NHS Continuing Healthcare Support
Make your next CHC step clearer. Nellie Supports helps families and professionals in England prepare for assessments, present evidence and challenge decisions. You receive independent s…
Read moreGUIDES
Who decides NHS Continuing Healthcare eligibility
Two different bodies are involved in an NHS Continuing Healthcare decision, and confusing them causes a great deal of frustration. The multidisciplinary team assesses and recommends. The Integrated Care Board decides. This guide explains who does what, on what evidence, and what that means if you disagree. This guide covers England.
Two different bodies are involved in an NHS Continuing Healthcare decision, and confusing them causes a great deal of frustration. The multidisciplinary team assesses and recommends. The Integrated Care Board decides. This guide explains who does what, on what evidence, and what that means if you disagree. This guide covers England.
The multidisciplinary team
A full needs assessment informs the MDT's use of the DST; the tool itself is not the assessment. The legal minimum is two professionals from different healthcare professions, or one healthcare professional and someone responsible for Care Act needs assessment. The team should usually include health and social care input, assess all relevant needs and give a reasoned primary health need recommendation.
The Integrated Care Board
The Integrated Care Board makes the eligibility decision. It is the responsible commissioner and holds accountability for the outcome, so the recommendation, however carefully reached, is not the decision itself. In the large majority of cases the Board accepts the recommendation. Where it does not, the Framework expects that departure to be exceptional and properly explained, and the reasons should be given in writing to the person and their representative rather than communicated as a bare outcome.
When a recommendation can be departed from
The Framework contemplates a Board rejecting a recommendation only in exceptional circumstances, for example where the Decision Support Tool is incomplete, where the recommendation is not supported by the evidence recorded, or where there is a clear error in the application of the primary health need test. Disagreement with a properly reasoned professional judgement is not, on its own, a sound basis. Where a recommendation of eligibility is overturned, asking for the specific reasoning is a reasonable and often productive step.
What evidence must be considered
The decision must rest on the evidence gathered during the assessment. That includes the Decision Support Tool itself, care records, clinical notes, medication records, risk assessments, care plans, and the contributions of professionals involved in the person's care. It must also include the views of the person and, where appropriate, their family or representative. Evidence should be contemporaneous and specific rather than general, and gaps in the record should be identified rather than filled with assumption.
The role of the person and their representative
The person should be informed, supported to participate and offered reasonable notice. Family involvement and sharing personal information require consent or another appropriate legal or best interests basis. Capacity is decision specific and communication difficulties do not alone establish incapacity. The team should record contributions and significant differences of opinion.
Timescales
In most cases, the decision should be made within 28 calendar days of the ICB receiving a positive Checklist or other notification of potential eligibility. This is a policy expectation, not a guaranteed completion time. Ask about interim support, the reason for delay and the expected decision date; if eligibility is established, ask whether reimbursement is due.
How the decision should be communicated
The outcome should be given in writing, with reasons, together with a copy of the completed Decision Support Tool and information about how to ask for the decision to be reviewed. A decision communicated only by telephone, or given without the underlying paperwork, is difficult to test and it is reasonable to request the full documentation before deciding whether to challenge.
If you disagree
The route is local resolution first, then referral to NHS England for an Independent Review Panel if the matter remains unresolved. The most effective challenges identify specific domains where the recorded level does not match the evidence, or specific gaps in the reasoning on the four key characteristics, rather than expressing general disagreement with the outcome.
Key takeaway
The multidisciplinary team assesses and recommends, the Integrated Care Board decides. The decision must rest on the evidence and must be explained in writing. If the Board departs from a recommendation, that departure should be exceptional and reasoned, and you are entitled to see the reasoning.
Frequently asked questions
Can the Integrated Care Board overturn the team's recommendation?
Yes, but the Framework expects this to be exceptional and properly reasoned, for example where the Decision Support Tool is incomplete or the recommendation is not supported by the recorded evidence. You can ask for the reasons in writing.
Who must be in the multidisciplinary team?
At least two professionals from different healthcare professions, or one healthcare and one social care professional. In practice a nurse assessor and a social worker are typical, with input from others who know the person's day to day needs.
Can family attend the assessment?
The person can choose a family member or representative to support them, subject to the appropriate consent or information-sharing basis. They should be invited or represented wherever practicable, with views sought if attendance is not possible. Ask how contributions and disagreements will be recorded.
What happens if the 28 days is missed?
The decision is not invalidated, but the delay can be raised. Where the delay meant care was privately funded that should have been NHS funded, the period concerned should be addressed when the decision is finally made.
Should I get a copy of the Decision Support Tool?
Yes. You should receive the completed tool alongside the written decision. Without it there is no way to see which domain levels were recorded or what reasoning was applied, so request it before deciding whether to challenge.
Putting this into practice
Request the completed DST, MDT recommendation, written decision and reasons. Check the start point for the expected timetable and ask how interim care will be maintained.
Related NHS Continuing Healthcare pages
The links below explain related stages, funding arrangements and sources of support. Use the guidance that matches the decision or care issue you are dealing with.
NHS Continuing Healthcare Support
Who sits on the multidisciplinary team
The MDT recommendation and the final decision
The 28-day timescale explained
Sources and further reading
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 Further guidance: DHSC, NHS continuing healthcare decision support tool guidance. https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool/nhs-continuing-healthcare-decision-support-tool-guidance
R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
Written by Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by Kerry Slater, Director of Operations
Last reviewed: 2026-07-20
Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie SupportsReviewed by: Kerry Slater, Director of OperationsLast 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-care2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents Further guidance: DHSC, NHS continuing healthcare decision support tool guidance. https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool/nhs-continuing-healthcare-decision-support-tool-guidance
Copyright
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 who makes NHS Continuing Healthcare eligibility decisions in England. It sets out the role of the multidisciplinary team in assessing need and making a recommendation, the role of the Integrated Care Board in reaching the decision, the narrow circumstances in which a recommendation may be departed from, what evidence must be considered, and the rights of the person and their representative throughout.
Whats on this page
Related NHS Continuing Healthcare pages
Who sits on the multidisciplinary team
The MDT recommendation and the final decision
The 28-day timescale explained
How to appeal a CHC decision
Using this guidance
This guide explains NHS Continuing Healthcare in England. You can take part in assessments and challenge an eligibility decision without buying a private report. Ask your ICB for its process, the relevant records and information about free advice or advocacy. Nellie Supports contact: 0333 987 5118.