NHS Continuing Healthcare in Wales: eligibility, assessment, appeals

NHS Continuing Healthcare (CHC) in Wales is care arranged and paid for in full by your local health board when your main need is a health need, known as a “primary health need”. It is not means-tested: in a care home it covers the whole fee, including accommodation, and at home it covers health and personal care. Eligibility is decided under the Welsh Government’s 2021 National Framework, and if you disagree you must tell the health board within 28 days and appeal in writing within 6 months.

In short

• CHC in Wales is decided by the local health board, using a multidisciplinary team (MDT) and the Welsh Decision Support Tool, which covers 12 care domains.
• The test is whether your needs, taken together, amount to a primary health need, judged on their nature, intensity, complexity and unpredictability. A diagnosis alone does not decide it.
• The whole process should take no longer than 8 weeks. A fast track for someone rapidly deteriorating should be completed within 2 days.
• To appeal, tell the health board in writing within 28 days of the decision letter, then submit your written appeal within 6 months.
• Since 1 April 2026, adults eligible for CHC in Wales can ask for an NHS direct payment to arrange their own care.
• If you paid for care you think the NHS should have funded, a retrospective claim normally has to be made within 12 months of the end of the period claimed.

Who decides, and under what rules

CHC is the responsibility of Wales’s seven local health boards. The rules are in Continuing NHS Healthcare: The National Framework for Implementation in Wales (2021), in force since 1 April 2022. An interim statement from 1 April 2026 added NHS direct payments, pending a full review.

The dividing line comes from the law. Section 47 of the Social Services and Well-being (Wales) Act 2014 stops councils providing services the NHS is required to provide, other than incidental ones. If your needs are mainly health needs, the NHS must fund them. If they are mainly social care needs, the council’s means test applies instead: the £50,000 capital limit for a care home, or the £100 weekly cap for home care in Wales.

The primary health need test

The MDT looks at four features of your needs as a whole:

• Nature: the type of needs and the help needed to manage them.
• Intensity: how severe they are and how much care they demand.
• Complexity: how needs interact and the skill needed to manage them.
• Unpredictability: how hard changes are to predict, and the risk if care comes late.

The Welsh framework is clear that well-managed needs are still needs: seizures controlled only because staff watch closely day and night still count. People with advanced dementia can qualify: see continuing healthcare and dementia.

The assessment, step by step

1. Information and consent. The health board should give you the CHC information booklet, get consent (or follow the Mental Capacity Act 2005) and ask which language you want, Welsh or English.
2. The Checklist. This screening tool is not compulsory, but if a health board screens, it must use it. A full assessment follows if there are two or more domains at level A, or five at level B, or one at A and four at B, or one A in a domain marked with an asterisk.
3. A care co-ordinator gathers evidence, including your own account.
4. The MDT meeting. Professionals from health and social care complete the Decision Support Tool across 12 domains: breathing, nutrition, continence, skin integrity, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, altered states of consciousness, and other significant care needs. You and your representative should be invited.
5. The decision. The health board decides on the MDT’s recommendation and writes to you with reasons and how to appeal.
6. Care in place within 8 weeks of when it was first thought you might have a primary health need. Only rehabilitation justifies longer.
7. Reviews follow at 3 months, then at least every 12 months. Eligibility is not permanent and can end after a review if needs reduce.

How to prepare for the MDT meeting

• Keep a care diary for two to four weeks: night-time disturbances, falls, choking, aggression, and how long each episode took to manage.
• Go through each domain at the meeting and say if you disagree with a level. The tool asks for your views before you leave, and they should be recorded.
• Bring someone to take notes. If things go wrong later, Llais, the independent citizen voice body for health and social care in Wales, offers free complaints advocacy.

The fast track for end of life

For someone with a rapidly deteriorating condition that may be entering a terminal phase, a doctor or registered nurse involved in their care, including hospice staff, can complete a fast track assessment. Health boards must be able to complete it within two days and act on it immediately. There is no fixed life-expectancy rule. See fast track CHC and end of life care at home.

Assessments and hospital discharge

The Welsh framework says assessments should normally happen at home or in another community setting, not on an acute ward, with rehabilitation first under “Discharge to Recover then Assess”. CHC must not delay a safe discharge, so ask what interim NHS-funded care will be provided. See our hospital discharge checklist.

What CHC pays for

In a care home: the whole cost, including accommodation, food and personal care. You are not charged anything towards it.

At home: the health and personal care in your care plan, but not rent, food or general household bills. Most disability benefits, such as Attendance Allowance, usually stop after 28 days of NHS funding when the NHS funds a care home place, but they normally continue at home. See NHS Continuing Healthcare at home.

Top-ups and extras

You cannot pay towards NHS care, so there is no top-up on a CHC place. You can buy genuine extras separately, such as extra physiotherapy, but if the package does not meet assessed needs, ask for a review instead.

NHS direct payments, new from April 2026

The National Health Service (Direct Payments) (Wales) Regulations 2026 let health boards make direct payments to adults eligible for CHC from 1 April 2026 (children from 1 October 2027), to spend on an agreed care plan. Paying a relative in the same household needs the health board to agree it is necessary. A refusal must be explained in writing within 4 weeks.

If you are not eligible

• NHS-funded nursing care: in a nursing home, the health board pays a weekly amount towards registered nursing care. See FNC rates.
• A joint package, or council funding with a means test. See paying for care in Wales and selling the house to pay for care in Wales.

How to appeal a CHC decision in Wales

1. Within 28 days of receiving the decision letter, tell the health board in writing that you intend to appeal. Late notice is accepted only in exceptional circumstances.
2. Within 6 months of receiving the decision letter, send your written appeal. You can challenge the procedure the health board followed, or how the primary health need was considered.
3. Local resolution. If you dispute the clinical assessment, you should be offered an external peer review. Each board publishes its own review stages.
4. Independent Review Panel. If doubt remains, the board can convene a panel after advice from its chair. A refusal must be explained in writing.
5. The Public Services Ombudsman for Wales. If the panel upholds the decision, you can complain to the Ombudsman, normally within 12 months of becoming aware of the problem.

Complaints about how you were treated, rather than the decision, go through the NHS Wales “Putting Things Right” process: raise them within 12 months, and the health board should reply within 30 working days. Our CHC appeal letter template and appeals guide help you set out your case.

Claiming back care fees you paid

If you paid for care and believe your relative was eligible, you can make a retrospective claim. The claim period must normally end no more than 12 months before you apply. Within 5 months of registering, send proof of fees paid and your authority to act (a registered power of attorney, deputyship, or probate). Providers get up to 3 months to supply records, then the health board reviews the case in two stages.

Mistakes to avoid

• Missing the 28-day deadline. Send a short letter of intention to appeal straight away, even before you have all the evidence.
• Letting the meeting focus on diagnosis. Steer every discussion back to the four key features.
• Selling the house before a decision. If CHC is likely, ask for an assessment before committing to fees.

Elsewhere in the UK

England has its own framework and appeal routes. Scotland ended CHC in 2015: see NHS continuing care in Scotland and, for Northern Ireland, continuing healthcare in Northern Ireland. Our CHC eligibility checker gives a quick first view.

Frequently asked questions

Who is eligible for NHS Continuing Healthcare in Wales?

Adults whose care needs, taken as a whole, amount to a primary health need. A multidisciplinary team judges this on the nature, intensity, complexity and unpredictability of the needs, using the Welsh Decision Support Tool across 12 domains. Diagnosis alone does not decide it, and income and savings make no difference.

How long does a CHC assessment take in Wales?

The National Framework says the whole process should take no longer than 8 weeks from the point someone is thought to have a primary health need, with the care package in place by then. A fast track assessment for someone rapidly deteriorating should be completed within 2 days and actioned immediately.

How do I appeal a continuing healthcare decision in Wales?

Write to the local health board within 28 days of receiving the decision letter to say you intend to appeal, then send your written appeal within 6 months. Local review comes first, then an Independent Review Panel, then the Public Services Ombudsman for Wales.

Does CHC pay care home fees in full in Wales?

Yes. When the NHS funds a care home place through CHC, it pays the whole fee, including accommodation, food and personal care, and the home cannot charge a top-up for that care. Most disability benefits usually stop after 28 days. Extras you choose separately, such as hairdressing, are still yours to pay.

Can I get direct payments for CHC in Wales?

Yes, since 1 April 2026 for adults. Health boards can make NHS direct payments so you can arrange the care in your agreed plan yourself. Paying a relative who lives in the same household needs the health board’s agreement. A refusal must be explained in writing within 4 weeks.

Can I claim back care fees if my relative should have had CHC?

Yes, through a retrospective claim to the health board. The period you claim for should normally end no more than 12 months before you apply, and you have 5 months from registering the claim to provide proof of fees paid and your legal authority to act.

Sources

• Welsh Government: National Framework for Continuing NHS Healthcare
• Welsh Government: Continuing NHS Healthcare interim policy statement (2026)
• Welsh Government: direct payments for Continuing NHS Healthcare
• The National Health Service (Direct Payments) (Wales) Regulations 2026
• Welsh Government: CHC information booklet for individuals, families and carers
• Welsh Government: NHS Wales complaints (Putting Things Right)
• Public Services Ombudsman (Wales) Act 2019
• GOV.UK: benefits if you go into a care home

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.