What is... Continuing Health Care?

A Comprehensive Guide for Patients, Families, and Professionals

Navigating the complex world of health and social care in the UK can be daunting, particularly when long-term care needs arise. NHS Continuing Healthcare (CHC) is one of the most critical - and often misunderstood - aspects of this landscape. At Apex Experts, we work closely with families, legal professionals, and healthcare providers to support accurate, evidence-based decision-making when it comes to CHC assessments and funding eligibility.

In this guide, we demystify NHS Continuing Healthcare: what it is, who qualifies, how to apply, and where medico-legal experts like those at Apex come in.

So What is Continuing Health Care?

Continuing Health Care (CHC) is a package of care arranged and funded solely by the NHS for individuals aged 18 or over who have significant ongoing healthcare needs. This funding covers the full cost of a person’s assessed health and associated social care needs - including accommodation, if applicable.

Unlike social care, which is means-tested, CHC is not dependent on a person’s wealth or savings. If you meet the criteria, you are entitled to NHS funding, regardless of your income or assets.

Who is Eligible for CHC?

To be eligible, an individual must have a “primary health need”. This means their care requirements go beyond what local authority social services are legally expected to provide.

Eligibility is not condition-specific, having a diagnosis like dementia, multiple sclerosis or Parkinson’s does not automatically qualify a person. Instead, assessments focus on:

• Nature: What is the condition, and how does it affect the person?

• Intensity: How severe are the needs? Are they continuous or fluctuating?

• Complexity: Are there multiple conditions or symptoms that interact?

• Unpredictability: How likely is the condition to change rapidly, creating risk?

A multi-disciplinary team (MDT) carries out the Decision Support Tool (DST) to assess these domains across 12 key care areas.

More information on the eligibility criteria can be found via the NHS official guidance.

What Does CHC Funding Cover?

If approved, CHC covers the entire cost of care, which may include:

• Care home fees

• Domiciliary (at-home) care

• Equipment and specialist nursing input

• Personal care and support

It is designed to relieve the burden from individuals and families who might otherwise fund these services privately.

The Assessment Process

1. Initial Checklist - Often completed by a nurse, doctor, or social worker, this screening tool determines whether a full assessment is needed.

2. Full Assessment (DST) - Conducted by an MDT using the Decision Support Tool. Each domain is scored, and a recommendation is made.

3. Panel Review - The local Integrated Care Board (ICB) reviews the recommendation and makes a final decision.

4. Right to Appeal - If CHC is refused, individuals have the right to a Local Resolution Meeting and ultimately a full review via NHS England if needed.

Where Do Medico-Legal Experts Come In?

At Apex Experts, our nursing and healthcare expert witnesses are frequently called upon to provide independent opinions on CHC matters. We support:

• Solicitors challenging or defending CHC funding decisions.

• Families who believe their relative was wrongly denied CHC.

• Insurers and regulators reviewing long-term care needs.

Our consultants offer robust, evidence-based reports on whether a person has a “primary health need” as defined by national CHC criteria. Our op

inions are based on the same standards that underpin court proceedings — objective, independent, and clinically justified.

CHC vs Local Authority Care: What’s the Difference?

This distinction is crucial when appealing decisions or planning long-term care. Legal and expert support can make a significant difference in borderline or complex cases.

Common Challenges in CHC Cases

CHC decisions are often contested due to:

• Lack of clarity in the interpretation of the Decision Support Tool

• Inconsistent assessments across different NHS regions

• Retrospective claims, especially in end-of-life care situations

• Insufficient evidence, often due to gaps in care records

This is where specialist medico-legal expertise is invaluable. Apex Experts can assist in reconstructing accurate timelines, assessing clinical risk, and evaluating whether needs were underestimated or misrepresented.

How Apex Experts Can Help

We are one of the UK’s leading providers of expert nursing opinions in CHC cases. All of our nurse consultants:

• Are NMC-registered and active in clinical practice

• Have undertaken Apex’s in-house training specific to medico-legal standards

• Use our secure document handling platform to ensure GDPR compliance

Whether you are looking to challenge a CHC decision, require a second opinion, or instruct an expert witness for litigation or tribunal, we are here to help.

Understanding NHS Continuing Healthcare is essential for anyone navigating complex care needs, whether personally or professionally. It represents an important right — one that can transform the financial and emotional burden on families — but only if properly assessed and awarded.

If you believe you or a loved one may be eligible for CHC, or if you're working on a legal case involving CHC decisions, contact Apex Experts today to explore how our skilled consultants can assist.

For further information on our CHC services, please contact us at info@apexexperts.co.uk or visit our contact us page to send us a message - we can't wait to hear from you!