I Think Someone May Qualify for NHS Continuing Healthcare, Who Do I Speak To?

If you believe an adult’s ongoing care needs may be primarily health-related, you can ask whether they should be considered for NHS Continuing Healthcare.

You do not need to calculate a Decision Support Tool score yourself before raising the question.

For most people, consideration begins with the NHS Continuing Healthcare Checklist, completed by an appropriately trained health or social-care practitioner.

Who should I ask?

The route depends on where the person is.

You can raise CHC with professionals involved in their care, for example a nurse, doctor, social worker, care-home team or discharge team, and ask whether a Checklist should be completed.

The local Integrated Care Board, or ICB, is the NHS body responsible for CHC in its area. NHS information also points people to their ICB where they need to pursue CHC directly.

What should I say?

Keep the request simple and factual.

Explain that you are concerned the person’s ongoing needs may warrant consideration for NHS Continuing Healthcare and ask whether a Checklist is appropriate.

Then describe the needs: repeated night interventions, severe cognitive impairment, behaviour, seizures, swallowing risk, complex medication, skin breakdown, breathing problems, unpredictable deterioration or whatever actually applies.

Do not add needs the person does not have.

What if somebody says ‘they won’t qualify because they have dementia’?

Ask for the decision to be based on the person’s needs, not a diagnosis or assumption.

The National Framework is clear that eligibility is not based on a particular disease, diagnosis or condition.

Equally, dementia does not automatically create eligibility. The proper question is what needs the dementia and any other conditions create.

What if they say the care home is already managing everything?

Well-managed need is still need.

The Decision Support Tool guidance says needs should not be marginalised simply because they are successfully managed. The assessment should consider the underlying need and the care required to manage it.

A calm afternoon in a well-run care home does not prove that the person’s needs are minor.

What if a Checklist is negative?

You should receive the completed Checklist and reasons for the decision.

If you disagree, ask the ICB about its local review process and explain which needs or evidence you believe were misunderstood or omitted.

Avoid arguing only that the outcome feels unfair. Identify the factual point you say is wrong.

When is a Checklist not the right route?

If the person has a rapidly deteriorating condition and may be entering a terminal phase, ask whether the Fast Track Pathway Tool is appropriate.

Fast Track is designed for immediate CHC provision and does not require the ordinary Checklist or Decision Support Tool process.

Guide 13.27 explains it separately.

Last reviewed

5 September 2026

Important informationThis guide provides general information about NHS Continuing Healthcare in England and is not intended to provide legal, financial, medical or other professional advice. Rules and processes differ elsewhere in the UK and individual circumstances can be different. You may wish to check current official information and seek advice from an appropriately qualified professional before making important decisions.