One route puts the whole cost of care on the NHS, with no financial assessment at all, and it is decided by need rather than by money. NHS continuing healthcare is for people whose needs are, in the framework’s words, primarily health needs. This page is the government’s own description of who qualifies, how the checklist and the assessment work, and what to do when the answer is no.
What it is, and what “free” means
NHS continuing healthcare is a package of ongoing care arranged and funded solely by the NHS for adults found to have a primary health need, to meet health and associated social care needs arising from disability, accident or illness (public information leaflet, checked 1 November 2026).
The leaflet says it is free, unlike support provided by local authorities, which may involve a contribution depending on income and savings.
That difference is the whole point of pursuing it. The capital limits, the tariff income and the home disregards on our paying for care hub do not apply to someone found eligible: the NHS pays for the package wherever it is delivered, at home or in a care home, but not in an acute hospital.
Who qualifies: the primary health need
The test is whether you have a primary health need, and the leaflet is explicit that it is not dependent on a particular disease, diagnosis or condition. A full assessment looks at the totality of your needs against four characteristics: nature, the type of needs and their overall effect.
Intensity, their extent and severity; complexity, how they interact and the skill needed to manage them; and unpredictability, how much they fluctuate and the risks if care is not timely (public information leaflet, checked 1 November 2026).
Eligibility is relatively rare by design: the leaflet describes the scheme as being for the relatively small number of individuals with high levels of need. That is not a reason not to ask for the checklist; it is a reason to expect the assessment to be thorough.
Step one: the checklist
The leaflet says the first step for most individuals is screening using the checklist tool, which a practitioner can complete in a variety of settings to identify who may need a full assessment. There are two outcomes. A negative checklist means you do not require a full assessment and are not eligible.
A positive checklist means you require a full assessment; the guidance says practitioners should tell people that a positive checklist does not automatically lead to eligibility (checklist guidance, checked 11 September 2026).
The scoring is published. Each care domain is marked in column A, B or C, and a full assessment is required if two or more domains are marked A; five or more are marked B, or one A and four B; or one domain is marked A in one of the priority domains, which carry a priority level in the decision support tool, whatever the other columns show (checklist guidance, checked 11 September 2026). The guidance adds that a full assessment may occasionally be appropriate even below that threshold, with a clear rationale.
Knowing the threshold matters for one reason: the leaflet says you should normally be given the opportunity to be present when the checklist is completed, and the practitioner’s markings are the evidence. Our checklist scorer lets you mark the eleven domains first and see which ones the threshold would turn on. What is said in that conversation is what gets scored. Our Attendance Allowance wording checker was built for a different form, but the discipline it teaches, saying how often, how long, what the risk is and whether it happens at night, is the same discipline.
Step two: the full assessment
A positive checklist leads to a full assessment of eligibility by a multidisciplinary team, which reviews evidence such as medical records and assessments and uses a standardised decision support tool. The tool brings your needs together in 12 care domains, each broken into levels.
So that the team can assess their nature, complexity, intensity and unpredictability and recommend whether you have a primary health need (public information leaflet, checked 1 November 2026).
The team recommends; the integrated care board decides. The leaflet says the board should normally make its decision within 28 days of being told a full assessment is needed, though in some situations it takes longer, and should then tell you in writing, with clear reasons and an explanation of your right to request a review.
The fast track
If you have a rapidly deteriorating condition that may be entering a terminal phase, you may be eligible for urgent access to continuing healthcare through the fast track pathway. The leaflet says no checklist or decision support tool is needed; an appropriate clinician completes the fast track pathway tool instead (public information leaflet, checked 1 November 2026).
The clinician to ask is the one treating the person.
After a decision
If you are eligible, the NHS funds your care and the leaflet says you should normally have a review after three months and then every 12 months, focused on whether the care plan still meets your needs. If your needs change enough to affect eligibility, the board may arrange a full reassessment.
And funding can change, because eligibility is based on needs at the time.
If you are not eligible, the route depends on where the no came from. After a negative checklist, you can ask the integrated care board to reconsider. After a full assessment, or if you have concerns about the procedure, you can ask the board to review the case through its local resolution process; where that does not resolve it, you can apply to NHS England for an independent review; and if the original decision is upheld and you remain dissatisfied, you can complain to the Parliamentary and Health Service Ombudsman (public information leaflet, checked 1 November 2026). Since 1 October 2026 it has been called the Public Service Ombudsman (ombudsman’s announcement, checked 1 November 2026).
If you are not eligible: NHS-funded nursing care
For people in a nursing home who need registered nursing care but are not eligible for continuing healthcare, the NHS makes a payment direct to the care home. The leaflet calls this NHS-funded nursing care, a standard-rate contribution towards the cost of registered nursing care.
And says councils are not permitted to provide or fund registered nursing care except in very limited circumstances. The rest of the fee is then assessed under the council rules on our paying for care hub.
What this page does not do
It does not say whether you will qualify. That turns on an assessment of your needs by people who have met you, against the national framework, and this page describes the process rather than predicting its outcome. Nor does it say what the NHS pays a care home; that is a matter between them.
The national framework itself, and the checklist and decision support tool, are published on GOV.UK and are worth reading before an assessment rather than after.