NHS continuing healthcare: who qualifies

NHS continuing healthcare is a package of care arranged and paid for by the NHS for people who have significant ongoing health needs. If someone qualifies, the NHS pays for their care in full, including care home fees.

Who qualifies

Eligibility depends on whether the person has a “primary health need”. This means their main need for care is because of their health, rather than help with daily tasks. It is not based on a particular diagnosis. Two people with the same illness can have different results.

How it is decided

There are usually two stages.

1. The checklist. A nurse, doctor, social worker or other professional fills in a short checklist to see whether a full assessment is needed.
2. The full assessment. A team of health and social care professionals looks at the person’s needs in detail, across areas such as breathing, nutrition, continence, skin, mobility, communication, behaviour, cognition and medication. They use a document called the Decision Support Tool.

The local Integrated Care Board (ICB) makes the decision.

People who are very ill and nearing the end of life can be assessed quickly through a fast track.

How to ask

Ask the person’s GP, social worker or hospital team for a checklist assessment. If the person is in hospital, it should be considered before discharge if it may be needed.

If someone does not qualify

They may still get other help. In a nursing home, the NHS may pay a contribution towards nursing care. The council may help with care costs after a financial assessment.

Reviews and appeals

Eligibility is reviewed, usually after three months and then at least once a year. If you disagree with a decision, you can ask the ICB to review it.

Read our overview of paying for a care home.