NHS Continuing Healthcare in Wales: How Funding Works for Complex Care

Of all the questions families bring to a first conversation with us, funding is the most tangled — and Continuing NHS Healthcare (CHC) is the most tangled part of it. It’s also, for people with complex needs, often the most important: CHC can fund a full package of care, at home, with no means testing.

Here’s a plain-language guide. One note before we start: Wales has its own CHC framework, set by the Welsh Government and run by local health boards. If you’ve read guidance online, check it’s about Wales — England’s rules and timescales differ.

What CHC is

Continuing NHS Healthcare is a package of care arranged and funded entirely by the NHS, for adults whose need for care is primarily driven by their health. The test is whether someone has a “primary health need” — broadly, that the main reason they need support is a health condition rather than social care needs alone.

Two things follow that surprise many families. First, CHC is not means tested — income and savings are irrelevant. Second, CHC can be delivered at home, not only in nursing placements. Many of the packages we support across Wales are CHC-funded packages delivered in people’s own homes.

How the assessment works

Step one: the Checklist. A screening tool completed by a health or social care professional, which decides whether someone should go forward for full assessment. You can ask for a Checklist to be completed — if you think there’s a case, ask your GP, social worker, community nurse or health board.

Step two: full assessment. A multidisciplinary team looks at needs across areas such as mobility, cognition, behaviour, medication and breathing, using a Decision Support Tool to build a picture of the nature, intensity, complexity and unpredictability of need. The Welsh framework is explicit that this should be person-centred: you and your family should be involved throughout, not informed afterwards.

Step three: the decision. The health board decides eligibility based on the assessment. If eligible, the NHS funds the package in full. If not, care may still be funded through other routes — including joint packages where the health board and local authority share costs, Direct Payments through the local authority, or a Personal Health Budget in some circumstances.

If you disagree with the decision

Decisions can be challenged, and successfully challenged decisions are not rare. In Wales the timescales are specific — you must normally tell the health board in writing, within 28 days of the decision, that you want it reviewed, and your decision letter will set out the exact process. So if you disagree, act promptly and put it in writing early, even while you gather your case. Keep copies of every assessment document, and ask for the Decision Support Tool record if you weren’t given it.

Where we fit in

We’re a care provider, not a benefits adviser — but we work inside this system every week, alongside families, social workers and health board teams. We can help you understand what stage you’re at, what to ask for next, and what a funded package could actually look like at home — including employing someone you already trust as a PA. If you’re starting from scratch, our guide to supporting complex needs at home is a good companion to this one.

And if you’ve already had an assessment, we’re happy to talk through what a CHC-funded package could look like in practice — before any funding decision is finalised.

Talk it through with us. Book a free, no-obligation conversation via our contact form or on 0345 061 9000.