What is continuing healthcare (CHC)?
Continuing healthcare (CHC) is a package of care for people who are not in hospital and have been assessed as having a 'primary health need'. You don't have to pay for CHC – it's arranged and paid for by the NHS. However, it's not common for people to receive CHC if they have only mental health problems as opposed to physical health needs.
CHC can be provided in your own home. The NHS might pay for community nurses or specialist therapists to treat you at home, or give you support with things such as bathing, dressing and doing the laundry. CHC may also be provided in a care home with the NHS paying for your care home fees and providing other services such as nursing.
Who qualifies for CHC?
To be eligible for CHC you must:
- be over 18
- be assessed as having a 'primary health need' – this means that your main need must relate to your health
- have substantial and ongoing care needs.
Seeing whether you're eligible for CHC is a two stage process:
- Preliminary assessment
- Full assessment
What is the preliminary assessment?
First, you'll have a preliminary assessment of your needs using a checklist. This might be carried out by a doctor or a nurse when you're being discharged from hospital, or by your GP or by a social worker.
Preliminary assessment checklist
The checklist covers the following categories (also known as 'care domains'):
- behaviour
- cognition (understanding)
- communication
- psychological/emotional needs
- mobility (ability to move around)
- nutrition (food and drink)
- continence
- skin (including wounds and ulcers)
- breathing
- symptom control through drug therapies and medication
- altered states of consciousness
- other significant needs.
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What is the full assessment?
If the preliminary assessment shows that you may be eligible for CHC, then you'll have a full assessment. This will be carried out by a multi-disciplinary team, consisting of either:
- two healthcare professionals from different healthcare professions, or
- one healthcare professional and one specialist community care assessor.
The multi-disciplinary team will use a checklist similar to the one used in the preliminary assessment checklist and score you on how serious your needs are in each of the categories in the checklist.
Because most of the categories considered in the assessment process don't relate to mental health, and because of the way they are scored, people with only mental health problems are rarely considered eligible for CHC, as opposed to those with physical health problems.
What happens after the full assessment?
The multi-disciplinary team will make a recommendation to your clinical commissioning group if you're in England or local health board in Wales about whether you're eligible for CHC. The clinical commissioning group or local health board will write to you to tell you whether you're eligible and give reasons for their decision.
If you are eligible for CHC, the clinical commissioning group or local health board will discuss with you:
- how your care and needs will be managed
- where it will be provided (for example in your own home or a care home)
- which organisation will be responsible for meeting your needs.
Can I challenge the decision if I'm not eligible for CHC?
Yes – if you have not been found eligible for CHC, you can challenge the decision this way:
- Follow the review procedure of the clinical commissioning group that made the decision. The clinical commissioning group must have its own review procedure which should be publicly available and must be sent to you if you request it.
- Apply for an Independent Review Panel. If the local clinical commissioning group review doesn't uphold your complaint, you can apply for an Independent Review Panel to review the decision. For more information, see the NHS Continuing Healthcare page.
This information was published in February 2018. We will revise it in 2020.
