Continuing Healthcare

NHS Continuing Healthcare Funding is designed to pay for the care fees of people that require ongoing care and support due to having a primary health need.

Whether an individual has a physical health need, a mental health need, or a combination of both, if found to be eligible the NHS should pay 100% of the cost of their care.

NHS Continuing Healthcare (CHC) is a package of care which is fully funded by the NHS, for individuals aged 18 or over who have complex and ongoing healthcare needs. It can be provided in a number of care settings including (but not limited to) care homes, nursing homes, or in your own home. The process to determine eligibility follows a structured pathway with clear timelines and stages, designed to ensure fair and consistent decision-making.

In simple terms, if a person’s primary need is for healthcare, they may be eligible to have the entire cost of their care paid for by the NHS, regardless of their income, savings or owning property, meaning unlike social care, it is not means-tested.

Who Is It For?

NHS Continuing Healthcare is designed for people who need ongoing care and support due to a primary health need — whether physical, mental, or a combination of both. It may apply to individuals living with:

• Dementia or Alzheimer’s
• Parkinson’s disease
• A stroke or brain injury
• A terminal or progressive illness
• Serious mobility issues or long-term medical conditions
• Mental health needs such as severe depression, schizophrenia, or other psychiatric conditions — even if the person is physically mobile and otherwise in good physical health.

Every person is different.

What matters most in determining eligibility is not a specific diagnosis, but how complex, intense, or unpredictable their care needs are on a daily basis.

Even if someone appears outwardly independent or mobile, their internal struggles — whether cognitive, behavioural, or emotional — may still mean they qualify for full NHS Continuing Healthcare funding.

At Acorn Continuing Healthcare, we help you understand where your loved one’s needs fit within the NHS CHC criteria, and whether it’s worth pursuing an assessment, review or progressing with an appeal.

The process

1. Initial Screening – The Checklist Tool

The journey typically begins with a Checklist Assessment, completed by a nurse, social worker, or another qualified health professional. This initial screening determines whether the person should proceed to a full assessment for NHS Continuing Healthcare.
Timeframe: The NHS recommends the Checklist be completed within 14 calendar days of a request or referral being made. This helps ensure timely progression through the process, especially in community settings.

2. Full Assessment – Decision Support Tool (DST)

If the Checklist indicates a potential for eligibility, a full assessment is conducted by a Multi-Disciplinary Team (MDT), using the Decision Support Tool (DST). This assesses needs across 12 care domains including mobility, cognition, nutrition, and behaviour.
Timeframe: The NHS aims to complete this full assessment and reach a decision within 28 calendar days of the positive Checklist outcome.

3. Eligibility Decision

The local NHS Integrated Care Board (ICB) makes the final decision based on the MDT’s recommendation.
Outcome: If eligible, the individual will receive a tailored care and support plan, with NHS CHC funding covering the full cost of their assessed care needs. Funding may also be backdated and recovered retrospectively if delays occurred during the assessment process, or it is established care fees have been paid for a previously unassessed period of Care (PUPOC).

4. Appeals and Reviews

If following the NHS CHC assessment process you disagree with the eligibility decision, you have the right to request a review.

A Local Review Request, should be made within 6 months of the decision (or deadline on decision the letter you receive). The ICB will organise a local resolution process, which may include a review meeting.

If the outcome remains unsatisfactory, you can escalate the matter to NHS England for their Independent Review Panel (IRP) to review the decision further. The NHS England IRP have the ability to overrule the decision made by the Local Integrated Care Board.

Local reviews typically occur within 3 months, while IRPs can take 6–12 months, depending on complexity and caseload.

5. Annual Reviews

If CHC funding is approved, the care package will be reviewed after 3 months, and then every 12 months thereafter, to ensure the person’s needs are still being met appropriately.

How can Acorn Continuing Healthcare help with your NHS CHC Application?

NHS Continuing Healthcare can be difficult to obtain

If you or a loved one or someone you are responsible for is living with a primary health need, it can be shocking to find out how difficult it is to access NHS Continuing Healthcare (CHC). Even people who clearly need full-time support and meet the criteria for entitlement to CHC funding are often refused funding. So why is the process so challenging?

1. Eligibility Is Complex

NHS CHC isn’t based on a diagnosis or how much help someone appears to need. It’s about whether a person’s needs are primarily health-related and whether they meet the NHS CHC criteria across the assessed domains. The assessment process also includes key principles,  meaning having the appropriate levels of complexity, intensity, unpredictability and considering the nature of the individuals condition. These key principles can be highly technical, often open to interpretation and can be hard to prove without specialist knowledge and experience of where and how to include them in the assessments themselves.

2. Assessments Depend on Documentation

NHS CHC assessments rely heavily on written care notes and medical records. If symptoms or behaviours aren’t recorded properly, or difficult to make sense of or find in written records, areas like risk of falls, episodes of confusion, or frequency of interventions, may be seen as less serious or even missed or ignored during the assessments completely.

3. Even Healthcare and Medical Professionals can Misunderstand the NHS Continuing Healthcare Criteria 

Many doctors, nurses, and social workers have limited understanding or no training or awareness of NHS CHC, or have only seen funding rejected during assessments. Some may unintentionally give misleading advice, telling families that someone is “unlikely to qualify” or that NHS CHC is only for people who are in late stages of life. This is completely false, and such guidance can stop people from applying altogether, leading to incorrectly using a lifetimes savings and property to pay for care fees.

4. It’s Inconsistent Across Regions

The NHS Continuing Healthcare assessment framework is regularly open to interpretation. What one local NHS Integrated Care Board (ICB) team accepts, another might reject. This lack of consistency creates confusion and frustration for families. Processes may also differ across regions, while the National Framework provides details on process and timescales, one ICB might for example provide deadlines that state 6 months to appeal as stated in the National Framework, however they might add to that saying the 6 month deadline is only applicable if you respond within so many days of the date on that letter. ICB’s might also have set ways to communicate with their NHS CHC funding department, this can mean if you email they won’t accept or respond to it, while others might do the same with letter in the post. They might also change their process part way through your CHC journey.

Due to the time assessments and decisions can take, you might be passed to other staff members and communication methods might change. All of this can lead to lengthy delays or having your case closed without you being aware, due to missed timelines caused by delays or changes in communication that are completely out of your control in the process.

5. Most People Are Refused and Are Then Faced With Having To Appeal

Initial NHS CHC applications are often unsuccessful, even when full funding is evident. Appeals are time-consuming and emotionally draining, leaving families without support for months or longer. This can end with families giving up due to the stress and emotions or simply losing track of time and having cases closed. We hear from so many individuals that might have not progressed to appeal due to the stress, emotional impact, time constraints or being busy with other family matters or simply not wanting to look like they are causing the NHS more work. Appeals can also be incredibly intimidating and can mean families would prefer to have a quiet life.

In summary

In Summary, NHS Continuing Healthcare is hard to access not because people don’t need it, but because:

• It’s incredibly difficult to even apply for
• Applications can be misplaced by the NHS
• The criteria can seem overly strict and complex
• Assessments often miss key issues
• Many professionals can misunderstand the process
• Outcomes vary across the country
• Appeals are the norm, not the exception

How we can help

• Free Early-Stage Advice
• If you’re planning for future care, we’ll help you understand your rights and the options available before costs begin to build
• Support During Assessments
• We guide families through the full NHS Continuing Healthcare (CHC) assessment process, ensuring it’s fair, thorough, and properly documented
• Appeals, Reviews & Retrospective Claims
• Was funding wrongly denied? We specialise in challenging NHS CHC decisions, managing appeals, and recovering costs from previously unassessed periods of care (PUPOC)
• Ombudsman Complaints

Why choose Acorn?

• Our team have years of experience and have been key to a high number of successful outcomes.
• Independent & Client-Focused – We work only for you and your family.
• Clear, Straightforward Advice – No jargon. Just support you can trust.
• Compassionate Approach – We understand the emotional and financial strain families face.
• Cost effective – We offer the most cost effective fees when compared to like for like services.
• Fixed costs quoted from the outset.

Let us take the pressure off, we can deal with the whole process on your behalf.

Whether you’re just beginning to explore your options or you are already deep in the process, we are here to help.

We take time to listen to you and understand how you came to be where you are now, getting to know either you or the patient you are acting on behalf of and your situation as much as possible. We are regularly told that just speaking to us during the first call has helped families significantly with the emotional burden.

For free advice contact us using the form below: