NHS Continuing Healthcare Guide: CHC Eligibility, Appeals & Legal Support
- Team Nellie
- 11 hours ago
- 9 min read
When a loved one has complex health needs, navigating NHS Continuing Healthcare (CHC) can feel overwhelming. At Nellie Supports, we provide specialist legal and social work support throughout the entire CHC process—from initial advice and application preparation through to formal appeals if required.
Our multidisciplinary team includes registered social workers, an SRA-regulated solicitor (Ruth Tarr), psychologists, and healthcare specialists who work together to assess eligibility, prepare applications, and where necessary, challenge unfavourable decisions.
This comprehensive guide addresses frequently asked questions about NHS Continuing Healthcare eligibility, the DST assessment process, the 12 care domains, and how to appeal CHC decisions.
📋 NHS CHC Quick Facts
✓ Fully NHS-funded – No cost to eligible individuals
✓ Not means-tested – Income and assets don't affect eligibility
✓ All ages – Available for adults of any age with complex health needs
✓ Flexible settings – Care at home, care homes, nursing homes, or hospices
✓ 51,582 in March 2025 received CHC funding annually in England
✓ 21% approval rate for those who complete full DST assessment
Source: NHS England Continuing Healthcare Data (2024)
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What is NHS Continuing Healthcare (CHC)?
NHS Continuing Healthcare (often called CHC) is a package of care that is fully funded by the NHS for people who have significant ongoing health needs.
Unlike social care, which is means-tested, CHC is free. This means that if your relative qualifies, the NHS pays for the full cost of their care—whether that's in their own home, a nursing home, or another setting.
Who Qualifies?
To be eligible, a person's needs must:
Go beyond what a local authority can legally provide
Be primarily healthcare needs rather than purely social care
The assessment process involves:
CHC Checklist (initial screening)
Decision Support Tool (DST) meeting (full assessment)
Appeal process (if the application is refused)
Because the process can be complex, many families find it confusing or overwhelming. That's where we step in- providing clear guidance and supportive representation at every stage.
NHS CHC Eligibility: Will My Relative Qualify?
Eligibility for NHS CHC hinges on whether an individual has a "primary health need." This means their health requirements outweigh their social care needs.
Key Eligibility Factors
The NHS assesses eligibility based on four key characteristics:
Nature of needs: The type and quality of care required
Complexity: How multiple health conditions interact
Intensity: The extent and severity of needs
Unpredictability: How health needs can change rapidly
What Does NOT Affect Eligibility
Age (CHC is available for adults of all ages)
Diagnosis alone
Where you live or receive care
Your financial circumstances (it's not means-tested)
Important: In 2024, about 60% of those who completed a full DST assessment were deemed eligible for NHS CHC. However, we cannot guarantee that you will receive funding- and no provider can. Funding decisions are made by the NHS against national criteria set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
The NHS CHC Assessment Process: From Checklist to DST Meeting
The CHC Process Timeline
Stage | Timeframe | What Happens |
Initial Checklist | 1-2 weeks | Screening assessment by a healthcare professional |
DST Meeting Scheduled | 2-4 weeks | Multidisciplinary team assessment arranged |
DST Assessment | 2-3 hours | Comprehensive evaluation of all 12 care domains |
Decision | Within 28 days (estimated) | Eligibility determination and care package planning |
Appeal (if needed) | 6-12 weeks | Review of decision if you disagree |
What is a DST Meeting?
A DST meeting (also called a Multidisciplinary Team meeting) is where health and social care professionals assess your relative's needs across 12 "care domains."
The meeting is led by an NHS nurse and a social worker who compile the information to determine eligibility for NHS CHC. Family members and advocates are encouraged to attend and contribute—your input about daily care needs is valuable and important.
Understanding the 12 NHS CHC Care Domains
Familiarity with the 12 care domains is essential for anyone involved in the NHS CHC assessment process. Each domain is rated as:
Priority (P): Immediate life-threatening needs
Severe (S): Significant care needs with major impact
High (H): Considerable care needs
Moderate (M): Regular care needs
Low (L): Minimal care needs
No needs (N): No care needs in this domain
Understanding the 12 NHS CHC Care Domains
Familiarity with the 12 care domains is essential for anyone involved in the NHS CHC assessment process. These domains comprehensively evaluate individual health needs.
The domains include:
1. Breathing
Considers any breathing-related issues, including respiratory conditions, oxygen therapy requirements, ventilation support, or management of chronic breathing difficulties.
2. Nutrition – Food and Drink
Assesses needs related to food and drink, including risks of malnutrition or dehydration, aspiration problems, swallowing difficulties (dysphagia), feeding tube requirements, and dietary management.
3. Continence
Examines an individual's continence needs, including bladder and bowel control, catheter care, stoma management, and the use of continence products.
4. Skin (Including Tissue Viability)
Covers all aspects of skin problems, including the risk of wounds or ulcers, pressure sores, existing skin conditions, wound management, and tissue viability concerns.
5. Mobility
Evaluates the individual's ability to move around, including transfers, walking, wheelchair use, risk of falls, and the need for mobility aids or equipment.
6. Communication
Looks at the ability to communicate needs, including speech difficulties, hearing or visual impairments, language barriers, and the need for communication aids or interpretation.
7. Psychological and Emotional Needs
Assesses psychological and emotional needs, including mental health conditions, anxiety, depression, emotional distress, and the impact of health conditions on psychological wellbeing.
8. Cognition
Considers any cognitive impairments, including memory problems, decision-making capacity, awareness, understanding, conditions like dementia, and the impact on daily functioning. Learn more about our mental capacity assessments.
9. Behaviour
Evaluates behavioral needs, including challenging behaviors, aggression, self-harm, wandering, behaviors that pose risks to self or others, and the support needed to manage these behaviors safely.
10. Drug Therapies and Medication (Symptom Control)
Assesses the need for symptom control through medication, including complex medication regimens, pain management, administration methods (injections, infusions), monitoring requirements, and side effect management.
11. Altered States of Consciousness
Includes conditions like seizures, epilepsy, episodes of unconsciousness, fluctuating consciousness levels, and the monitoring and management required for these conditions.
12. Other Significant Care Needs
A catch-all for any other significant needs not covered by the other domains, including any additional health-related requirements that impact care needs and complexity.
How Domains Are Scored
Each domain is rated as:
Priority (P): Immediate life-threatening needs requiring constant intervention
Severe (S): Significant care needs with major impact on daily life
High (H): Considerable care needs requiring regular professional intervention
Moderate (M): Regular care needs with some professional input
Low (L): Minimal care needs with occasional support
No needs (N): No care needs in this domain
The combination of scores across all domains determines eligibility. Generally, individuals with multiple severe needs, one or more priority needs, or a particular pattern of high needs across multiple domains may qualify for NHS CHC.
What Happens After Your CHC Assessment?
If You're Found Eligible:
A personalised care plan will be developed
The NHS will arrange and fund your care package
You'll be assigned a CHC coordinator
Your care will be reviewed regularly (at least annually)
You can choose your care provider (subject to availability and suitability)
If You're Found Ineligible:
If an individual is found ineligible, a detailed explanation will be provided. The decision letter should clearly outline:
Which care domains were assessed
The scores given for each domain
The rationale for the ineligibility decision
Your right to request a review or appeal
You have six months from the decision letter to appeal.
The Appeals Process:
Local Resolution: Request a review of the decision with the local CHC team (Integrated Care Board in England or Local Health Board in Wales)
NHS England Independent Review Panel (IRP): If local resolution doesn't succeed
Parliamentary and Health Service Ombudsman: Final stage if still unresolved
How Nellie Supports Helps with NHS CHC
At Nellie Supports, we understand that navigating NHS CHC can be challenging. Our dedicated team provides professional support at every step of your CHC journey.
Our NHS CHC Services Include:
✓ Initial Consultation
A consultation to discuss your situation and provide tailored guidance on your CHC eligibility and options.
✓ CHC Checklist Support
Assistance with completing the initial CHC checklist to ensure all relevant health needs are properly documented and presented.
✓ DST Meeting Preparation
Comprehensive preparation for your Decision Support Tool meeting, including:
Gathering and organising medical evidence
Identifying key care needs across all 12 domains
Preparing family members and care professionals
Attending the DST meeting with you for support and advocacy
✓ Assessment Support
Assistance in preparing for the assessment to ensure all necessary information is collected and presented clearly.
✓ Appeal Assistance
Professional support throughout the appeal process, including:
Reviewing the original decision and identifying grounds for appeal
Gathering additional evidence to strengthen your case
Drafting appeal submissions and representations
Representation at Independent Review Panels
Guidance through all stages of the appeals process
✓ Ongoing Support
Answers to your questions and continuous support throughout your CHC journey.
Our CHC Services & Fixed Fees
We believe in transparency. Every service comes with a fixed price, so you'll always know the cost upfront—no hidden charges or unexpected bills.
Service Pricing
Service | Price | What's Included |
Initial CHC Consultation | £250 + VAT | One-hour consultation with a qualified professional to review your situation and provide tailored advice |
CHC Checklist Support | £495 + VAT | Comprehensive Care Act 2014 assessment and prospective NHS CHC Checklist |
DST Representation | £2,000 + VAT | Full preparation and attendance at your DST meeting |
CHC Decision Review | £2,000 + VAT | Comprehensive review of your DST outcome to identify grounds for appeal |
Appeal Stage 1: Local Resolution | £8,000 + VAT | Full support through the first stage of the appeals process |
Appeal Stage 2: Independent Review Panel | £9,000 + VAT | Comprehensive representation at IRP hearing |
Appeal Stage 3: Ombudsman Support | £8,000+ VAT | Specialist support preparing and submitting your case to the PHSO |
Travel Charges: All travel undertaken as part of service delivery is chargeable at £40 per hour, calculated based on the most efficient reasonable route.
A Note on Fees
If you are acting as a financial attorney under a Lasting Power of Attorney (LPA), or as a Deputy appointed by the Court of Protection, you may usually use the funds of the person you support to pay for our services.
This is because:
The advice is being sought on their behalf (the person who may be entitled to NHS Continuing Healthcare funding)
Attorneys and Deputies have a duty to act in the best interests of the person they represent
Provided the cost is reasonable and affordable, using their funds to cover professional advice on CHC is generally acceptable
SRA Compliance & Legal Information
Important: Nellie Supports is not a law firm and is not regulated by the Solicitors Regulation Nellie Supports is not a law firm and is not regulated by the Solicitors Regulation Authority (SRA). However, our team includes an SRA-regulated solicitor who provides legal expertise as part of our multidisciplinary approach to CHC support. This ensures you benefit from both legal knowledge and comprehensive professional input, while fees remain transparent and fixed.
Professional Indemnity Insurance
We are required to have professional indemnity insurance, and our insurance details are available upon request.
No Guarantees
We cannot guarantee that you will receive NHS Continuing Healthcare (CHC) funding—and no provider can. Funding decisions are made by the NHS against national criteria set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
What we can provide is:
Professional legal and advocacy support
Expert preparation of your case
Comprehensive representation throughout the process
Clear, honest advice about your prospects
No Win-No Fee
Nellie Supports does not offer no-win-no-fee arrangements. We believe this model can create uncertainty for families. Instead, we provide all our CHC services on fixed fees, inclusive of VAT, so you always know the cost in advance with no hidden charges.
Complaints Procedure
If you are unhappy with our service, please contact us at:
Email: Nellie@nelliesupports.com
Phone: 0333 987 5118
We will do our best to resolve your concerns promptly.
If we are unable to resolve your complaint, you may refer it to the Legal Ombudsman:
Website: www.legalombudsman.org.uk
Phone: 0300 555 0333
You must usually refer a complaint to the Legal Ombudsman within six months of our final response.
Your Privacy Matters
We handle all personal and health information in strict confidence, in line with GDPR and SRA regulations.
NHS CHC Support Across England and Wales
Nellie Supports provides NHS Continuing Healthcare advice and appeal support throughout England and Wales. We offer both face-to-face and remote consultations, with particular expertise serving families in:
London and the South East
The Midlands
Wales
Northern England
South West England
Our nationwide service ensures you receive expert CHC guidance regardless of your location, with the same compassionate, professional support that has earned us a 4.9-star rating from over 122 client reviews.
Common Misconceptions About NHS Continuing Healthcare
❌ Myth: NHS CHC is only for the elderly
✅ Fact: NHS CHC is available for adults of all ages with complex health needs—not just the elderly. Young adults with conditions like brain injuries, neurological conditions, or complex disabilities may also qualify.
❌ Myth: You must be in a care home to qualify
✅ Fact: Funding is available for various care settings, including home care. Many people receive CHC funding to support them living in their own homes with appropriate care packages.
❌ Myth: NHS CHC is means-tested
✅ Fact: It is not means-tested; your financial situation does not impact eligibility. Unlike local authority social care funding, CHC is based solely on health needs, not income or assets.
❌ Myth: If you have a terminal illness, you automatically qualify
✅ Fact: While terminal illness may suggest a primary health need, eligibility is based on the overall complexity of health requirements.
This is an educational resource about Continuing Healthcare. If you need professional CHC advice, assessment support, or appeal representation, visit our NHS CHC Services page or book a free consultation.
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