FAQs
How do I apply for NHS Continuing Healthcare?
The process usually starts with an NHS Continuing Healthcare Checklist, which helps decide whether a full assessment is needed. This can be requested through a GP, social worker, care home, hospital discharge team or the relevant NHS body. We can help you understand the process and prepare the right evidence before an assessment takes place.
What happens during a NHS CHC assessment?
If a full assessment is needed, a multidisciplinary team will review your loved one’s care needs using the Decision Support Tool. They will consider areas such as mobility, cognition, behaviour, nutrition, continence, medication, skin integrity and other health needs before making a recommendation on eligibility.
What is the difference between NHS Continuing Healthcare and social care funding?
NHS Continuing Healthcare is arranged and funded by the NHS for adults with a primary health need and is not means-tested. Social care funding is usually arranged by the local authority and is financially assessed, meaning savings, income and assets may be taken into account.
Find out if your loved one could be eligible for NHS CHC funding
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If your loved one is paying privately for care and has significant health needs, it is worth seeking advice.
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Can I challenge a past NHS CHC decision?
Yes, in some cases. If your loved one was refused NHS Continuing Healthcare, you may be able to challenge the decision if needs were not properly considered, evidence was missed, or the criteria were not applied correctly. Time limits can apply, so it is important to seek advice promptly.
Can someone receive NHS CHC funding at home?
Yes. NHS Continuing Healthcare can fund care in a person’s own home, as well as in a care home, nursing home or other care setting. Eligibility depends on the person’s assessed health and care needs, not where they receive care.
How can you help with appeals?
We can review the decision, identify potential grounds of challenge, gather supporting evidence and help present your loved one’s needs clearly under the NHS Continuing Healthcare criteria. We can also support you through local resolution and, where appropriate, further review stages.
Can you help recover care fees that were wrongly paid?
Yes, where there may be grounds to argue that your loved one should have been assessed or found eligible for NHS Continuing Healthcare during a past period of care. We can advise on whether a retrospective review may be possible and help prepare the evidence needed to pursue a claim.
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Emerald Law client recovers more than £160,000 in care home fees
When a loved one moves into residential care, families are often told that savings, pensions, property or other assets must be used to cover the cost.
But that is not always the case.
In this matter, Emerald Law Solicitors helped a family recover more than £160,000 after their late aunt, referred to as Ms B to protect the family’s privacy, was found to have been eligible for NHS Continuing Healthcare funding for more than two and a half years.
The situation
Ms B had lived independently in Marlborough, Wiltshire, before moving into residential care in December 2015 at the age of 85.
Her health had deteriorated significantly. She had a range of complex and escalating needs, including:
- Alzheimer’s disease
- Frailty
- Recurrent falls
- Serious weight loss
- Dysphagia
- Mobility issues
- Altered states of consciousness
- Episodes of aggression
Despite the seriousness of her condition, Ms B continued to pay privately for her care until she died in March 2020.
As her savings were depleted by care home fees, her family entered into a deferred payment agreement with the local council. Her flat was later sold to repay the loan, significantly reducing the estate she had worked hard to leave behind for her family.
The problem
It was only after Ms B died that her family discovered she may have been eligible for NHS Continuing Healthcare.
NHS Continuing Healthcare can cover the full cost of care for adults with significant health-related care needs. It is not based on income, savings or property. Instead, eligibility depends on the nature, intensity, complexity and unpredictability of the person’s condition.
For Ms B’s family, this meant there was a serious question to answer:
Should she have been paying privately for care at all?
How Emerald Law helped
Ms B’s family approached Emerald Law Solicitors in 2022.
Our NHS Continuing Healthcare team carried out a detailed review of the available evidence, including care home records, medical records, adult social care records and wider clinical information.
We then argued that Ms B should have been eligible for NHS Continuing Healthcare funding from 4 August 2017 until her death on 1 March 2020, due to the nature, complexity, intensity and unpredictability of her health needs during that period.
Following a final multidisciplinary team assessment involving a trained nurse and a social worker from the local authority, Ms B was found to have been eligible for NHS Continuing Healthcare for two years, six months and 27 days.
The outcome
The case settled for:
£160,860.16
This represented a substantial recovery of care fees that had been wrongly paid privately.
For Ms B’s family, the outcome was about more than money. It helped restore a significant part of the inheritance Ms B had intended to leave behind.
As her niece explained:
“I am so pleased that I engaged Emerald Law to investigate whether my aunt should have been eligible for NHS Continuing Healthcare funding. Emerald Law discovered that this was in fact the case, recovered a substantial proportion of the care fees, and we have at last received the inheritance my aunt intended for us.”
She added that the family were “very grateful” to Emerald Law for the professional advice and successful outcome, which had financially helped the family.
Emerald Law helped a family recover £160,860.16 after their late aunt was found to have paid privately for care that should have been funded by the NHS.
Why this case matters
Many families assume that if they have been told to pay privately for care, there is nothing they can do.
This case shows that is not always true.
If someone has significant, complex or unpredictable health needs, they may be eligible for NHS Continuing Healthcare. This can apply whether they are receiving care in a care home, hospital, hospice or their own home.
In some cases, families may also be able to bring a retrospective claim to recover care fees that should not have been paid privately.
Phil Turner, NHS Continuing Healthcare specialist at Emerald Law Solicitors, said:
“NHS Continuing Healthcare can make a life-changing difference, but many families do not realise it may apply to them.
“If someone has significant, complex or unpredictable health needs, families should not assume that a decision to pay privately is correct. They should seek advice as early as possible, particularly because retrospective cases rely heavily on the quality and availability of historic evidence.”
Could your family have a claim?
You may wish to seek advice if your loved one:
- Pays privately for residential or nursing care
- Has complex, intense or unpredictable health needs
- Has conditions such as dementia, Parkinson’s, stroke-related needs, mobility issues, weight loss, falls, dysphagia or behavioural changes
- Has never been properly assessed for NHS Continuing Healthcare
- Has been refused NHS Continuing Healthcare and you believe the decision was wrong
- Has since passed away, but may have been eligible during their lifetime
Even if care fees have already been paid, it may still be possible to investigate whether NHS funding should have applied.
Book a free initial consultation
If you are concerned that your loved one has wrongly paid care fees, our NHS Continuing Healthcare team can help you understand your options.
We can review the circumstances, explain whether there may be grounds to challenge the position, and advise you on the next steps.
Book your free initial consultation today.
Did you know?
NHS Continuing Healthcare is NOT means-tested.
Many families assume their loved one cannot qualify for NHS Continuing Healthcare because they own a home, have savings, or are already paying privately for care.
That is not correct.
NHS CHC is based on assessed care needs, not financial circumstances. If someone is found to have a primary health need, their care may be arranged and funded by the NHS.
Did you know?
A full eligibility consultation & action plan with Emerald Law costs the same as two days of care
Private nursing care costs are averaging at £181 per day in England (Age UK). For just £250+VAT we offer a full 1-hour of tailored legal advice with a written action plan so that you know where you stand and what to do next.
This all starts with a free consultation. Start your enquiry below to book yours.
NHS Continuing Healthcare (CHC) funding is a package of care that is fully funded by the NHS for adults in England who have significant ongoing healthcare needs due to disability, accident, or illness.
If you qualify for NHS CHC, the NHS pays for all your care costs, whether you receive care:
- In a Care Home (including accommodation, food, and nursing costs), or
- In your own home (covering care workers, nurses, and some equipment).
What is NHS CHC funding?
You have the right to appeal if:
- The checklist did not lead to a full assessment, but you believe it should have.
- The full assessment resulted in a refusal, but you disagree with the outcome.
Appeals are initially made by way of resolution hearing with the ICB who made the final decision on eligibility. It can also be reviewed by NHS England through an Independent Review Panel (IRP).
What if my application is refused?
Eligibility is based on your health needs, not on your diagnosis or where you live. To qualify, your “primary need” must be a health need – that is, your care is required because of health issues, not social or personal care reasons.
The NHS look at areas like
- Mobility and physical ability
- Breathing and nutrition
- Continence and medication needs.
- Cognition, behaviour, and mental health
- Communication and emotional support needs.
Who is eligible for funding?