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CHC eligibility is not decided on the basis of a diagnosis. The NHS does not look at what condition a person has and say 'yes' or 'no' on that basis. Eligibility is decided entirely on the nature of the person's care needs. To qualify for NHS Continuing Healthcare (CHC), you must be an adult aged 18 or over living in England, Wales, or Northern Ireland who is assessed as having a "primary health need". This fully funded, free package of care is not means-tested and is entirely covered by the NHS, regardless of your personal savings or income. Key Eligibility Criteria Eligibility is not based on a specific disease, diagnosis, or condition, but rather on how your health and care needs impact your day-to-day life. To qualify, the NHS must determine that the majority of your care is focused on addressing or managing health needs. [1, 2, 3] Your needs are evaluated by a multidisciplinary team based on four main characteristics: [1, 2, 3, 4, 5] Nature: The type of your needs and the kind of support or treatment required. Complexity: How different needs interact with each other, requiring specialized oversight. Intensity: How severe and frequent your care needs are. Unpredictability: How unstable your health is and the risks this creates. Speak to an expert and find out if you're elligible for CHC Funding

NHS Continuing Healthcare, usually shortened to CHC or CHC funding, is a package of care that is paid for entirely by the NHS. Not partly. Not after a means test. Entirely. If a person qualifies, the NHS funds their care in full — whether they are living at home, in a care home, or in a nursing home. The person's savings, income, or property are irrelevant. CHC is not means-tested. It is a health entitlement. CHC is designed for adults whose main need for care arises from a health condition — rather than a social or personal care need. In practice, this often means people with: • Advanced dementia or cognitive impairment • A progressive neurological condition such as Parkinson's disease, multiple sclerosis, or motor neurone disease • Complex needs following a stroke • Terminal illness (including cancer) with significant symptom management needs • A combination of physical and cognitive conditions that create complex, unpredictable, or intense care needs These are common examples not an exhaustive list. Eligibility is decided on the basis of needs, not diagnosis.

CHC is not a legal claim. It is an NHS health entitlement (determined through a clinical assessment process). The grounds for challenging a refusal are clinical (not legal): incorrect scoring of needs, failure to apply the nature/intensity/complexity/unpredictability framework, clinical evidence not considered. A registered nurse with specialist CHC experience is better placed to make those arguments than a solicitor (because they speak the same language as the assessors, understand the clinical criteria from direct professional experience, and can identify clinical errors that a non-nurse would not recognise). SG67 is also, in most cases, more affordable than a law firm (which makes expert CHC advocacy accessible to more families). Not Sure Where You Stand? That Is Exactly What the Consultation Is For. The free consultation is 45 minutes, by phone or video, with a Senior Registered Nurse.

A CHC nurse advocate provides specialist support throughout the CHC process (from the initial Checklist through to appeals and retrospective claims). Unlike a solicitor or a general advocate, a nurse advocate understands the clinical framework of CHC from the inside. The CHC assessment is a clinical process, evaluated against clinical criteria, by clinical professionals. The strongest advocacy is clinical advocacy (presenting evidence in the framework and language that assessors use, and identifying the clinical reasons why a domain has been under-scored or a need has been overlooked). In practice, SG67's nurse advocates: - Attend CHC Checklist meetings and DST assessments as your clinical advocate - Review all medical and care records to build a complete picture of needs - Challenge under-scoring across all 12 DST domains - Prepare written submissions for appeals, supported by clinical evidence - Liaise directly with the ICB on your behalf - Manage the full process from initial enquiry through to resolution

Yes. Retrospective CHC claims can be made after a person has passed away. This is one of the most important (and least widely known) aspects of the CHC system. Many families who funded care privately for a deceased parent or spouse are unaware that they may be entitled to reclaim a significant portion of those costs. SG67 handles retrospective CHC claims on a no-win no-fee basis. There is no upfront cost, and no fee if the claim is unsuccessful.

Yes (in many cases, yes). If a person was paying for care during a period when they should have qualified for CHC funding (and an NHS assessment either did not take place, or was carried out incorrectly) a retrospective claim can be made to recover those costs. Retrospective claims can go back up to 14 years in some circumstances. The claim requires a review of the person's medical and care records from the relevant period, to establish whether their needs at the time would have met the CHC eligibility criteria.

Yes. CHC funding is not permanent. NHS Continuing Healthcare (CHC) funding is officially reviewed within 3 months of the initial approval and at least every year thereafter. The primary purpose of these regular reviews is to ensure that the current care package is still appropriate and continues to meet the individual's assessed needs. If the ICB believes needs have reduced below the CHC threshold, funding can be withdrawn. Withdrawals can be challenged in the same way as refusals. If you believe your loved one still meets CHC criteria but funding has been reduced or withdrawn, SG67 can review the decision and advise on grounds for challenge.

Receiving a CHC refusal is a significant moment (but it is not necessarily the end). Many CHC decisions are successfully overturned on appeal. In particular, refusals where domains have been under-scored, where clinical evidence has not been considered properly, or where the unpredictability of needs has not been factored into the assessment, are strong candidates for challenge. There are common patterns that suggest a refusal may have been incorrect: - One or more DST domains appear to be scored lower than the person's actual needs would indicate - The assessment did not adequately capture behaviour, cognition, or psychological need - The 'nature, intensity, complexity, and unpredictability' framework was not properly applied - The MDT lacked full clinical input, or key medical evidence was not presented - The person's needs were assessed during a 'good' period that does not reflect their typical experience

Yes (and it is refused more often than it should be). Fast Track applications can be declined by the ICB, delayed without proper justification, or withdrawn after funding has been put in place. All of these situations can be challenged. SG67 acts urgently in Fast Track cases. If a Fast Track application has been refused, delayed, or is urgently needed and has not yet been initiated, contact us as a priority.

NHS Continuing Healthcare (CHC) Local Authority Social Care Funded entirely by the NHS You may have to pay Covers all care costs (health and personal care) Covers personal care needs only Not affected by savings or property Threshold: roughly £23,250 in savings before you must pay in full Available at home or in a care home Subject to local authority eligibility criteria Decided by the NHS (Integrated Care Board) Decided by your local council