NHS Continuing Healthcare: how to keep evidence for an assessment

What NHS Continuing Healthcare is

NHS Continuing Healthcare, usually called CHC, is care arranged and paid for entirely by the NHS. It is for adults whose main need for care comes from their health. This is known as having a “primary health need”. CHC is not means-tested, so savings and income make no difference, and it can be provided at home or in a care home.

This guide describes the process in England, where the local Integrated Care Board (ICB), the NHS body that plans and pays for local health services, makes the decision. Wales has a similar system run by local health boards, with its own guidance. Northern Ireland has its own arrangements. Scotland is different: it replaced CHC in 2015 with Hospital Based Complex Clinical Care, which is for people whose needs can only be met in hospital. The English forms and appeal steps below do not apply there.

Step 1: the Checklist

The Checklist is a short screening tool. A nurse, doctor, social worker or other trained professional uses it to decide whether a full assessment is needed. It covers 11 of the 12 care areas described below. The bar is set deliberately low, so many people with a positive Checklist do not go on to qualify.

You should be told the result and the reasons in writing. Moments when it is often worth asking for a Checklist include a hospital discharge, a move into a care home, or a clear increase in needs. A negative result can be looked at again if needs change.

Step 2: the full assessment and the Decision Support Tool

The full assessment is done by a team of at least two professionals from health and social care. They complete a form called the Decision Support Tool, or DST. It rates the person’s needs in 12 areas, called care domains:

• breathing
• nutrition (eating and drinking)
• continence
• skin integrity (skin and wounds)
• mobility
• communication
• psychological and emotional needs
• cognition (memory, understanding and decision-making)
• behaviour
• drug therapies and medication, including symptom control
• altered states of consciousness, such as seizures or blackouts
• other significant care needs

Each domain is rated as no needs, low, moderate or high. Some domains also have a severe level, and four have a priority level, the highest. A priority rating, or severe ratings in two domains, would usually be expected to show eligibility. Other combinations can qualify too, because the team also looks at the nature, intensity, complexity and unpredictability of the needs as a whole.

The team sends a recommendation to the ICB, which makes the decision. The person and their family have the right to take part and give their views. It helps to ask for the date in writing, attend if you can, and ask for any disagreement to be written on the form.

If someone’s health is getting worse quickly and they may be nearing the end of life, a clinician can use the Fast Track Pathway Tool instead. This can arrange funded care within days, without waiting for a full assessment.

Why a daily diary helps

An assessment might last an hour on a good day. Needs happen at 3am, at mealtimes and on bad days. Notes written at the time, organised by care domain, show assessors what a short visit can miss.

Good care can also hide needs. If carers turn someone every few hours, their skin may look fine. The need is still there; it is being met. A diary can record the care that prevents problems, not only the problems themselves.

What to note in each entry

• the date and time, and which care domain it relates to
• what happened, in plain words, and how long it lasted
• what help was needed, and how many people gave it
• what would have happened without that help
• who saw it, such as a nurse, carer or GP
• any change in medication, and its effect
• night-time events, such as waking, falls, confusion or calling out

Short, frequent entries are more useful than long ones written weeks later. Over time they show how often things happen, which matters as much as how serious they are. Before an assessment, it also helps to ask the care home for its daily records and the GP for recent notes.

After the decision: reviews

If CHC is awarded, the first review is normally within 3 months of the decision, and then at least once a year, or sooner if needs change. Funding can stop if a review finds that needs have reduced. Keeping the diary going after an award helps show that the needs, and the care that manages them, are still there.

If you disagree: appeals

If you disagree with an eligibility decision, the first step is to ask the ICB to look at it again. This is called local resolution. The time limit is set by each ICB’s own policy, and is typically 6 months from the date you were told of the decision, so check the ICB’s policy and act soon. If you are still unhappy, you can ask NHS England for an independent review. After that, you can complain to the Parliamentary and Health Service Ombudsman.

For a review, ask for a copy of the completed DST. Note where you disagree with each rating, and why, linking to diary entries as evidence.

If CHC is not awarded: NHS-funded Nursing Care

Someone who does not qualify for CHC, but lives in a care home that provides nursing and needs care from a registered nurse, may get NHS-funded Nursing Care (FNC). The NHS pays a flat weekly amount straight to the care home, whoever pays the rest of the fees. In England the standard rate is £267.68 a week from 1 April 2026. Wales sets its own rate, and the 2026/27 figure had not been published when we checked. In Northern Ireland the Trust pays £100 a week towards nursing care. In Scotland, free nursing care payments of £117.10 a week apply from 1 April 2026, alongside free personal care payments of £260.30 a week for people who pay their own care home fees.

If the person pays their own fees, FNC should show as a credit on the invoice. For what happens to the rest of the fees, see our guide to paying for care.

How Seventide helps

Seventide’s CHC evidence diary is organised by the 12 care domains, with quick capture that takes about 20 seconds and voice dictation, so notes get written at the time. A CHC timeline tracks the Checklist, assessment, reviews and appeal deadlines, and template letters help you request records or a review. The evidence pack exports a PDF per domain, with how often things happen and who was involved, ready to hand to assessors.

This guide explains the published process in general terms. It is not legal or medical advice. Only the assessors and the ICB decide eligibility, and good evidence helps them see the whole picture. For help with a difficult case or an appeal, you may want to ask a solicitor or an independent advocate who specialises in Continuing Healthcare.

Official sources

• NHS: NHS continuing healthcare
• GOV.UK: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
• GOV.UK: NHS Continuing Healthcare Checklist
• GOV.UK: NHS Continuing Healthcare Decision Support Tool
• GOV.UK: NHS Continuing Healthcare Fast Track Pathway Tool
• NHS: NHS-funded nursing care
• Parliamentary and Health Service Ombudsman

Last checked: October 2026, figures for the 2026/27 tax year.