How Hard Is It to Get NHS Continuing Healthcare?

This is one of the most common questions families ask, and the honest answer is that it is harder than it should be, but not as hard as the NHS sometimes makes it appear.

NHS Continuing Healthcare is a legal entitlement. It is not a discretionary fund or a benefits payment. If a person meets the clinical criteria, the NHS is legally required to fund their care. The difficulty is in getting that eligibility recognised.

Why is NHS Continuing Healthcare difficult to obtain?

Several systemic factors make NHS Continuing Healthcare applications challenging for families approaching the process alone:

• Assessments are conducted by NHS and local authority staff who work under budgetary pressure. Research consistently shows variation in how NHS Continuing Healthcare criteria are applied across different Integrated Care Boards (ICBs).

• The assessment uses complex clinical language and a structured framework that most families are not familiar with. It is easy for needs to be underscored by people who did not observe them day to day.

• Families are rarely told that they have the right to be present at the assessment, to contribute evidence, or to challenge the outcome.

• The process can take weeks or months, during which the person's care costs continue, creating financial pressure that pushes families toward accepting an unfair refusal.

How many people are refused NHS Continuing Healthcare?

A significant proportion of NHS Continuing Healthcare applications are refused at first assessment. However, a substantial number of those refusals are overturned on appeal. This tells us that a large number of people who qualify for NHS Continuing Healthcare are being incorrectly turned down at the first stage.

The challenge is that many families accept a refusal without questioning it, either because they do not know it can be challenged, or because the appeals process feels daunting.

What makes an NHS Continuing Healthcare application more likely to succeed?

The single most important factor is whether someone is present at the assessment who understands the clinical framework and can ensure that the person's needs are presented accurately. This is typically a nurse advocate.

Preparation also matters significantly. Gathering evidence (care records, GP letters, carer logs, assessments from community nurses) before the assessment, and knowing which domains are likely to be scored and why, can meaningfully change the outcome.

Many NHS Continuing Healthcare refusals contain errors. Domains may have been scored too low, clinical evidence may not have been considered, or the unpredictability of the person's condition may have been underestimated. A nurse advocate can review the decision and advise whether there are grounds for appeal.