Use the continuing-care test for your nation
There is no single UK-wide CHC scheme. Identify the correct framework before collecting evidence or asking for review.
Build evidence around actual care needs
Diagnosis alone does not decide these funding routes.
- Confirm the national framework and the exact eligibility question being used.
- Gather current care plans, medicine records, clinical letters and risk assessments.
- Include night needs, incidents, supervision and what happens when care is delayed.
- Show complexity, intensity, unpredictability and interaction between needs where relevant.
- Record who made the decision and which evidence was considered.
- Request the full decision and reasons in writing.
- Check review, appeal and alternative health or social-care funding routes.
Questions for the assessor or coordinator
Use the terminology of the nation rather than assuming English CHC rules apply.
- Which national continuing-care framework and decision-maker apply?
- What test is being applied to the evidence?
- Is a fast-track route available in this nation and situation?
- Which evidence is missing or disputed?
- What care will be funded if this route is refused?
Ask for the legal and clinical basis
Avoid arguing only from the seriousness of the diagnosis.
“Please confirm the continuing-care framework, assessment process and decision-maker that apply in this nation.”
“Please provide written reasons showing how the evidence about these needs was considered against the eligibility test.”
Use the health-funding framework for the nation involved
There is no single UK-wide Continuing Healthcare scheme. England, Wales, Scotland and Northern Ireland use different tests, terms and review routes for complex ongoing health needs.
In England and Wales, separate national frameworks consider whether the overall need is primarily a health need, with fast-track processes for people who meet the relevant criteria. Scotland uses Hospital Based Complex Clinical Care, asking whether needs can properly be met outside hospital.
Build evidence around nature, intensity, complexity and unpredictability where those concepts form part of the framework. Care plans, medicines, night records, incidents, skilled interventions and the interaction between needs are more useful than a diagnosis list alone.
If health funding is refused, ask for the completed assessment, decision, reasons and national review route. Also ask how each assessed health and social-care need will be met and which costs may fall to the person. Do not assume a care-home place determines funding by itself.
A practical way through it
Use the parts that fit your situation and leave the rest.
- Identify the exact frameworkConfirm the nation, responsible health body and current assessment or fast-track route rather than requesting “CHC” as if it meant the same everywhere.
- Request assessment in writingState the changing or complex health needs and ask who will coordinate, what evidence is required and how the person and representative can participate.
- Build a needs chronologyCollect recent care plans, risk events, medicines, monitoring, night support, specialist input and evidence of unpredictable deterioration.
- Describe interactionsShow how pain, cognition, mobility, nutrition, breathing, skin or behaviour combine to increase skill, frequency or risk.
- Check the decision papersConfirm that the correct national test was used and that needs, evidence and disagreements are accurately recorded.
- Plan both outcomesUse the stated review route if needed, while obtaining a written plan for NHS, council, HSC and privately charged elements so care is not delayed.
What this can look like
When a diagnosis dominates the discussion
Alan’s family is told that advanced cancer does not automatically qualify him for funding. They feel the diagnosis is being ignored.
A stronger presentation
They document rapid symptom changes, complex medicines, night interventions and the consequences when skilled care is delayed.
They ask the assessor to apply the exact national framework to the combined needs rather than arguing that diagnosis alone decides eligibility.
They request the completed decision and arrange advice on the review route and interim care plan.
Identify the route
- In England and Wales, CHC concerns an assessed primary health need under separate frameworks, with fast-track routes for people who meet the relevant rapidly deteriorating and end-of-life criteria.
- Scotland uses Hospital Based Complex Clinical Care where needs cannot be met outside hospital. Northern Ireland asks whether needs can properly be met in any setting other than hospital.
Build the evidence
- Gather care plans, risk records, medicines, night needs and incidents.
- Ask for the assessment process, decision-maker and evidence requirements used in your nation.
Challenge or plan alternatives
- Request written reasons and use the stated review or appeal route.
- If needs can be met in community accommodation, ask which NHS and social-care services will meet each assessed need and which charges apply. In Scotland, eligible personal and nursing care is free, while non-personal support and accommodation may still be charged.
A manageable next step
What you could do now
- Identify the framework for your nation.
- Collect current evidence of complexity, intensity and unpredictability.
- Ask for the decision, reasons and review route in writing.
Checked sources
Read the original guidance
We summarise carefully and link to the source so you can check the full, most current information. Sources were checked 9 September 2026.