NHS continuing healthcare in England

NHS continuing healthcare (CHC) is a package of health and social care arranged and funded solely by the NHS to meet physical and/or mental health needs that have arisen because of disability, accident or illness. Eligibility decisions for CHC rest on whether someone’s need for care is primarily due to their health needs. For example, people who are eligible may have long-term complex medical conditions that require highly specialised support.

Equivalent provision in Scotland, Wales, and Northern Ireland are covered in the section 6 of this briefing.

In 2021/22, 104,400 people in England received NHS continuing healthcare (CHC). Around 61% of these were Fast Track cases, the pathway for those whose situation is deteriorating quickly.

Services provided by the NHS are free at the point of use whereas those arranged by local authority social services are means tested, the outcome of any decision as to who has responsibility for providing care can have significant financial consequences for the individual concerned. A separate Library briefing paper, Paying for adult social care in England, is designed to help answer constituents’ queries about the local authority means-test for care home charges.

Integrated Care Boards (which replaced Clinical Commissioning Groups in July 2022) are responsible for commissioning CHC in England, although NHS England also has commissioning responsibilities for some specified groups of people (for example, prisoners and military personnel).

National Framework for NHS continuing healthcare

In 2007 the Department of Health issued a National Framework for NHS continuing healthcare. This Framework intends to improve the consistency of approach taken by local NHS bodies by providing a common framework for decision making and the resolution of disputes. The latest version of this Framework was published in May 2022.

This briefing paper provides a summary of the key areas within the National Framework and other Department of Health and Social Care guidance. The official guidance should be consulted for a fuller account of the rules and duties that apply to NHS bodies responsible for determining eligibility for NHS CHC.

Legislation and the respective responsibilities of the NHS, social care and other services are different in child and adult services. For children and young people, from birth to their 18th birthday, needs are assessed against a children’s national framework, with a recommendation made to a multi-agency panel (see Gov.uk, Children and young people’s continuing care national framework, 2016).