://www.nice.org.uk
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains how NHS Continuing Healthcare eligibility is assessed where a person has epilepsy. It covers seizure type and frequency, the significance of warning and unpredictability, rescue medication protocols, the altered states of consciousness domain and its priority level, injury risk, well-controlled epilepsy, and the evidence that supports an accurate assessment.
Epilepsy and NHS Continuing Healthcare funding
Epilepsy engages the altered states of consciousness domain, one of only four that can reach priority. What drives the level is less how often seizures occur than how little warning there is and what has to happen when one does.
Seizure type and frequency
Record the types the person experiences, since a focal awareness seizure and a prolonged tonic-clonic seizure carry very different risks. Record frequency accurately from a seizure diary rather than from recollection. Clusters, and any history of status epilepticus, are particularly significant and should be stated explicitly.
Warning and unpredictability
The absence of any prodrome is what makes epilepsy dangerous, because it means the person cannot make themselves safe and someone competent must be available at all times. Infrequent seizures without warning may indicate more need than frequent seizures with a reliable aura. State how much warning there is.
Rescue medication
Where a protocol exists for buccal midazolam or similar, that is significant. It indicates seizures severe or prolonged enough to require intervention, and it requires staff trained to administer and to judge when. Record the protocol, the training required and the frequency of actual administration, which is often in the medication records.
The priority level
The altered states of consciousness domain can reach priority, alongside behaviour, breathing and drug therapies and medication. Where seizures are frequent, prolonged, without warning and require intervention, that possibility should be considered explicitly rather than passed over.
Injury and post-ictal needs
Injury during seizures, including head injury, fractures, burns and dental damage, engages skin and mobility. The post-ictal period may involve prolonged confusion, exhaustion, agitation or increased supervision needs lasting hours. That recovery period is real need and is very frequently omitted from assessments.
Well-controlled epilepsy
Where seizures are controlled by a finely balanced regime, that is managed need rather than absent need. Record what maintains control, including precise timing, monitoring, level checks and the history of what happened when doses were missed or changed. This is the well-managed need principle applied directly.
Key takeaway
Record seizure types and frequency from a diary, state how much warning there is, and describe the rescue protocol and post-ictal needs. Consider the priority level explicitly, and treat well-controlled epilepsy as managed need rather than resolved need.
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Frequently asked questions
Can epilepsy reach a priority level?
The altered states of consciousness domain can reach priority. Where seizures are frequent, prolonged, without warning and require intervention, that should be considered explicitly.
Seizures are well controlled. Does that count against us?
No. Control achieved through a finely balanced regime is managed need. Record what maintains it, including timing, monitoring and what happened when doses were missed.
Do infrequent seizures matter?
Yes, particularly where there is no warning. Infrequent seizures without a prodrome may indicate more need than frequent seizures with a reliable aura, because the person cannot make themselves safe.
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.