Unsure about the legalities surrounding the NHS Continuing Healthcare (CHC)? We asked Lisa Morgan, partner and head of the nursing care fee recovery team at Hugh James Solicitors, for everything you need to know.
What is it?
“The NHS Continuing Healthcare (CHC) is a package of care arranged, and funded solely, by the NHS for individuals18 or over who have significant ongoing health needs. Unlike social care, which is means-tested, CHC is free at the point of delivery. It can cover the full cost of a person’s care, whether in their own home, a nursing home, or another setting.”
Who’s eligible
“Eligibility is not based on a specific diagnosis, age, or condition. Instead, it depends on whether the person’s primary need for care is a health need. To assess this, healthcare professionals carry out a comprehensive review using the Decision Support Tool (DST). This looks at different areas such as mobility, breathing, nutrition, cognition, and behaviour, and considers the nature, intensity, complexity, and unpredictability of needs.”
How are you assessed?
“The process often starts with a Checklist ‘screening’ assessment, which determines whether a full CHC assessment should take place. If someone is found eligible after the DST, the NHS will fund their care in full. If not, they may still receive support via their local authority, but this could be subject to financial means-testing.”
Does that mean you’ll always get it?
No, it’s important to understand that eligibility is reviewed regularly, as a person’s needs may change over time. Families often find the process complex and daunting, but knowing the basics and being prepared can make a big difference as care fees will be paid by the NHS and even care fees can be reimbursed.”
What is someone was eligible but has passed away?
“Claims don’t end when someone dies. If a person should have been eligible for NHS Continuing Healthcare but was wrongly denied or not assessed at all, their estate can bring a claim for retrospective funding. This means the NHS may reimburse care costs that were wrongly charged, even after the individual passed away. While these cases can take some time, many families find them worthwhile especially where large sums were spent on care.”
Five top tips for navigating the NHS Continuing Healthcare
1. Know Your Rights
“CHC is not limited to certain conditions like dementia or terminal illness – anyone with significant health needs may qualify. Don’t be put off by myths or assumptions.”
2. Be Prepared for the Assessment
“Evidence is key. Keep detailed records of medical history, care plans, and daily challenges. Real-life examples of needs (such as risks of falls or medication management difficulties) can strengthen the case.”
3. Challenge if Needed
“If eligibility is refused, you have the right to appeal. Many families are successful on review, especially if they can provide additional evidence.”
4. Seek Professional Guidance
“You don’t need to navigate the system alone. Charities, advocacy groups, and solicitors can help you understand the process and present your case effectively and even attend assessments with you.”
5. Think Long-Term
“Needs can change, so even if you are not eligible now, you may be in the future. Keep records up to date and request reassessments if health declines.”
“Just remember, the NHS Continuing Healthcare can make a huge difference for families, removing the stress funding care and ensuring loved ones receive the funding and support they are entitled to,” continues Lisa. “The process may feel overwhelming at first, but with persistence, preparation, and the right advice, you can navigate it successfully. And even if the opportunity was missed during their lifetime, it’s never too late for families to see justice through the retrospective claim.”
For more help, contact the specialist team at Hugh James who have 18 years of experience in assisting families in securing CHC funding and have recovered over £250 million for our clients.
