NHS Continuing Healthcare
The NHS Continuing Healthcare Process, Explained
A clear, stage-by-stage guide to CHC in England, and specialist help at the point where your case actually turns.
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 and does not depend on savings or property. The process runs through a Checklist, a full assessment using the Decision Support Tool, an eligibility decision, and appeal stages. Nellie Supports helps families understand where they are and prepare the evidence that decisions turn on.
Free check
15 minute CHC check, paid support from £1,320 plus VAT
One working day
Enquiry triage response
England
Wales runs a separate Continuing NHS Healthcare framework
Social work led
Registered social workers, peer reviewed
Nellie Supports is a specialist independent social work practice supporting families through NHS Continuing Healthcare across England, from the Checklist through to appeals. Our team is permanently employed, social work led and peer reviewed. If you are unsure where you stand, you can start with a free 15 minute CHC check.
Where families usually need help
Most families contact us after a refusal, when the scoring on the Decision Support Tool does not reflect the reality of their relative's needs. Others seek help earlier, at the Checklist stage or before a full assessment meeting, where being prepared changes what the record shows.
Meetings are often arranged at short notice, and families are asked to take part without knowing what the assessors are looking for. Understanding the stage you are at, and what evidence matters, is where independent support makes the most difference.
The framework the process applies
NHS Continuing Healthcare in England is governed by the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Eligibility rests on whether the person has a primary health need.
A primary health need is judged by the nature, intensity, complexity and unpredictability of the person's needs, considered together, not by any single diagnosis or score.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Screening: the CHC Checklist. Full assessment: the Decision Support Tool across twelve care domains, completed by a multidisciplinary team. Decision: the Integrated Care Board. Appeals: local resolution, then the Independent Review Panel convened by NHS England, then the Parliamentary and Health Service Ombudsman.
For the deciding concept, read our guide: what is a primary health need?
The six stages of the CHC process
The CHC Checklist
A screening tool that decides whether a full assessment is needed. It should be completed by a trained assessor, involve family input and consider current care records. Meeting the threshold moves the case to full assessment. A failed Checklist can be challenged.
Full assessment with the Decision Support Tool
If the Checklist passes, the NHS arranges a multidisciplinary team meeting that scores twelve care domains using the Decision Support Tool. This is where most eligibility decisions are effectively made, judged on nature, intensity, complexity and unpredictability.
The decision letter
The Integrated Care Board issues the eligibility decision. A sound letter explains the reasoning, matches the Decision Support Tool scores and applies the Framework. Where it does not, that is the ground for challenge.
Local resolution
The first formal appeal stage, handled by the Integrated Care Board. You submit written grounds and attend a review. Full reconsideration of the evidence should happen here; too often the original decision is simply restated, which is where clear representation matters.
Independent Review Panel
If local resolution fails, the case can escalate to NHS England for independent review of whether the Framework was correctly followed and the decision was rational. It is not a simple re-scoring, and it is evidence driven.
The Ombudsman
If procedural unfairness remains, a complaint can be made to the Parliamentary and Health Service Ombudsman. The Ombudsman examines maladministration rather than re-deciding eligibility scoring.
How Nellie Supports helps at each stage
Support is practical and evidence led. Depending on where you are, that means checking a decision letter against the Framework, preparing for a Checklist or Decision Support Tool meeting, building the evidence the multidisciplinary team should see, or representing the person's needs at the meeting itself.
Find your stage
A free 15 minute CHC check to tell you plainly where you are and what should happen next.
Check the decision
A review of a decision letter or Decision Support Tool against the National Framework, so you know whether it is challengeable.
Prepare the evidence
Building the picture of need the multidisciplinary team should see, so domains are scored against reality, not minimised.
Represent at the meeting
Attending the Checklist, Decision Support Tool or appeal meeting to represent the person's needs and keep the Framework in view.
Support from £1,320 plus VAT
From £1,320 plus VAT
Start with a free 15 minute CHC check. Where paid support follows, every instruction starts with the Independent Social Care Needs Assessment and Care Plan at £1,320 plus VAT, completed and charged once per client. Stage support beyond that is fixed and stated in writing before anything begins.
Travel for in-person attendance is confirmed in writing before booking.
Free 15 minute CHC check
Where you are in the process and what should happen next, explained plainly.
Assessment and care plan first
Paid support starts with the Independent Social Care Needs Assessment and Care Plan, completed once per client.
Evidence mapped to the twelve domains
Needs set out in the language the assessment scores.
Support at the right stage
Checklist, Decision Support Tool, appeal or review, with representation where needed.
Peer review as standard
A second qualified professional reviews the work before it is used.
How this works in practice
Sarah contacted Nellie Supports after her mother moved into a nursing home. The local authority had advised that a multidisciplinary team meeting was being arranged to complete the Decision Support Tool, and Sarah wanted professional support at the meeting so that her mother's needs would be represented properly.
Before the meeting, our social worker completed an Independent Social Care Needs Assessment and Care Plan, then built an evidence map setting out her mother's needs against the twelve care domains, cross-referenced to the care records. At the meeting, we presented that evidence alongside the family, so the multidisciplinary team could make its recommendation on a complete and accurate picture of need.
Eligibility remained, as it always does, a matter for the multidisciplinary team and the Integrated Care Board.
This is an illustrative example drawn from our practice experience. It does not describe a specific identifiable person.
Why families and professionals choose Nellie Supports
Social work led
Assessments and evidence are prepared by registered social workers, not call handlers, and every output is peer reviewed.
Permanent employed team
Our team is employed and full time, not an associate panel, so quality and accountability are consistent.
Framework first
We work to the National Framework and the primary health need test, so the evidence answers the question the decision actually turns on.
Honest from the start
If a case is weak we say so at the outset, before you spend on full preparation, which protects families from paying for work that cannot succeed.
England focused
We work within the English Continuing Healthcare framework, and will tell you plainly where Wales differs.
Clear fixed pricing
Where paid work follows the free check, fees are fixed and stated in writing before anything begins.
Frequently asked questions about the CHC process
Does dementia qualify for CHC?
A dementia diagnosis does not decide eligibility on its own. NHS Continuing Healthcare is awarded on the basis of need, not diagnosis, so what matters is the nature, intensity, complexity and unpredictability of the person's health needs. Someone with dementia may well be eligible, but only where those needs, taken together, amount to a primary health need under the Framework.
Is CHC means tested?
No. NHS Continuing Healthcare is not means tested. Savings, income and property do not affect eligibility and are never taken into account. Funding depends entirely on whether the person has a primary health need. This is a key difference from local authority social care funding, which is means tested, and it is often misunderstood by families early in the process.
Can I appeal after six months?
There is normally a six month window to challenge an eligibility decision, running from the decision letter. If you are close to or past that point, contact us promptly and say so, because exceptions can apply and a well-prepared request submitted in time protects your position. Out of time requests can be refused, so acting quickly matters.
Can CHC funding be backdated?
Yes. Where the NHS should have assessed earlier or wrongly refused eligibility, retrospective funding may be recoverable for the unassessed period. These claims are evidence heavy and depend on the care records for the dates in question. We review whether the records support a claim before any full preparation begins, so you know where you stand.
What is a primary health need?
A primary health need is the deciding concept in NHS Continuing Healthcare. It is not defined by a single diagnosis or score. Instead it is judged by the nature, intensity, complexity and unpredictability of the person's needs, considered together. Where those needs are primarily health related rather than social care related, the person should be eligible under the National Framework.
Related NHS Continuing Healthcare guides
What is a primary health need?
The Decision Support Tool and the 12 care domains
How to appeal a CHC decision
CHC support at every stage
Wherever you are in the process, our team supports the next step. Start with a free 15 minute CHC check if you are not sure which stage you are at.
CHC Assessment Support
CHC Appeal Support
Fast Track Review Advocacy
Retrospective CHC Claims
Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.
Not sure where you are in the process?
Start with a free 15 minute CHC check. We will tell you plainly what stage you are at, what should happen next, and whether independent support would help.
We aim to respond to all enquiries the same working day.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.