Many families assume that once an elderly or disabled relative needs residential or nursing care, their savings and perhaps their home will automatically have to be used to pay the fees.
However, there is an important area of funding in Northern Ireland that families should be aware of:
Continuing Healthcare (CHC).
A recent case highlighted how one family fought for many years over the cost of a relative’s care and ultimately secured substantial healthcare funding. The case demonstrates why families should ask questions, obtain proper assessments, keep documentation and challenge decisions they believe are incorrect.
However, the rules in Northern Ireland are different from those in England, so advice about NHS Continuing Healthcare found in English newspapers and websites should not automatically be applied here.
What is Continuing Healthcare in Northern Ireland?
Continuing Healthcare is concerned with whether a person’s ongoing needs are such that responsibility for their care falls to the Health and Social Care system rather than being treated as ordinary residential social care.
Northern Ireland currently uses a particularly important eligibility question:
“Can this individual’s care needs be properly met in any setting other than a hospital?”
The decision should be made following a comprehensive assessment by a multidisciplinary team, which may include doctors, nurses, social workers, occupational therapists, physiotherapists and other relevant healthcare professionals.
The assessment may consider matters such as:
- the complexity of the person’s needs;
- their prognosis;
- how unpredictable their condition is;
- the seriousness or acuity of their needs;
- whether complex clinical interventions are required; and
- the consequences if necessary treatment is not provided
If it is decided that the person’s needs can properly be met outside hospital, for example in a residential or nursing home, they will normally fall under the usual Northern Ireland charging arrangements for that care.
This is different from England
This distinction is extremely important.
Information online about NHS Continuing Healthcare frequently describes the English system, including an initial checklist, a Decision Support Tool and assessment across 12 care domains.
That is not the current Northern Ireland eligibility system.
Northern Ireland has its own Department of Health guidance and its own HSC Trust assessment arrangements.
Make sure the family is involved
Families and carers should be involved throughout the assessment and discharge process where appropriate.
If you know the person well, you may be able to provide information that is not obvious from a short assessment.
For example, tell the assessment team about:
- deterioration over recent months;
- confusion or cognitive problems;
- falls;
- behavioral difficulties;
- mobility problems;
- eating or swallowing difficulties;
- breathing problems;
- medication needs;
- continence problems;
- night-time care;
- episodes requiring urgent intervention; and
- how unpredictable the person’s condition can
Do not exaggerate someone’s condition, but equally do not minimise it by simply saying “we manage” if considerable care and supervision are actually required.
The assessment should reflect what care is necessary to keep the person safe — not merely how they happen to appear on a particularly good day.
Keep everything in writing
Families should keep copies of:
- assessments;
- care plans;
- hospital discharge information;
- nursing records;
- correspondence with the Trust;
- consultant and GP letters;
- medication information; and
- decisions about Continuing
Northern Ireland Department of Health guidance says a comprehensive record of the decision-making process should be maintained and communicated to the individual and their family.
If you disagree with something recorded during the assessment, raise it and ask for your concerns to be recorded.
What about savings and the family home?
This needs particular care.
The Continuing Healthcare assessment itself is concerned with the person’s healthcare needs, not simply with how wealthy they are.
However, families should not interpret this as meaning that they should always refuse to provide financial information.
If the Trust decides that the person’s needs can be met in residential or nursing care, the normal means-tested Northern Ireland charging rules may then apply. At that stage information about income, savings and capital can legitimately be required to calculate what the person must contribute towards their care.
Therefore, it is important to distinguish between:
1. The healthcare assessment — what care does the person actually need?
and
2. The financial assessment — who pays for residential or nursing care once the appropriate care has been established?
These are separate issues and families should ensure that financial considerations do not replace a proper assessment of the person’s health and care needs.
What if the Trust refuses Continuing Healthcare?
A refusal does not necessarily have to be accepted without question.
Northern Ireland Department of Health guidance provides that a person or their family can seek a review if dissatisfied with the outcome of an assessment.
If disagreement continues, a complaint can be made through the relevant Health and Social Care Trust’s formal complaints procedure.
Independent assistance with an HSC complaint is also available from the Patient and Client Council.
If the matter remains unresolved after the Trust’s complaints procedure, a complaint may ultimately be taken to the Northern Ireland Public Services Ombudsman.
Do not assume Continuing Healthcare is “England only”
This is particularly important.
There have previously been cases where Northern Ireland families were incorrectly given the impression that Continuing Healthcare applied only in England.
Continuing Healthcare does exist in Northern Ireland, although the rules are different and eligibility under the current Northern Ireland policy is considerably narrower than under the English NHS Continuing Healthcare system.
The current policy followed lengthy legal proceedings. The Northern Ireland Court of Appeal reinstated the Department of Health’s 2021 policy, and in June 2025 the UK Supreme Court refused permission for a further appeal.
The practical lesson for families
If a relative has very substantial, complex or unpredictable healthcare needs, particularly when they are in hospital and long-term care is being discussed, families should ask:
“Has my relative been considered for Continuing Healthcare under the current Northern Ireland Department of Health guidance?”
If an assessment takes place:
- take part in it;
- make sure the person’s full needs are recorded;
- provide medical and care evidence;
- ask for copies of the assessment and decision;
- keep your correspondence;
- challenge factual errors; and
- request a review if you believe the decision is
The financial consequences of long-term care can be enormous. It is therefore worth establishing what care the person requires and whether the HSC should fund it before assuming that the family
must simply meet the cost themselves.
This article provides general information on the Northern Ireland Continuing Healthcare system and is not individual legal, medical or financial advice. Eligibility depends on the person’s individual circumstances and the applicable HSC assessment.