CHC Checklist & NHS Continuing Healthcare Guide

Two different NHS payments, often confused

NHS Continuing Healthcare vs. NHS-Funded Nursing Care

Knowing which one might apply changes everything that follows

Both are paid by the NHS. Both are not means-tested — savings, income, and property don't affect either one. That's where the similarity ends.

NHS Continuing Healthcare (CHC)

Covers all care and accommodation costs
Awarded when the primary need is a health need, not a social care need
Assessed using the Checklist, then the Decision Support Tool
Can be awarded in a care home, or to fund care at home

NHS-Funded Nursing Care (FNC)

Covers only the registered nursing element of care
A fixed weekly amount, paid straight to the nursing home
The fallback when CHC isn't awarded but nursing needs are confirmed
Only available in a nursing home, not at home

The relationship between them matters. A CHC checklist should always happen first. FNC is what's considered if CHC isn't awarded — not an alternative you choose instead of asking about CHC.

🔗 NHS England — Continuing Healthcare 🔗 NHS England — Funded Nursing Care

Getting started

The CHC Checklist — the first, quick screening step

It costs nothing to ask for one, and it's often never offered

The Checklist is a short initial screening tool, not the final decision. It's usually completed by a nurse, GP, hospital discharge team member, or social worker, and it looks at the same broad areas of need the full assessment does — just at a lighter level of detail, to work out whether a full assessment is worth doing.

Who can ask for one: the person themselves, a family member or carer, a GP, a hospital discharge team, a care home, or a social worker. You don't need a professional to raise it first — you're entitled to request one directly from the local Integrated Care Board (ICB).

A Checklist commonly happens around a hospital discharge, when a care needs assessment first takes place, or whenever someone's health needs change significantly — but there's no rule that it can only happen at those points. If no one has mentioned it and nursing-level needs are involved, it's reasonable to ask directly.

💡 A negative Checklist means no full assessment happens at that time — but it isn't permanent. Needs change, and a new Checklist can be requested later if the situation gets more complex.

🔗 NHS England — how the Checklist works

The full assessment

The Decision Support Tool — how eligibility is actually judged

Twelve domains, no points total, one legal test underneath it all

If the Checklist suggests a full assessment is warranted, a multidisciplinary team (MDT) — usually including a nurse and a social worker — completes the Decision Support Tool (DST). It records needs across 12 domains:

Breathing

Nutrition

Continence

Skin & tissue viability

Mobility

Communication

Psychological & emotional needs

Cognition

Behaviour

Drug therapies & medication

Altered states of consciousness

Other significant needs

Important: the DST is not a points calculator — the domains aren't added up to a total. It's the evidence record the panel uses to apply the real legal test: whether the person's needs, taken as a whole, amount to a primary health need. That's a qualitative judgement, not a score.

You (or the family) should be invited to take part in the DST meeting and can bring your own evidence — GP letters, care notes, medication records, anything documenting the nature, intensity, complexity, or unpredictability of the person's needs. It's worth asking in advance what the meeting will cover so you can prepare.

💡 Keep your own record as things go — dates, what was said, which professionals were involved. If a decision is later challenged, this is exactly the kind of evidence that matters.

The fallback payment

NHS-Funded Nursing Care — current rates and how it's paid

If CHC isn't awarded but nursing needs are confirmed

FNC is paid at a flat weekly rate directly from the NHS to the nursing home — it reduces the invoice, and never arrives as cash to the family. As of 1 April 2026:

Rate	Weekly amount	Who it applies to
Standard rate	£267.68	Most people receiving FNC
Higher rate	£368.24	Only those already on the pre-October-2007 "high band" when the single standard rate was introduced

FNC eligibility has stayed broadly stable while CHC eligibility has fallen in recent years. If someone is already receiving FNC, it's still worth asking whether their needs have moved beyond a nursing-only need and towards a full CHC review — FNC isn't necessarily the ceiling.

FNC is assessed using the same Checklist-first process as CHC. If a Checklist or full assessment finds the person doesn't meet the CHC threshold but does have a registered nursing need, FNC should follow automatically — you shouldn't need to make a completely separate application.

🔗 NHS England — Funded Nursing Care rates

If the answer is no

Challenging a declined CHC decision

A negative Checklist or DST outcome isn't the end of the road

⚠️ CHC eligibility has fallen sharply over the past decade. A decline doesn't automatically mean the decision was right — it's worth reviewing closely, especially if the person's needs feel more complex than the outcome suggests.

There are three possible stages, and you don't have to go through all of them — most cases are resolved before reaching the final one:

Local Resolution with the ICB

Request this in writing within 6 months of the decision letter. The ICB reviews the original assessment and any new evidence. This stage typically takes around 3 months.

Independent Review Panel (IRP)

If Local Resolution upholds the decline, you can ask NHS England to convene an Independent Review Panel. NHS England should aim to hold this within 3 months of your request, though timelines vary by area.

Parliamentary and Health Service Ombudsman (PHSO)

If you remain dissatisfied after the IRP — particularly if you believe the process itself was unfair or flawed — you can ask the PHSO to review the case.

💡 Ask for a copy of the completed Decision Support Tool and the ICB's written reasoning. If specific domains seem inconsistent with the care records you hold, naming exactly which ones — and why — is far more effective than a general objection that "the decision feels wrong."

🔗 NHS England — Continuing Healthcare 🔗 Parliamentary and Health Service Ombudsman

🔗 Already worked through Care Home Funding?

This guide picks up exactly where Part 4 of the Care Home Funding guide left off. If you haven't yet covered the means test, self-funding, or top-up fees, that guide walks through all of it in five short parts.