Criteria for CHC funding: who qualifies in England
To qualify for NHS Continuing Healthcare in England, a person must be assessed as having a ‘primary health need’. The assessors look at four things: the nature of the needs, their intensity, their complexity and how unpredictable they are. Diagnosis, where the person lives and who gives the care don’t decide it.
What are the criteria for CHC funding?
The criteria for CHC funding in England are all in one document, the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. NHS Continuing Healthcare (CHC) is care the NHS pays for in full. The Framework’s glossary calls it “a complete package of ongoing care arranged and funded solely by the NHS” (National Framework, glossary, page 167). Every integrated care board (ICB), the NHS body that decides CHC funding in your area, works to the Framework.
The Framework asks one question: does the person have a primary health need? In short, that means their care is mainly about health. To answer it, the assessors look at four characteristics of the person’s needs: nature, intensity, complexity and unpredictability. These are the four tests most people mean by the CHC eligibility criteria.
The first step is the Checklist, a short screening form that shows whether a full assessment is due. At the full assessment, a multidisciplinary team (MDT) of at least two professionals completes the Decision Support Tool (DST). The professionals usually come from health and social care. The team makes a recommendation, and the ICB decides.
If CHC is new to you, our guide to what NHS Continuing Healthcare is covers the basics. This page is about the test itself.
What are the 4 criteria for CHC funding?
The 4 criteria for CHC funding are the four characteristics of need in the National Framework (pages 23 to 24). The assessors use them to judge whether the person’s needs, taken together, add up to a primary health need. Here’s each one in the Framework’s own words, with an everyday example from home or a care home.
| Characteristic | What the National Framework says | An everyday example |
|---|---|---|
| Nature | “This describes the particular characteristics of an individual’s needs (which can include physical, mental health or psychological needs) and the type of those needs. This also describes the overall effect of those needs on the individual, including the type (‘quality’) of interventions required to manage them.” | A man with a feeding tube that needs skilled care, or seizures that need a trained carer. That’s a different nature of need from help with shopping and meals. |
| Intensity | “This relates both to the extent (‘quantity’) and severity (‘degree’) of the needs and to the support required to meet them, including the need for sustained/ongoing care (‘continuity’).” | A woman who has to be turned every few hours through the night to protect her skin. She needs two carers every time she moves. |
| Complexity | “This is concerned with how the needs present and interact to increase the skill required to monitor the symptoms, treat the condition(s) and/or manage the care.” | Diabetes on its own may be routine. Diabetes with dementia and swallowing problems can be complex, because each condition changes how the others have to be managed. |
| Unpredictability | “This describes the degree to which needs fluctuate and thereby create challenges in managing them. It also relates to the level of risk to the person’s health if adequate and timely care is not provided.” | Falls with no warning, seizures at any hour, or behaviour that changes from hour to hour. A slow response could put the person’s health at risk. |
Source: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, July 2022 revision, pages 23 to 24. The examples are ours.
Many families think they have to show all four. The Framework says: “Each of these characteristics may, alone or in combination, demonstrate a primary health need, because of the quality and/or quantity of care that is required to meet the individual’s needs” (National Framework, page 24). So a case can rest on intensity alone, or on unpredictability alone, if the evidence shows it.
What is a primary health need?
Everything in the CHC eligibility criteria leads back to one idea, the primary health need. The National Framework defines it like this.
The definition in the National Framework
“An individual has a primary health need if, having taken account of all their needs (following completion of the Decision Support Tool), it can be said that the main aspects or majority part of the care they require is focused on addressing and/or preventing health needs. Having a primary health need is not about the reason why an individual requires care or support, nor is it based on their diagnosis; it is about the level and type of their overall actual day-to-day care needs taken in their totality.”
National Framework, page 22, paragraphs 55 to 67
In plain words, is most of the person’s care about treating, managing or preventing health problems? Or is it mainly help with everyday living? The assessors look at all the needs together, once the Decision Support Tool is complete.
What is the National Framework for NHS Continuing Healthcare?
The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care is the rulebook for CHC in England. The Department of Health and Social Care publishes it. The version in use today is the July 2022 revision, corrected in July 2023. It covers the whole process: the Checklist, the full assessment, the ICB’s decision, the Fast Track Pathway, reviews and how to challenge a decision. Behind it sit regulations it calls the Standing Rules, which date from 2012.
The Checklist and the Decision Support Tool each have their own CHC guidance. Both were updated in October 2026, and the thresholds below read the same as before. The NHS CHC framework applies in England only. You can read it free on the National Framework page on gov.uk. It’s worth having to hand before any assessment.
What scores point to eligibility?
The CHC scoring criteria work in two steps, and each step has its own lines.
The Checklist: when a full assessment is due
The Checklist scores 11 areas of need at level A, B or C, where A is the highest level of need. The Checklist guidance says a full assessment is required if any one of these is true:
- two or more areas score A
- five or more areas score B, or one scores A and four score B
- one of the four priority areas scores A: breathing, behaviour, drug therapies and medication, or altered states of consciousness
The guidance says the threshold “has intentionally been set low”. A positive Checklist only means a full assessment is due. Our guide to the CHC Checklist and its 11 areas of need goes through each area. Our Checklist score checker applies the scoring rules to a completed form.
The Decision Support Tool: 12 areas and six levels
At the full assessment, the MDT records the person’s needs in 12 care domains. The Decision Support Tool adds a twelfth, “other significant care needs”, to the 11 the Checklist covers. Each domain has levels from no needs through low, moderate, high and severe up to priority. Only some domains reach the top levels.
| Care domain | Highest level it can reach |
|---|---|
| Breathing | Priority |
| Nutrition: food and drink | Severe |
| Continence | High |
| Skin (including tissue viability) | Severe |
| Mobility | Severe |
| Communication | High |
| Psychological and emotional needs | High |
| Cognition | Severe |
| Behaviour | Priority |
| Drug therapies and medication: symptom control | Priority |
| Altered states of consciousness | Priority |
| Other significant care needs | Severe |
Source: NHS continuing healthcare decision support tool guidance, Department of Health and Social Care, updated 22 October 2026, figure 1.
The lines that point to eligibility
The DST guidance says a clear recommendation of eligibility “would be expected” in either of these situations:
- a priority level in any one of the four domains that carry it (breathing, behaviour, drug therapies and medication, and altered states of consciousness)
- two or more severe levels across all the domains
Below those lines, the answer depends on the whole picture. Take a severe need alongside needs in several other domains, or several domains at high or moderate. The guidance says these “may also indicate a primary health need, depending on the combination of needs”.
The guidance also warns against simple sums, so two moderates don’t add up to a high. The Framework says its indicative thresholds “are not to be viewed prescriptively” (National Framework, page 51). Sometimes the team can’t agree between two levels. Then the DST guidance tells it to “choose the higher of the levels under consideration” and record the evidence.
What doesn’t decide eligibility?
Some common beliefs about CHC don’t match the Framework. This table shows what counts in the CHC eligibility criteria and what doesn’t, in the Framework’s own words.
| Factor | Does it decide eligibility? | What the National Framework says |
|---|---|---|
| The person’s day-to-day care needs, taken together | Yes, this is the test | “the level and type of their overall actual day-to-day care needs taken in their totality” (page 22) |
| The diagnosis | No | “The diagnosis of a particular disease or condition is not in itself a determinant of eligibility” (page 24) |
| Where the care is given | No | Eligibility is “not determined or influenced either by the setting where the care is provided” (page 24) |
| Who gives the care | No | Nor is it decided “by the characteristics of the person who delivers the care” (page 24) |
| Money, savings and the home | No | “Financial issues should not be considered as part of the decision” (page 24) |
| Needs that are well managed | They still count | “well-managed needs are still needs” (page 51) |
Source: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, July 2022 revision, pages 22, 24 and 51.
Council help with care fees is means tested. Our guide to who pays for care home fees in England explains how that works.
Well-managed needs are still needs
This rule matters most when care is going well, because good care can make serious needs look small on paper.
What the Framework says about well-managed needs
“The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs. Only where the successful management of a healthcare need has permanently reduced or removed an ongoing need, such that the active management of this need is reduced or no longer required, will this have a bearing on NHS Continuing Healthcare eligibility.”
National Framework, page 51, paragraphs 162 to 166
Think of a resident whose challenging behaviour is kept safe by a careful support plan, so the records show no incidents. The Framework uses this very example. It says those needs “should be recorded and taken into account in the eligibility decision” (page 51). It suggests asking the care provider to keep “a detailed diary over a suitable period of time”. There’s a limit, though. Well-controlled conditions shouldn’t be recorded “as if medication or other routine care or support was not present” (page 52). The rule applies at the Checklist and at reviews too.
Who qualifies for NHS Continuing Healthcare?
So an adult in England qualifies for NHS Continuing Healthcare when the assessment finds a primary health need. There’s no list of qualifying conditions. Someone with advanced dementia, Parkinson’s, motor neurone disease or the effects of a stroke may or may not qualify. The answer turns on the care they need rather than the name of the condition.
The Fast Track Pathway is for someone with a rapidly deteriorating condition that may be entering a terminal phase. Its Fast Track Pathway Tool takes the place of the Checklist and the full assessment. The Framework says an ICB “must accept and immediately action” a properly completed Fast Track Pathway Tool (National Framework, page 79).
Most people who are assessed are found not eligible. In the 12 months to September 2026, 17.4% of standard CHC assessments in England found the person eligible (8,950 of 51,327). This is our own sum from NHS England’s quarterly CHC figures, published on 12 November 2026. The bar is high, so the evidence you gather matters.
How can you tell if your relative might qualify?
Start with the shape of the care, because that’s what the test measures. Ask yourself what would happen if the support stopped for a day. Would your relative’s health be at risk? Do their needs flare up without warning, or need care through the night? Do several conditions have to be managed around each other? If so, the four characteristics may well be in play.
Then gather evidence before anyone assesses. Keep a dated diary of the hardest days. Note every fall, night-time call and change in behaviour. Ask the care home for its charts and care plan, and ask for the Checklist in writing, with the reasons behind every score. If a full assessment is coming up and you’d like someone alongside you, see our help to prepare for the CHC assessment. Our main guide to continuing healthcare funding in England sets out the whole process.
For a quick view first, the free check asks short questions about the same areas of care as the Checklist. You’ll see straight away whether a full assessment looks worth asking for. We can talk the result through with you.
Questions families ask
Is CHC means tested?
No. The National Framework says financial issues should not be considered as part of the decision on eligibility for NHS Continuing Healthcare. Savings, pensions and the family home play no part at any stage. A self-funder in a care home, a council-funded resident and someone cared for at home by family all face the same test of need.
Do dementia patients qualify for CHC?
Some do and some don’t, because the diagnosis doesn’t decide it. The National Framework says a diagnosis “is not in itself a determinant of eligibility”. What counts is the care the person actually needs. In dementia, that can mean high needs in cognition, behaviour, mood, medication and mobility. The assessors should look at how those needs affect each other.
What is a patient with complex care needs?
In CHC terms, complexity is about how needs present and interact to increase the skill needed to monitor symptoms, treat conditions or manage care. It can come from one condition or from several that affect each other. The National Framework also counts a person’s response to their own condition, such as a physical illness that leads to a mental health need.
Can you get CHC at home?
Yes. The National Framework says NHS Continuing Healthcare may be provided in any setting, including a care home, a hospice or the person’s own home. Eligibility isn’t decided by where the care is given or by who gives it. Someone cared for at home by family faces the same test as a nursing home resident.
Is there an age limit for CHC?
CHC is for adults, which the Care and Support Statutory Guidance describes as people aged 18 or over. The National Framework sets no upper age limit. The decision rests on the person’s assessed needs, so someone in their seventies and someone in their nineties face the same test.
This is information, not legal advice. It explains the rules for England, which are set out in the National Framework for NHS Continuing Healthcare.
Sources
- National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, Department of Health and Social Care, July 2022 revision, corrected July 2023.
- NHS continuing healthcare checklist: guidance, Department of Health and Social Care, updated 20 October 2026.
- NHS continuing healthcare decision support tool: guidance, Department of Health and Social Care, updated 22 October 2026.
- NHS Continuing Healthcare and NHS-funded Nursing Care quarterly data, Q2 2026/27, NHS England, published 12 November 2026.
- Care and support statutory guidance, Department of Health and Social Care, updated 30 October 2026.