by Lisa Morgan
NHS Continuing Healthcare (CHC) is a package of care arranged and fully funded by the NHS for adults with complex, ongoing health needs.
It can be provided at home, in a care home or in a hospice. Eligibility depends not on diagnosis or income, but on whether a person’s primary need is for healthcare rather than social care. At a time when the cost of care continues to rise sharply, CHC can represent a crucial financial lifeline for families.
The cost of residential care in England now averages £1,000–£1,200 per week, with nursing care often exceeding £1,500 per week. Over a year, this can amount to £60,000–£80,000, frequently met through savings or the sale of a family home. Against this backdrop, the importance of CHC — which covers care costs in full where eligibility is established — cannot be overstated.
The England picture (ICB averages)
Across England, the average Integrated Care Board (ICB) recorded around 44 CHC referrals per 50,000 people during the reporting period. Of those who went on to full assessment, only 17% were found eligible through the standard (non fast-track) route. In practice, this means fewer than one in five people assessed nationally secure NHS funding, despite often facing very high care costs.
Timescales remain a concern. On average, 76% of standard CHC assessments were completed within the 28-day target, leaving almost a quarter delayed. During these delays, families frequently continue to self-fund care. England-wide, 15% of local resolution requests — formal challenges to eligibility decisions — resulted in funding being awarded, demonstrating that initial refusals are not always the final word.
Cheshire & Merseyside ICB: higher activity and higher eligibility
Within the Cheshire & Merseyside Integrated Care Board, referral rates are higher than the England average, at 53 referrals per 50,000 people. Eligibility outcomes are also stronger: 23% of standard assessments resulted in eligibility, compared with the England average of 17%. For those who qualify, this can mean relief from care costs running into tens of thousands of pounds each year.
However, performance against timescales is weaker. Only 70% of standard assessments were completed within 28 days, meaning delays — and ongoing self-funding — are more common locally. While fewer eligibility decisions were formally challenged, only 9% of local resolution requests resulted in eligibility, suggesting a more restrictive approach to reviews at ICB level.
NHS Warrington: a mixed picture
NHS Warrington presents a more nuanced position within the wider ICB. Referral activity sits above the England average, with 63 referrals per 50,000 population, indicating both demand for CHC and engagement with the process locally. Throughput appears efficient, with the majority of referrals progressing to completion and assessment.
In contrast to the wider ICB, Warrington performs relatively well against national timescales. 83% of standard CHC assessments were completed within the 28-day target, placing it ahead of both the England and Cheshire & Merseyside averages. However, this still leaves nearly one in five individuals waiting beyond the recommended timeframe—often during periods where care is being privately funded. Even in higher-performing areas, delay continues to carry real financial consequences for families.
Eligibility outcomes are slightly below the ICB average. Of 200 individuals assessed, 45 were found eligible, giving an assessment conversion rate of approximately 22.5%. While this remains above the England average, it still means that the majority of individuals entering the CHC process in Warrington are ultimately found not eligible. This raises ongoing questions about how consistently the “primary health need” test is being applied in practice.
The volume of discounted referrals—41 cases excluded before full assessment—is notable. Screening decisions at Checklist stage are intended to operate as a low threshold gateway into full multidisciplinary assessment. A comparatively high number of discounted referrals may indicate that this threshold is being applied restrictively, potentially preventing individuals with arguable eligibility from progressing further. This is often a key point at which disputes arise.
There are also questions around challenge and review. Only three local resolution requests were recorded in Warrington, with none resulting in eligibility. Given that national data demonstrates that a proportion of CHC decisions are overturned on review, such low levels of challenge may reflect barriers to accessing the appeals process or a lack of awareness among families, rather than uniformly robust initial decision-making.
What this means for families in Warrington
For families in Warrington, the data points to a system that is functioning efficiently in administrative terms but remains difficult to access in practice. While assessments are completed more quickly than in many areas, a significant minority still experience delay at a point when care costs are often being privately met.
At the same time, eligibility rates — although above the national average — demonstrate that most applicants will not secure funding without a robust and well-evidenced case. The level of discounted referrals further underlines the importance of the early stages of the process, where decisions can determine whether a full assessment takes place at all.
Given the complexity of the CHC framework, and the financial stakes involved, families may wish to seek specialist advice when preparing an application or considering a challenge — particularly where care needs are significant but funding has been refused.
With care costs continuing to rise, NHS Continuing Healthcare is more than a clinical assessment process; for many families, it represents the dividing line between financial security and severe financial strain. Understanding how the system operates at a local level can make a critical difference at an already challenging time.
Lisa Morgan is head of the nursing care fee recovery team at Hugh James
