Thousands of vulnerable individuals across England are facing severe delays in NHS Continuing Healthcare (CHC) checklist assessments, leaving many without timely evaluation or appropriately funded care.
These delays have significant consequences: individuals who may urgently need support remain unassessed and potentially without vital services, while families endure prolonged financial and emotional uncertainty and distress.
National Framework targets missed
Despite the National Framework’s ambition for a two-week turnaround, data from Compass CHC shows more than 150 clients are currently awaiting their initial Checklist, stuck in bureaucratic limbo.
NHS England figures reveal that even after passing the Checklist, patients can face further delays in receiving a full assessment date from their Integrated Care Board (ICB). In early 2025, over 1,089 referrals exceeded the 28-day decision threshold, with 54 cases waiting more than six months.
Causes of delays
There appear to be common factors contributing to these delays:
- Regional variation in CHC delivery
- Procedural inefficiencies and unclear accountability
- Workforce shortages and financial pressures.
Regional variation
Each ICB implements CHC differently, creating a postcode lottery for patients. A recent Nuffield Trust study found eligibility rates for CHC varied dramatically between ICBs, from under 8% to over 42%, highlighting inconsistencies in both speed and outcome.
Lack of coordination and staffing shortages
Responsibility for completing the Checklist is often unclear, with families and professionals passed between ICBs, hospital discharge teams, GPs, and social services. This lack of standardisation and coordination, especially at the interface of health and social care, leads to confusion, inaction, and mounting backlogs. Staffing shortages and workload pressures further exacerbate capacity bottlenecks.
Financial pressures and policy gaps
Policy gaps and financial pressures can encourage delays. There is an uncomfortable reality that CHC funding is costly for ICBs. If an individual is found to be eligible, the ICB assumes responsibility for funding their care costs. All ICBs are under pressure to reduce running costs, which can influence decision-making and timeliness. Concerns have been raised about the impact of budget constraints on CHC outcomes.
The continuing healthcare process in practice
The practical implementation of the CHC process reveals significant barriers to timely assessments. Although the National Framework permits a range of trained professionals to complete the CHC Checklist, many ICBs remain reluctant to accept Checklists from independent nurses. This reluctance persists despite mounting delays, with NHS England appearing hesitant to support outsourcing, possibly due to concerns over quality assurance and consistency. The absence of penalties for breaching the 14-day guideline has allowed these delays to become entrenched, resulting in substantial backlogs. Consequently, patients face prolonged waits for essential care, and criticism has grown that access to CHC remains unfair and inconsistent across England.
Kia Jago, Legal Services Director, Compass CHC, commented:
“We call on policymakers and NHS leaders to recognise these failings and urgently address the CHC assessment process. Without meaningful reform, vulnerable patients will continue to suffer, and the postcode lottery in access to care will persist. More granular data collection is essential to reveal how long people are currently waiting at each stage of the process and to drive improvement. From an independent perspective, we see a clear call to action – make access to NHS Continuing Healthcare prompt, fair and consistent for all who need it.”
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