CHC Eligibility Has Halved Since 2017: What the Latest NHS Data Means for Families and Professionals
- funmi sobanke
- Aug 4
- 5 min read
NHS England's latest figures show that fewer people than ever are being found eligible for Continuing Healthcare funding. If a decision has gone against you or your client, here is what you need to know.
The Numbers Behind the Headlines
NHS Continuing Healthcare (CHC) is not a discretionary benefit. It is a legal entitlement: where a person's primary need is a health need, the NHS must fund their full care costs regardless of their assets or income. But the latest NHS England data (Q3 2025/26) tells a troubling story.
The national eligibility rate at full CHC assessment now stands at approximately 17% meaning fewer than 1 in 6 people who reach a full assessment are being found eligible. In 2017, that figure was 31%. In less than a decade, the rate has almost halved. The variation across Integrated Care Boards (ICBs) makes the picture more concerning still. Depending on where you live in England, your chance of a successful CHC assessment ranges from 2.26% to 35.37%. The same National Framework for NHS Continuing Healthcare applies to every ICB. The same decision support tool is used but it looks like to get CHC funding, you would need to play the postcode lottery. This is not a reflection of changing clinical need across the country. It reflects inconsistency, under-resourcing, and in some cases, a systemic failure to apply the legal framework correctly.
What Is NHS Continuing Healthcare?
CHC is NHS-funded care for adults in England whose primary need is assessed as a health need. It covers the full cost of care; whether in a care home, nursing home, or the person's own home; and is entirely separate from means-tested local authority care funding.
Eligibility is determined through a two-stage process: a checklist screening, followed by a full multidisciplinary assessment using the Decision Support Tool (DST). The DST assesses need across 12 care domains, including cognition, behaviour, communication, and medication.
A person does not need a specific diagnosis to qualify. The question is whether the nature, intensity, complexity, or unpredictability of their health needs means the NHS, not the local authority or themselves, should be responsible for funding their care.
Why Are Fewer People Being Found Eligible?
There is no single answer, but several factors are well-documented:
ICB financial pressure: CHC is an expensive funding stream. ICBs facing budget constraints have financial incentives, whether explicit or structural, to limit eligibility. Research and parliamentary debate have repeatedly highlighted the tension between clinical objectivity and financial context in CHC decision-making.
Inconsistent application of the framework: The National Framework is clear that CHC decisions must not be influenced by cost or service availability. In practice, the wide variation in ICB eligibility rates suggests this principle is not being applied uniformly.
Families and professionals accepting initial decisions: Many families are not told that a refusal can be challenged. Some are not offered a full assessment at all, progressing no further than the checklist stage. Without independent advice, many eligible people never reach the appeal process.
COVID-era change impact: Temporary changes to CHC processes during the pandemic, including a pause in assessments and a shift to discharge-to-assess models altered the population being assessed and the conditions under which assessments took place. Some of those changes have had lasting effects on practice.
A CHC Eligibility Refusal Is Not the End of the Process
If you or someone you support has been refused CHC funding, or if you have never been offered a full assessment despite significant health needs, the decision can be challenged.
Your decision letter should state the deadline for requesting a review. Many ICBs allow six months, so it is important to act promptly. The challenge pathway runs as follows:
Checklist screening: A positive checklist result does not award funding, it triggers the full assessment. If the checklist was not offered at all, that too can be challenged.
Decision Support Tool (DST) assessment: A multidisciplinary team scores needs across 12 care domains. Errors or omissions at this stage are one of the most common grounds for a successful appeal.
Local resolution with the ICB: The first stage of challenge, where additional evidence can be submitted and the original decision reviewed.
Independent Review Panel. If local resolution does not resolve the matter, an application can be made to the Independent Review Panel, this is an independent process outside the ICB.
Parliamentary and Health Service Ombudsman (PHSO). Where the process itself has been administered incorrectly, a referral to the Ombudsman may be appropriate.
At any of these stages, the quality of the evidence base is critical. A CHC appeal is not simply a complaint, it is a structured process in which clinical and care evidence is weighed against the criteria set out in the National Framework.
Independent CHC advice, separate from the ICB, and without the financial conflict of interest that can affect local authority practitioners is increasingly important in ensuring that those who are legally entitled to NHS funding are not left bearing costs that should be met by the health service. This is why independent social workers and other professionals experienced in CHC can help gather and present that evidence, identify where the original assessment failed to apply the framework correctly, and support the person and their family through a process that can honestly be lengthy and demanding.
How Nellie Supports Can Help
Nellie Supports is England and Wales' largest private social work practice. Our registered social workers and specialist practitioners provide independent CHC application and appeals support grounded in the National Framework. We work with families, solicitors, professional deputies, and case managers across England and Wales.
Every new CHC case starts with an Independent Social Care Needs Assessment and Care Plan (https://www.nelliesupports.com/services/continuing-healthcare/chc-needs-assessment) charged once and becomes the evidence base for everything that follows. From there, we can support at every stage of the pathway:-
Case Review and Merits Assessment: https://www.nelliesupports.com/services/continuing-healthcare/chc-case-review-merits) for new clients coming to us after a refusal, to assess the grounds for challenge before committing to an appeal.
Checklist Screening Support: https://www.nelliesupports.com/services/continuing-healthcare/chc-checklist-screening) preparation and challenge support at the initial screening stage.
CHC Assessment Support: https://www.nelliesupports.com/services/continuing-healthcare/chc-assessment-support) preparation and representation for the Decision Support Tool multidisciplinary assessment.
CHC Appeal Application: https://www.nelliesupports.com/services/continuing-healthcare/chc-appeal-application) - we draft and submit the appeal application on your behalf.
CHC Appeal Support and Local Resolution: https://www.nelliesupports.com/services/continuing-healthcare/chc-appeals) - advocacy through the ICB local resolution process.
Independent Review Panel: https://www.nelliesupports.com/services/continuing-healthcare/chc-independent-review-panel) - application and representation at the Independent Review Panel.
Fast Track Review Advocacy: https://www.nelliesupports.com/services/continuing-healthcare/chc-fast-track) - for people with rapidly deteriorating conditions requiring urgent funding decisions.
Retrospective CHC Claims: https://www.nelliesupports.com/services/continuing-healthcare/chc-retrospective-and-pupoc) - fixed fee support for periods of care that were never properly assessed, beginning with a £495 qualification review credited against fees if you proceed.
Ombudsman referrals: https://www.nelliesupports.com/services/continuing-healthcare/chc-ombudsman-referral) where appropriate.
Services start from £1,100 plus VAT. We respond to new enquiries within one working day. If you are not sure which stage applies to your situation, contact us and we will confirm the right support and the fixed fee in writing.
Call: 0333 987 5118
Email: nellie@nelliesupports.com
P.S We are not a law firm and not a claims company so we never take a percentage of anything recovered. Our fees are fixed, published, and confirmed in writing before you instruct us.
Source: NHS England, NHS Continuing Healthcare and NHS-Funded Nursing Care Report, Q3 2025/26.
*This article is for information purposes only and does not constitute legal advice. Individual circumstances vary. If you require advice specific to your situation, please contact us directly. Nellie Supports provides independent social work assessment, evidence and advocacy support across England. Wales operates its own Continuing NHS Healthcare framework through health boards.*
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