NHS Continuing Healthcare Glossary

This NHS Continuing Healthcare glossary explains common CHC terms, acronyms and assessment tools in plain English, helping individuals and families understand eligibility, funding decisions and care pathways.

We know how overwhelming applying for NHS Continuing Healthcare funding can be, and that it’s not made any easier by the number of unfamiliar terms and acronyms that are used in the process.

This glossary explains the most common CHC terms in plain English. To make it easier to digest, we have broken it down into primary CHC areas.

• CHC Funding Basics – NHS Continuing Healthcare, Primary Health Need, NHS-funded Nursing Care, Integrated Care Board, National Framework.
• Assessments & Tools – CHC Checklist, Decision Support Tool, Fast Track Pathway Tool, Multidisciplinary Team, Care Domains, Retrospective Claims, Previously Unassessed Periods of Care, Needs Portrayal Document.
• How Decisions are Made – Four Key Characteristics, Eligibility Decision, Joint Package of Care, Person-Centred Approach, Consent.
• Care Settings & Packages – Care Package, Personal Health Budget, Care Home vs. Nursing Home.
• Reviews, Disputes & Complaints – Review, Reassessment, Challenging a Decision, Local Resolution Meeting, NHS England, Independent Review Panel, Parliamentary and Health Service Ombudsman.
• Capacity, Representation & Rights – Mental Capacity Act, Best Interests Decision, Lasting Power of Attorney, Authority to Act.
• Related Health & Social Care Terms – Healthcare vs Social Care, Local Authority, Care Act 2014, All Age Continuing Care.

NHS Continuing Healthcare (“CHC” for short) – A complete package of care arranged and funded solely by the NHS for adults with high levels of long-term health care needs.

Primary Health Need – The key qualification needed for a person to be eligible for NHS Continuing Healthcare. It’s not a medical diagnosis; it’s a way of highlighting that a person’s care is intense or complex enough that specialised healthcare is needed.

Read our detailed guide What is a Primary Health Need? to find out more.

NHS-funded Nursing Care (“FNC” for short) – Funding paid by the NHS to a nursing home to cover the care by a registered nurse. This typically happens when a person does not qualify for continuing healthcare but requires nursing care.

Explore our full explanation in our guide, What is NHS-funded Nursing Care?

Integrated Care Board (“ICB” for short) – The NHS organisation responsible for arranging continuing healthcare assessments and funding decisions in England (replacing Clinical Commissioning Groups in 2022). Each area in England has a local Integrated Care Board.

National Framework – The rulebook for the continuing healthcare application process. It tells health and social care staff exactly how to carry out their assessments, including the forms to use, the decision-making timeline, and the legal duties of local authorities and the NHS.  

CHC Checklist – A screening tool used by the NHS to determine whether a person should be fully assessed for continuing healthcare. This is the first step in the process and is intentionally designed with a low threshold so anyone who might possibly qualify for continuing healthcare will pass.

Learn more about the process in our article, Continuing Healthcare Checklist and Process.

Decision Support Tool (“DST” for short) – When the CHC Checklist has been passed, the next stage is the Decision Support Tool (or DST). This is the more detailed phase of the assessment and determines whether a person is eligible for continuing healthcare.   

Learn more about how the tool works in our guide, What is the Decision Support Tool?

Fast Track Pathway Tool – An “express” version of the assessment used when a person is nearing the end of life, and urgent care needs to be arranged. Rather than the usual 28-day timeline, the Fast Track route is designed to get care in place within 48 hours.

Explore the Fast Track process in our article, What is a Fast Track Assessment?

Multidisciplinary Team (“MDT” for short) – A team made up of at least two professionals from different health or social care backgrounds (e.g. a nurse and a physiotherapist) who will work together to complete a person’s continuing healthcare assessment. The professionals who make up someone’s MDT should already be involved in their care.

Care Domains – These are the categories used to properly measure a person’s healthcare needs.

The 12 care domains are: Breathing, Nutrition, Continence, Skin, Mobility, Communication, Psychological and Emotional Needs, Cognition, Behaviour, Drug Therapies and Medicine, Altered States of Consciousness, Other Significant Needs.

Learn more about each of those domains in our guide, What are the 12 Care Domains of Continuing Healthcare?

Retrospective Claims (sometimes referred to as ‘Retro’) – NHS Continuing Healthcare cases where eligibility is reviewed after the care has already been provided. They look back at a past period of care to assess whether the individual should have received NHS funding at the time, often because no assessment took place, or the original decision was flawed. If eligibility is confirmed, the NHS may refund care fees that were previously paid.

Read more about the timeframes and conditions in our article, Can I claim back care home fees?

Previously Unassessed Period of Care (PUPoC) – A PUPoC is a past period of care where a person funded their care themselves and were not assessed for NHS Continuing Healthcare at the time, even though they may have been eligible. A PUPoC review allows the NHS to look back at that period to decide whether NHS funding should have applied and, if so, whether care fees should be repaid.

Needs Portrayal Document (NPD for short) – An evidence-based summary that sets out an individual’s health and care needs over a specific period of time. It is compiled by the ICB primarily for retrospective cases, using available records such as care notes, medical records, and professional reports, and is used to build a clear picture of the person’s needs in order to assess eligibility for NHS Continuing Healthcare.

Four Key Characteristics/Indicators – Whilst the 12 care domains assess individual problems and provide evidence, the four key characteristics aim to understand how those problems interact and provide the “bigger picture”. The characteristics provide the argument for why the NHS should pay for an individual’s care.

They are:

• Nature: This describes the type of health condition a person has and what it does to them.
• Intensity: This looks at how much care is needed and how often.
• Complexity: This looks at how different needs overlap.
• Unpredictability: This looks at how unstable a person’s condition is.

Eligibility Decision – The final verdict on whether the NHS will fully fund a person’s care. It is the end result of the assessment; however, it can be appealed.

Joint Package of Care – If a person is found not eligible for full NHS Continuing Healthcare funding, a Joint Package of Care might be put in place. This is a “split-the-bill” arrangement between the NHS and a person’s local council and serves as more of a middle-ground outcome.

Person-Centred Approach – This describes how the NHS conducts the assessment. Rather than just a “case”, the NHS’s Person-Centred Approach requires the assessment to include a person’s views and history and must give a person a chance to actively participate in the assessment.

Consent – This is the formal permission a person must give for the assessment to proceed legally. Consent must be given voluntarily, in an informed manner, and by someone with the mental capacity to do so. If a person is unable to give consent due to a lack of capacity, a legal representative can give consent, or it can be given in a person’s best interests.

Care Package – The combination of services, support and sometimes equipment needed to meet a person’s specific health and social care needs. For those eligible for NHS Continuing Healthcare, the NHS is responsible for arranging and funding this.

Personal Health Budget (“PHB” for short) – The amount of money the NHS allocates to meet a person’s health and wellbeing needs. This is a legal right for eligible individuals receiving NHS Continuing Healthcare.

Care Home vs Nursing Home – The primary difference between a care home and a nursing home is the level of medical support available. Whilst both provide 24-hour care, a care home is unlikely to have qualified nurses on-site, whereas a nursing home will. Therefore, those with more intense or complex health needs are better suited to a nursing home.

Review – A check-in to ensure the care package in place is still appropriate. The first review will take place three months after funding starts, and subsequent reviews will occur annually. An earlier review can be requested if health needs change significantly.

Reassessment – If a review shows clear signs that a person’s health needs have changed, a reassessment might be triggered. This can happen if a person’s condition worsens and they need more complex care, or stabilises, meaning they need lighter care. This will then start a full Multidisciplinary Team assessment using the Decision Support Tool.

Challenging a Decision – If the Integrated Care Board decides a person is not eligible, or if funding is withdrawn as a result of a reassessment, a person has the legal right to ask them to reconsider; this is challenging a decision.

Read our detailed guide How do I appeal an NHS Continuing Healthcare funding decision? to find out more.

Local Resolution Meeting (LRM) – Arranged by the ICB as part of the NHS Continuing Healthcare process to review and discuss concerns or disagreements about an eligibility decision. It allows the individual or their representative to raise questions, clarify issues, and seek resolution before the case is escalated to an Independent Review Panel (IRP)

NHS England – Responsible for overseeing and supporting the National Health Service (NHS) in England. It works with the government and local NHS organisations to plan services, allocate funding, set national priorities, and ensure NHS care is safe, effective, and provides value for the public. If an appeal with the local ICB is unsuccessful, we may have the option to request an independent review with NHS England.

Independent Review Panel (IRP for short) – a formal NHS England process that reviews whether an Integrated Care Board (ICB) has followed the correct procedure and reached a reasonable decision when assessing someone’s eligibility for NHS Continuing Healthcare. It is used when a disagreement cannot be resolved locally and provides an independent review of the original decision.

Parliamentary and Health Service Ombudsman (“PHSO” for short) – The final stage of the NHS complaints process. The Parliamentary and Health Service Ombudsman are the final referee when someone challenges a CHC decision.

Mental Capacity Act 2005 (MCA for short) – The law in England and Wales that provides a legal framework for making decisions on behalf of people aged 16 and over who lack the mental capacity to make specific decisions themselves. The Act is built on key principles, including presuming capacity unless proven otherwise, supporting people to make their own decisions wherever possible, and ensuring that any decision made for someone who lacks capacity is made in their best interests and is the least restrictive option.

Best Interests Decision – A decision made on behalf of a person who has been assessed as lacking mental capacity for a specific decision, in accordance with the Mental Capacity Act. The decision-maker must consider all relevant circumstances, including the person’s past and present wishes, feelings, beliefs and values, and must involve the person and those close to them wherever possible. Decisions must not be based on assumptions and must aim to achieve the most appropriate outcome for the individual. CHC assessments can sometimes be undertaken on this basis where the patient does not have the ability to provide consent.

Lasting Power of Attorney (LPA for short) – A legal document that allows a person (the donor) to appoint one or more trusted individuals (known as attorneys) to make decisions on their behalf if they lose mental capacity in the future. There are two types of LPA: Health and Welfare, which covers decisions about care and medical treatment, and Property and Financial Affairs, which covers decisions about money and property. An LPA must be created while the donor has capacity and must be registered before it can be used.

Read our guide I’m next of kin, do I need a LPA? to find out how it can help when applying for NHS Continuing Healthcare funding.

Authority to Act – The legal evidence required to show that a person is entitled to represent an individual during the NHS Continuing Healthcare process. This may include documents such as a Lasting Power of Attorney, Court of Protection deputyship, or proof of executorship if the individual has passed away. ICBs must be satisfied that appropriate authority is in place before sharing information or accepting instructions from a representative.

Healthcare vs Social Care – In simple terms, healthcare focuses on managing or “fixing” a medical condition, while social care focuses on living with its impact. Social care helps someone do a task they are unable to do, and healthcare manages a medical risk while that task is being done. Social care tasks are usually carried out by Care Assistants or Support Workers, whilst healthcare tasks are usually carried out by Registered Nurses, Physiotherapists or Doctors.

For more information about how they differ, read our guide, What’s the Difference Between Healthcare and Social Care?

Local Authority -The body responsible for managing a person’s social care. While the NHS is responsible for health needs, the local authority – usually an Adult Social Services department – is responsible for managing social needs.

Care Act 2014 -The primary law in England that governs how Adult Social Care is provided. In the context of NHS Continuing Healthcare, the Care Act 2014 defines the “boundary” between what the council must do (social care) and what the NHS must do (healthcare).

All Age Continuing Care (“AACC” for short) – A collective term for the various NHS services and funding streams that provide care for individuals of any age with ongoing, complex health and care needs. It covers NHS Continuing Healthcare, NHS-funded Nursing Care and more.

We guide individuals and families through the complexities of NHS Continuing Healthcare – providing expert advice, advocacy and legal support to ensure those who are eligible receive the funding and care they deserve.

If you’re starting the NHS Continuing Healthcare assessment process and require support, we’re here to help. Complete our enquiry form to arrange a free, no-obligation confidential assessment today.