- NHS Continuing Healthcare (CHC) is care arranged and funded entirely by the NHS. It is not means-tested.
- Eligibility depends on a person’s needs, not their diagnosis.
- In Kent, the Kent and Medway Integrated Care Board makes the final decision.
- Fast Track is a quicker route for people nearing the end of life.
- Daily care notes from a provider already in place can show needs that a care plan cannot.
By Rachael Fox, Registered Manager at All About Home Care
If someone you love has complex health needs, you may be paying for their care without anyone having told you that the NHS might cover it. NHS Continuing Healthcare (CHC) is a package of care that is arranged and funded entirely by the NHS for people whose main need is a health need. It is not means-tested, so savings and income are not part of the decision. It is free funding, and for a family that can be a very big win, because it can remove what might otherwise be a very large care bill.
The one thing I wish more families knew is that CHC exists. Most don’t, so they never even consider it as an option. Over the years, I’ve supported people through the process, and in this article I’ll explain how it works in practice, what can slow it down, and why the everyday notes our carers write can matter far more than people expect.
What CHC is, in plain terms
CHC can be provided at home or in a care home. If someone is found eligible, the NHS pays for their care.
The key question is not which condition someone has. It is how much help they need, how complex, intense and unpredictable their needs are, and whether those needs are mainly health-related.
The people I see considered for CHC most often are living with:
- advanced dementia with severe behavioural symptoms;
- Parkinson’s disease with complex care needs;
- motor neurone disease;
- acquired brain injury;
- Huntington’s disease;
- other complex physical and medical needs; or
- end of life and palliative care needs.
A diagnosis on its own does not decide eligibility. Two people with the same condition can have very different needs, and it is the needs that are assessed.
Who decides?
In Kent, the organisation responsible for the final decision is the Kent and Medway Integrated Care Board (ICB). That is the local NHS body that plans and pays for health services, and it must make sure that eligibility decisions follow the national guidance. The All Age Continuing Care Service, now run by Kent Community Health NHS Foundation Trust (the NHS organisation that runs community nursing and other local health services), may carry out assessments on the ICB’s behalf.
How the process works
This is the usual route, though every person’s situation is different.
- Someone identifies a possible need. This might be a district nurse, a hospice team, a hospital discharge team, a family member or the care provider.
- The CHC Checklist is completed. This is a short screening tool, usually done by a health or social care professional such as a district nurse or the hospice team. You can download the Checklist on GOV.UK.
- If the Checklist is positive, a full eligibility assessment follows. A positive Checklist does not mean someone is eligible. It means a full assessment is needed.
- A team of professionals carries out the assessment. This is called a multidisciplinary team, or MDT, which simply means people from different professions, such as nurses, social workers and therapists, working together. You’ll often hear it called “the MDT”. They use a standard form called the Decision Support Tool to look at the person’s needs in detail.
- The ICB makes the eligibility decision.
- If eligible, a care package is put in place and reviewed regularly.
Fast Track
For people who are rapidly deteriorating and may be entering the final stage of their lives, there is a separate Fast Track route. It skips the Checklist, and it is designed to avoid delays. It can be turned around in days, and sometimes within 24 to 48 hours. The Fast Track tool is available on GOV.UK.
Whether someone goes down the Fast Track route is not something we decide. It is for the health professionals carrying out the assessment, who judge whether the person’s needs meet the criteria. What we can do is make sure the right people know that someone’s needs are changing, and give them the evidence. We haven’t supported anyone through Fast Track ourselves, but I’d always want families to know it exists.
How long should it take?
National guidance says the overall assessment and eligibility decision should be completed within 28 calendar days. In practice, it depends on the person’s circumstances, how quickly assessments can be arranged, and how urgent the case is judged to be.
Why CHC can be hard to get
Sadly, getting CHC isn’t straightforward. Age UK’s research has found that the number of people receiving standard CHC has fallen sharply in recent years, while Fast Track approvals have risen. That tells me families often only get support when someone is very near the end of life, and that many people with serious long-term needs miss out.
From my own experience, these are the hurdles families most often come across:
- Getting the referral and assessment moving. Often the biggest barrier is that families don’t know CHC exists, so nobody asks for it;
- Showing that needs are health-led. Needs that feel obviously medical to a family can be hard to evidence on paper;
- Delays between the assessment and the decision;
- Eligibility approved, but the care package not yet agreed. Funding being confirmed and care being arranged are two different steps; and
- Disagreement about eligibility or the care plan. If you disagree with a decision, you can ask for it to be reconsidered.
None of these are reasons not to try. They are reasons to be prepared.
How we get involved
Most of the people we support through CHC are already receiving private care from us when their needs progress to the point where CHC should be considered. Often, families don’t know to ask, so it’s us who notice the change and raise it. When that happens, we advise the family to speak to the district nursing team or the hospice team, who can complete the initial assessment.
Less often, the NHS asks us directly to deliver a package of care under CHC funding. In my experience, those packages tend to be shorter-term, with shorter visits.
When someone is being assessed, we can attend the assessment meeting (the MDT meeting) to give evidence and support the process. We can also share:
- the person’s care plan and risk assessments; and
- their daily visit notes.
The assessment documents themselves are held by the NHS, not by us.
Why having care already in place helps
A care provider who is already involved can help the assessment in three ways:
- We can show actual needs, not predicted ones;
- We can show complexity and intensity over weeks and months, not a single snapshot; and
- We can show continuity, because the same team has seen how the person’s needs change over time.
“The care notes told a different story”
One thing has stayed with me through all of this: how often the daily notes tell the real story. Here is an example from one of the families we supported. I’ve changed nothing important, but I have left out anything that could identify them.
A lady in our care was nearing the end of her life. Her husband had never heard of CHC. He was struggling to cope, and he was supporting her through the nights himself. With his permission, we spoke to the hospice team and asked them to carry out a CHC Checklist. The Checklist was completed within seven days.
When CHC was being considered, our carers’ daily notes showed what the care plan did not. They showed that she was struggling through the night. Her husband would tell the carers, and the carers would also pick up on the signs and record them. The notes also showed a day-by-day decline: she was becoming sleepier, less mobile, and eating and drinking less. A care plan isn’t updated every day, so it couldn’t show any of that. The carers’ notes could.
Sadly, she passed away before the funding was fully set up and agreed. Because we expected the funding to be agreed, we had already increased her care so that she had the level of support she needed straight away, without waiting.
That is the point where the written care plan stopped telling the whole story, and our carers’ observations showed what managing her needs really involved.
Why this matters under the national guidance
The national guidance on CHC includes the idea of a “well-managed need”. It means that a need which is being managed well by good care can still count towards eligibility, even if good care means the need doesn’t look so severe on the day. In plain terms, if a person needs skilled, constant management to stay safe and well, that should still be recognised. Detailed, honest daily notes are how that gets shown.
That is why careful note-taking at every visit isn’t paperwork for its own sake. It can shape someone’s care.
What a CHC care package can look like
Once eligibility is agreed, the package is based on the person’s assessed needs. It may include:
- regular daily visits. A typical end of life package is funded at four visits a day, as it was for the lady in our example, but there is no rule limiting this;
- longer visits or additional care where it is clinically necessary; and
- overnight care or live-in care, round the clock, where someone’s needs require it.
See our pages on live-in care, dementia care and end of life care for what these look like in practice.
If you think CHC might apply to someone you love
- Ask. The first step is to contact the GP (family doctor) surgery or the hospice team and ask for a CHC Checklist to be carried out. If you’re in touch with a district nurse, you can ask them too;
- Keep records. Notes about good days and bad days, falls, night-time needs, behaviour and medication all help. Dates matter;
- Ask for the reasons behind any decision, and ask how to have it reconsidered if you disagree;
- Talk to your care provider. If you already have care in place, ask whether they can share the care plan, risk assessments and daily visit notes; and
- Get independent advice. Dementia UK and Age UK both publish clear, free guidance on CHC.
If you’d like to talk it through, please call us on 01892 575 499. I’m happy to help you work out where to start, even if you’re not yet receiving care from us.
This article is general information, not legal or financial advice. Eligibility decisions are made by the NHS, and everyone’s circumstances differ.
Registered Manager at All About Home Care
Published 26 October 2026
