A plain-English guide to every domain in the NHS Continuing Healthcare Decision Support Tool — what each level means, real examples, and how the scoring works.
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There is no single pass mark. The Decision Support Tool produces a recommendation, not a decision, based on the pattern of needs across all 12 domains. NHS guidance says at least one priority need, severe needs in at least two areas, or one severe need plus other needs can usually point towards eligibility. The Integrated Care Board makes the final decision after the multidisciplinary team assessment.
Yes. GOV.UK calls this a request for a previously unassessed period of care. ICBs generally consider requests for care provided from 1 April 2012 onwards where there is objective evidence that the person should have been considered for NHS Continuing Healthcare but was not. Older periods are difficult and usually need exceptional circumstances.
A multidisciplinary team (MDT) — usually a nurse, social worker, and at least one other health professional — carries out the assessment using the Decision Support Tool. The MDT makes a recommendation; the Integrated Care Board makes the final funding decision. You have the right to be present at the assessment and to see the completed DST.
NHS Continuing Healthcare covers the full assessed care package where the person has a primary health need. NHS-funded nursing care is a weekly contribution paid directly to a registered nursing home for the registered nursing element of care. From 1 April 2026, the England standard rate is £267.68 per week and the higher rate is £368.24 per week for people who still qualify for the old higher band.
No. If someone qualifies for NHS Continuing Healthcare, the NHS pays the full cost of their care. The care home cannot charge the family a top-up. If you have been paying top-up fees for someone who should have been assessed for CHC, those fees may be recoverable as part of a retrospective claim.
You have the right to request a local resolution meeting with the ICB. If that fails, you can request an Independent Review Panel hearing. The Parliamentary and Health Service Ombudsman can investigate complaints about the process. Some families use a specialist CHC solicitor or advocacy organisation for appeals, especially where substantial care fees are at stake.