Understanding CHC
How the assessment works
NHS Continuing Healthcare is a package of care funded entirely by the NHS. It is not means tested. It does not depend on a diagnosis, on savings, or on where someone is cared for. It depends on one thing: whether the care they need is judged to be primarily a health need.
That judgement is reached through an assessment, and the assessment is where most families find themselves lost. This page sets out what is actually being measured, and why sound cases are so often refused.
The Decision Support Tool
Eligibility is decided on twelve care domains
Not on a diagnosis, and not on savings. Each domain is scored from No needs up to a ceiling that differs by domain. Understanding this grid is usually the difference between a decision that sticks and one that gets overturned.
What tips a case into eligibility
A recommendation of eligibility would normally be expected where the scoring shows:
- AOne domain at Priority, or
- BTwo or more domains at Severe
It can also be indicated by one Severe alongside needs in several other domains, or by a number of High and Moderate scores taken together. The board must look at the overall picture — nature, intensity, complexity and unpredictability — not just count boxes.
Select a domain to see what it covers →
Why the score is not the whole story
It is tempting to read the grid above and conclude you can work out the answer yourself. In practice it rarely works that way, and this is the single most common reason a strong case is lost.
A domain is scored on the evidence in front of the assessors — the daily notes, the care plan, the charts, the medication records. If a person is physically aggressive most days but the notes record two incidents, the domain is scored on those two incidents. The need was real. The record did not show it.
The assessment also has to weigh the whole picture together: the nature of the needs, their intensity, their complexity, and how unpredictable they are. Two people with identical scores can receive opposite decisions on the strength of how those four things were argued.
This is why we do not screen anyone out on their scores. We look at the evidence that was available at the time of the assessment, and whether it was read properly.