Understanding CHC in South West London
South West London's geography disguises a critical inequity. Kingston and Richmond are among the most affluent London boroughs, with strong family support networks and average household incomes that permit private care funding. Yet they also have uniquely high dementia prevalence — nearly 50% of adults over 75, double the national average. This paradox means families in these areas face an insidious bias in CHC assessment: assessors may assume that because families are wealthy enough to pay privately, health needs don't warrant NHS funding. Legally this is incorrect — the test is whether primary health need exists, not whether the family can afford to supplement — but the bias persists.
Croydon, by contrast, is the largest single borough in the South West London area (~400,000 people) with a younger demographic, higher ethnic diversity, and lower average household incomes than Kingston/Richmond. CHC assessments in Croydon are more likely to approve funding because families demonstrably lack resources for private care — yet this creates a perverse incentive structure where affluence becomes a barrier to NHS support.
The ICB operates a place-based structure with six Places, one per borough, co-terminus with local authorities. Service quality and assessment speed vary significantly between places. Croydon CHC operates at significant scale (400,000 population); Kingston/Richmond serve smaller but more complex older populations; Merton, Sutton, and Wandsworth operate in the middle ground. A case involving depression in an older adult may be assessed very differently depending on which place team leads.
St George's University Hospitals is a dominant force across the region. It serves 1.3 million people locally but draws specialist referrals from 3.5 million across Surrey and Sussex. This means acute hospital discharge assessments are often robust and well-coordinated — but St George's also carries expectations of "high standards," which can create unconscious pressure on assessors to justify approving CHC in complex cases with high costs. Leverage St George's reputation for excellence if your case involves any acute hospital involvement.
CHC approval statistics for South West London
Source: NHS England official CHC statistics, 2024/25 · Rank 6 of 36 ICBs in England
Standard approval rate
14.0%
National avg: 19.5%
Assessments completed
1,172
164 found eligible
Fast-track approved
1,802
of 1,802 fast-track assessments
Local review requests
40
15.0% changed to eligible
Currently receiving CHC
893
Snapshot Q3 2025/26
England rank
6 / 36
1 = lowest approval rate
How South West London compares — 2024/25
Three-year approval rate trend
National average: 19.5% in 2024/25 · Source: NHS England
What this means
South West London's 14.0% approval rate sits broadly in line with the national average of 19.5%. Roughly 1 in 7 people assessed receives a positive decision via the standard route. The quality of evidence presented at the DST assessment remains the single most important factor within families' control.
How to apply for CHC funding in South West London
NHS Continuing Healthcare (CHC) is assessed and funded by your local Integrated Care Board. If you live in the South West Londonarea, here's what you need to know.
Step 1: Request a CHC screening
You can request a CHC Checklist screening at any time — in hospital, at home, or in a care home. Contact your GP or the South West London CHC team on 020 3668 1900 to start the process.
Step 2: The Checklist assessment
A healthcare professional will complete the CHC Checklist with you. If you score positively on two or more domains (or one domain at "priority" level), you'll be referred for a full assessment.
Step 3: The full Decision Support Tool assessment
A multidisciplinary team will carry out a comprehensive assessment using the Decision Support Tool (DST). This evaluates your needs across 12 care domains.
Advocacy tips for South West London
These tips are specific to applying for CHC in the South West London area.
action
**Affluence paradox:** In Richmond/Kingston, explicitly argue that 'primary health need is not determined by family wealth or ability to pay privately.' Frame your case around the 4 key characteristics (nature, intensity, complexity, unpredictability) of health needs themselves, not family financial capacity. If the assessor suggests family should supplement care, push back in writing: 'NHS CHC obligation exists independent of family resources.'
action
**Croydon-specific:** Leverage the lower average household income and higher ethnic diversity as supporting evidence for complexity and urgency. Document any barriers to private care access (language, immigration status, family separation). This strengthens the case for NHS-funded provision.
action
**Dementia hotspot:** Kingston/Richmond have 50% dementia prevalence in older adults — request a dementia-specialist assessor. Ensure DST captures the complexity of multiple behavioural/cognitive/communication domains interacting with other age-related conditions (falls, incontinence, medication management).
action
**St George's tertiary reach:** If your case involves acute hospital discharge, complex neuro, stroke, cardiac, or surgery recovery, reference St George's specialist team involvement. Their rigorous assessment protocols command respect from the ICB and can elevate the credibility of your evidence.
action
**Multi-borough delays:** If caring for someone in a different borough (e.g., person lives in Wandsworth but cared for in Croydon), flag coordination risks upfront. Request a single lead assessor from the primary place, with support from the secondary borough team.
action
**Retrospective claims:** If a person has been in a privately-funded care home and now needs CHC assessment, you may claim back fees dating up to 3 months prior (or longer if funding inadequacy is recent). Request this explicitly in writing.
Hospital trusts in South West London
These are the main NHS trusts whose patients may be assessed for CHC in this area. If your relative is being discharged from one of these hospitals, ask the ward about CHC screening.
St George's University Hospitals NHS Foundation Trust
St George's Hospital (southwest London), Serves 1.3 million locally; 3.5 million for specialist services
Kingston Hospital NHS Foundation Trust
Kingston Hospital (~350 beds, 2,900 staff)
Epsom and St Helier University Hospitals NHS Trust
Epsom Hospital, St Helier Hospital, Sutton Hospital
Croydon Health Services NHS Trust
Croydon University Hospital, Purley War Memorial Hospital, Integrated home/community services
Contact South West London
Frequently asked questions
My relative lives in a care home in Croydon. How do I get them assessed for CHC?
Ask the care home manager to request a CHC Checklist screening from the Croydon CHC team (020 3668 1900 or swlccg.croydonchcenquiries@swlondon.nhs.uk). Or contact the team directly yourself. The Checklist can be completed by the care home nurse, GP, or an NHS assessor. If the home is already funded privately, you have the right to request a **retrospective** assessment dating back up to 3 months (or longer if funding inadequacy is recent). If approved, the NHS reimburses care home fees from CHC date.
I disagree with a CHC refusal in South West London. What evidence do I need for appeal?
**(1) DST copy** (request immediately if not provided); **(2) Care records** (daily logs, frequency of interventions, incident reports); **(3) Medical records** (GP notes, hospital discharge summaries, specialist reports); **(4) Risk assessments** (falls, pressure ulcers, behaviour); **(5) Evidence of complexity** (e.g., dementia + Parkinson's + incontinence — show how these interact); **(6) Documentation showing incorrect DST scoring** (e.g., 'Mobility marked as Low but patient cannot walk unassisted — see care logs'). Submit to relevant borough CHC team within 6 months of refusal.
How does the 'primary health need' test apply in affluent areas like Richmond?
**Primary health need is NOT determined by family wealth.** The test asks: **Is the main reason the person needs care due to health factors?** A person with advanced dementia + Parkinson's requiring 24/7 skilled care has a primary health need **regardless of whether the family is wealthy enough to pay privately**. However, affluent areas may see assessors assume 'family will supplement,' so you must **explicitly argue:** 'This person requires skilled nursing assessment and intervention for complex health needs. Family financial capacity is irrelevant to NHS funding obligation.' Reference the 4 characteristics (nature, intensity, complexity, unpredictability) of health needs themselves.
Kingston and Richmond have very high dementia prevalence. Does this help or hinder CHC approval?
High dementia prevalence doesn't automatically guarantee approval — each case depends on the 4 key characteristics (nature, intensity, complexity, unpredictability) and whether health needs are primary. However, assessors in Kingston/Richmond typically have significant dementia expertise, so sophisticated evaluation is more likely. Request a dementia-specialist assessor. The risk is that affluence bias ('family can afford private care') undermines otherwise strong health need cases — counter this proactively in writing.