Continuing healthcare in Northern Ireland: the 2021 test explained

Since 11 February 2021, continuing healthcare in Northern Ireland turns on one question: can this person’s care needs be properly met in any setting other than a hospital? If the answer is yes, they are discharged and the normal charging rules apply, so care at home is free but a care home place is means-tested. Fully funded care is effectively kept for people whose needs can only be met in hospital, which is far narrower than NHS Continuing Healthcare in England.

In short

• The single-question test was introduced by Department of Health circular HSC (ECCU) 1/2021 and explained in guidance issued on 18 May 2022.
• A multidisciplinary team (MDT) decides, normally while the person is in hospital. Anyone still in hospital 3 months (90 days) after admission should be considered against the test, unless they are medically fit and waiting for discharge.
• People getting continuing healthcare before 11 February 2021 keep it while they stay eligible under the old rules.
• If needs can be met at home, domiciliary care is free. In a care home, the 2026/27 limits of £23,250 and £14,250 apply, with a Personal Expenses Allowance of £36.62 a week.
• Self-funders in nursing homes with assessed nursing needs get £100 a week from the Trust towards nursing.
• There is no fast-track route and no Decision Support Tool. Challenges go through review, the HSC complaints procedure and then the Ombudsman.

The test, word for word

The Department’s guidance frames the question as: “can this individual’s care needs be properly met in any setting other than a hospital?” That is the whole test. There is no scoring across care domains, no “primary health need” and no checklist screen.

The answer is a specialist judgement made after a comprehensive assessment by an MDT. As a minimum, the team includes medical and allied health professionals, and it may include doctors, nurses, social workers, occupational therapists, speech and language therapists, dietitians and physiotherapists, with psychology or psychiatry where needed. The assessment normally uses the Northern Ireland Single Assessment Tool (NISAT) or an equivalent.

The guidance lists what the assessment should weigh up:

• the complexity of needs
• prognosis
• how unpredictable the needs are
• acuity, meaning how severe or intense the needs are
• whether complex clinical interventions are needed that are not readily available in the community
• the risk of serious illness or death if those interventions are not given in time

Those last two points are where families should focus. If a nursing home or a care package at home can safely deliver what is needed, the answer will be yes, another setting can meet the needs.

Why Northern Ireland changed the rules

Northern Ireland has a single, integrated health and social care system run by five Trusts. The legal duty to provide integrated care now sits in section 2 of the Health and Social Care (Reform) Act (Northern Ireland) 2009. Before 2021, continuing healthcare was covered by two paragraphs of the Department’s 2010 care management circular, and a Department review found confusion and inconsistency between Trusts.

A public consultation ran from 19 June to 15 September 2017. The results were published on 11 February 2021, and the single-question option took effect the same day. The 2022 guidance replaced paragraphs 17 and 88 of circular HSC (ECCU) 1/2010. Applications already in the system before 11 February 2021 were assessed under the old policy.

English CHC guides, checklists and appeal routes do not apply in Northern Ireland. If your parent lives in England, see our NHS Continuing Healthcare guide instead.

What happens when the answer is “another setting”

Most people assessed will be told their needs can be met outside hospital. What they then pay depends on where they go.

The full care home means test, including how property is treated, is explained in our Northern Ireland paying for care guide and our guide to selling a house to pay for care in Northern Ireland.

Worked example: a long hospital stay

Brian, 79, has a major stroke and spends three months in hospital in the South Eastern Trust area. He has £62,000 in savings and a house his wife still lives in.

1. Day 90: Brian is not yet medically fit for discharge, so his team considers the single question. The MDT finds he needs PEG feeding, two-person moving and regular nursing checks, all of which a registered nursing home can provide. The answer is yes, his needs can be met elsewhere.
2. The record: the family are given the assessment record before the final decision, as the guidance requires, and ask for a second opinion from another consultant. It reaches the same view.
3. Discharge: Brian moves to a nursing home charging, say, £1,050 a week (an illustrative figure; real fees vary by home). His house is ignored because his wife lives there, but his £62,000 of savings is above £23,250, so he pays the fee himself.
4. Nursing contribution: a nursing needs assessment confirms registered nursing care, so the Trust pays £100 a week directly to the home. Brian’s bill falls to £950 a week.
5. Later: when his capital nears £23,250, the Trust’s means test starts and he contributes from income, keeping £36.62 a week.

If Brian’s needs had required, for example, ventilation and specialist intervention only available on a ward, the answer could have been no, and his care would have stayed in hospital at no charge.

End of life and palliative care

There is no fast-track route in Northern Ireland. The 2022 guidance says palliative and end of life care can take place at home, in care homes, hospices or hospitals, and that these situations “should be considered on a case by case basis”. In practice:

• At home, Trust domiciliary care and district nursing are free, so most families pay nothing for care in the last weeks or months.
• In a nursing home, the normal means test applies unless the Trust agrees otherwise. Ask the Trust directly how it will treat the placement if your parent is expected to live only a short time.

Our guides to end of life care at home and palliative versus end of life care cover the practical side.

How to challenge a decision

The route is different from England, where families appeal to the integrated care board. In Northern Ireland:

1. Ask for the records. The guidance says records of the decision-making should be given to the person and family before a final decision is made. Ask for the NISAT, the MDT notes and the reasons in writing.
2. Ask for a second opinion. The person is entitled to one, as in standard medical practice.
3. Request a review if you disagree with the outcome of the assessment.
4. Make a formal complaint to the Trust under the HSC complaints procedure. Complain within six months of becoming aware of the problem where you can, and normally no later than 12 months after the event. A full reply is due within 20 working days.
5. Get free help from the Patient and Client Council on 0800 917 0222 at any stage.
6. Go to the Ombudsman. If you are still unhappy, the Northern Ireland Public Services Ombudsman (NIPSO) can look at it. You must normally bring it within six months of the Trust’s complaints procedure ending. Freephone 0800 34 34 24.

Focus your evidence on the test itself. Which interventions does your parent need, how often, and who can deliver them? A written list of night-time events, falls, choking or seizures is far more useful than a general statement that care is complex.

One limit is firm: the guidance says no one has a right to stay in hospital once they are clinically ready for discharge. You can still refuse a particular care home, and you can ask for an interim place while your first choice has no vacancy. A review does not keep the bed open.

Mistakes to avoid

• Using English CHC tools. Quoting the Decision Support Tool or “primary health need” will not help in Northern Ireland.
• Waiting for the 90-day point. If you think hospital-level care is needed, ask the consultant to consider the question earlier.
• Missing the nursing contribution. Self-funders in nursing homes should check every invoice shows the £100 a week deduction. See our guide to residential or nursing homes.
• Overlooking home care. Because home care is free, discharge home with a full package can cost far less than a care home.

Scotland and Wales

Each UK nation runs its own scheme. Scotland replaced continuing care with “hospital-based complex clinical care”, and Wales uses its own continuing NHS healthcare framework. See NHS continuing care in Scotland and continuing healthcare in Wales.

Frequently asked questions

Is there NHS Continuing Healthcare in Northern Ireland?

Not in the English sense. Since 11 February 2021, continuing healthcare in Northern Ireland depends on one question: can the person’s care needs be properly met in any setting other than a hospital? If yes, they are discharged and normal charging applies. Care at home is free, while care home places are means-tested.

Who decides continuing healthcare eligibility in Northern Ireland?

A multidisciplinary team in the Health and Social Care Trust decides, after a comprehensive assessment usually using the Northern Ireland Single Assessment Tool. The team includes medical and allied health professionals, such as doctors, nurses, social workers and therapists. Families should be involved throughout and given the records before the final decision.

Can you get continuing healthcare in a nursing home in Northern Ireland?

Rarely, for new cases since February 2021, because needs that a nursing home can meet do not pass the single-question test. Self-funders with assessed nursing needs do get £100 a week from the Trust towards nursing. People who had continuing healthcare before 11 February 2021 keep it while they remain eligible under the old rules.

How do I appeal a continuing healthcare decision in Northern Ireland?

Ask for the assessment records and a second opinion, then request a review. If you still disagree, complain to the Trust under the HSC complaints procedure, which should reply within 20 working days. After that, you can go to the Northern Ireland Public Services Ombudsman, normally within six months of the complaints process ending.

Is there a fast track for end of life care in Northern Ireland?

No. There is no equivalent of England’s Fast Track Pathway Tool. Department guidance says palliative and end of life care should be considered case by case. At home, Trust care and district nursing are free. In a nursing home, ask the Trust in writing how the placement will be charged.

When is continuing healthcare considered in Northern Ireland?

Normally in hospital. Department guidance says everyone still in hospital three months (90 days) after admission should be considered against the single question, unless they are medically fit and waiting for discharge. You can ask the team to consider it earlier if you believe your parent’s needs can only be met in hospital.

Sources

• Department of Health: Circular HSC (ECCU) 1/2021, Continuing Healthcare in Northern Ireland
• Department of Health: Continuing Healthcare in Northern Ireland guidance, 18 May 2022
• Department of Health: Continuing Healthcare consultation and outcome
• Department of Health: Guidance on charging for residential accommodation, including HSC (CHU) 1/2026
• nidirect: Paying your care home fees
• nidirect: How to complain or raise concerns about health services
• Northern Ireland Public Services Ombudsman: FAQs
• Health and Social Care (Reform) Act (Northern Ireland) 2009, section 2

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.