What is a primary health need?

A primary health need exists where an individual's nursing or healthcare needs are more than incidental or ancillary to accommodation provided by a local authority, or are beyond what a local authority can lawfully provide. Where a primary health need is established, the NHS is responsible for funding all assessed needs, including accommodation.

How long does the NHS Continuing Healthcare process take?

The CHC process can take several weeks to many months. Delays often occur between Checklist, full DST assessment, decision letter, and appeal stages. Independent Review Panels and Ombudsman complaints can extend the timeline further.

Can you appeal a CHC refusal?

Yes. If NHS Continuing Healthcare is refused, you usually have six months to lodge an appeal. The process begins with Local Resolution and may escalate to an Independent Review Panel or Ombudsman if necessary.

Is NHS Continuing Healthcare means-tested?

No. NHS Continuing Healthcare is not means-tested. Eligibility is based on care needs and the primary health need test, not on savings or property ownership.

Does the Decision Support Tool automatically determine eligibility?

No. The Decision Support Tool records levels of need across domains. Eligibility depends on how the totality of needs relates to the four key characteristics of Nature, Intensity, Complexity and Unpredictability.

Who makes the final NHS Continuing Healthcare decision?

The multidisciplinary team makes a recommendation based on the completed DST. The final eligibility decision is made by the Integrated Care Board.

The NHS Continuing Healthcare (CHC) Process – A Step-by-Step Guide

If you’ve been told your relative may qualify for NHS Continuing Healthcare (CHC) — or you’ve just received a refusal — the process can feel overwhelming.

This guide explains:

What NHS Continuing Healthcare is
Every stage of the CHC process
Where decisions commonly go wrong
Your appeal rights
When to seek professional support

If you're unsure where you stand, you can book a Free 15-Minute CHC Check with our team.

What Is NHS Continuing Healthcare (CHC)?

NHS Continuing Healthcare is a package of care funded entirely by the NHS for adults with a primary health need.

It is:

Not means-tested
Not dependent on savings or property
Based on care needs - not diagnosis

If eligible, the NHS must fund:

Care home fees
Home care packages
Nursing support
Specialist health needs

The legal framework is governed by the National Framework for NHS Continuing Healthcare and NHS-Funded Nursing Care.

Overview: The 6 Stages of the CHC Process

The process

The Checklist
Full Assessment (DST / MDT)
Decision Letter
Local Resolution Appeal
Independent Review Panel (IRP)
Ombudsman

Each stage has different risks, rights, and opportunities.

Stage 1: The CHC Checklist

What is the Checklist?

The Checklist is a screening tool used to determine whether a full CHC assessment is required.
It should:

Be completed by a trained assessor
Involve family input
Consider current care records
Be scored against set thresholds

If the threshold is met → the case proceeds to full assessment.

Where Things Often Go Wrong

Checklist refused or delayed
Carried out without family present
Incorrect scoring
Assessor minimises needs
Told “they won’t qualify anyway”

A failed Checklist can be challenged.

If you are at this stage, see our CHC Application & Checklist Support service.

Stage 2: Full Assessment (DST / MDT)

If the Checklist passes, the NHS must arrange a Multi-Disciplinary Team (MDT) meeting.

The MDT completes the Decision Support Tool (DST).

What Is the DST?

The DST assesses 12 care domains, including:

Behaviour
Cognition
Mobility
Nutrition
Continence
Skin integrity
Medication
Psychological needs

Eligibility is determined using:

Nature
Intensity
Complexity
Unpredictability

This is where most eligibility decisions are effectively decided.

Common Problems at MDT Stage

Domains under-scored
Behaviour minimised
No proper analysis of complexity
Failure to apply “primary health need” correctly
ICB overturns MDT recommendation

If preparing for MDT, see our DST Representation & Evidence Pack Support.

Stage 3: The CHC Decision Letter

What to Check in the Decision Letter

Does it explain why eligibility was refused?
Does the rationale match the DST scores?
Has the Framework been correctly applied?
Were nature, intensity, complexity and unpredictability analysed?

If unsure, we offer a fixed-fee CHC Appeal Viability Review.

Stage 4: Local Resolution Meeting

This is the first formal appeal stage.

You submit written grounds of appeal and attend a review meeting with the ICB.

What Should Happen

Full reconsideration of evidence
Clear discussion of disputed domains
Framework applied correctly

What Often Happens Instead

Rubber-stamping the original decision
Limited analysis
Intimidating panel structure

Professional representation significantly improves clarity and structure at this stage.

See our Local Resolution Support Service.

Stage 5: Independent Review Panel (IRP)

If Local Resolution fails, the case can escalate to NHS England for Independent Review.

IRP focuses on:

Whether the National Framework was correctly followed
Whether process errors occurred
Whether the decision was rational

It is not simply a re-scoring exercise.

IRP is complex and evidence-driven.

Stage 6: Ombudsman

If procedural unfairness remains, a complaint can be made to:

Parliamentary & Health Service Ombudsman (England)
Public Services Ombudsman for Wales

The Ombudsman examines maladministration, not eligibility scoring.

Where Do Most Families Contact Us?

Most families contact us after receiving a refusal decision. While some seek support at the Checklist stage or before a Full Assessment (MDT), the most common entry point is immediately following a negative Decision Letter. At this stage, many families realise the scoring does not reflect the reality of their relative’s needs. Fewer cases begin at the Independent Review Panel (IRP) or Ombudsman stage, as these are typically escalations following earlier challenges. In short, support is most often sought once eligibility has been formally declined.

You can read a full step-by-step overview in our guide to the NHS Continuing Healthcare process.

How Long Does the CHC Process Take?

Checklist: 2–4 weeks (often delayed)
Full assessment: 4–12 weeks
Decision letter: 2–4 weeks post-MDT
Local Resolution: Several months
IRP: 6–12 months
Ombudsman: 12+ months

Delays are common.

Can CHC Be Backdated?

Yes.

If the NHS should have assessed earlier or wrongly refused eligibility, retrospective funding may be recoverable.

This is complex and evidence-heavy.

When Should You Seek Help?

You should consider professional support if:

The Checklist was refused
The MDT felt rushed
The DST does not reflect care reality
You’ve received a refusal letter
You feel the decision is unfair
You are considering IRP

Frequently Asked Questions

Diagnosis alone does not determine eligibility. Eligibility depends on the nature and complexity of health needs.
No. Savings and property do not affect eligibility.
There is no automatic score, but certain combinations strongly indicate eligibility under the Framework.
Usually appeals must be lodged within 6 months, but exceptions may apply.
The term “primary health need” is not explicitly defined in legislation. However, it is central to determining eligibility for NHS Continuing Healthcare (CHC).

The National Framework for NHS Continuing Healthcare explains that a person should be considered to have a primary health need where the nursing, healthcare treatment, or services they require are:

More than incidental or ancillary to the provision of accommodation that a local authority would otherwise provide under means-tested social care arrangements; or

Of a nature beyond what a local authority can lawfully provide.

In practical terms, this means the individual’s needs must be primarily health-related rather than social care-related.