CHC Funding Guide
The NHS should have funded her care.
Here's how to claim it back.
If your loved one was paying care home fees during a period when they may have qualified for NHS Continuing Healthcare, you can ask the NHS to review that decision — even years later. This is called a retrospective review, and it is a legal right under the NHS National Framework.
Jump to the calculator → to see what could be at stake, or read on to understand your rights first.
What the law says about retrospective reviews
The NHS National Framework for Continuing Healthcare and NHS-funded Nursing Care (2022) sets out the rules for retrospective reviews. Key points:
Families can request a review going back up to 6 years
There is no obligation on the NHS to review periods beyond 6 years, but there is no bar on requesting one. The ICB must consider any request and respond in writing.
A review can apply even if no assessment was ever carried out
This is the most common situation. A person was discharged from hospital directly to a care home with no CHC Checklist completed. That failure to assess may itself be grounds for a retrospective review.
The ICB must assess whether a primary health need existed at the time
The ICB will look at clinical records from the period in question — GP notes, hospital discharge letters, care home records — to determine whether the person's needs at the time met the CHC threshold.
If the review finds CHC should have been funded, the ICB must repay the fees
Repayment covers the period for which CHC should have been funded, less any contributions that would have been applicable. The ICB cannot simply offer a goodwill payment — they must follow the Framework.
How to request a retrospective review: step by step
Write to your Integrated Care Board (ICB)
Your request must be in writing. Address it to the CHC team at the ICB responsible for the area where your loved one received care. Include: the person's name, NHS number (if known), the period you believe should be reviewed, and a brief statement of why you believe CHC may have applied.
Gather the clinical evidence
The ICB will need to see clinical records from the relevant period. You are entitled to request these under the UK GDPR (as next of kin or with consent, or as the estate representative). GP records, hospital discharge letters, and care home care plans are the most important.
The ICB carries out a retrospective assessment
The ICB will review the records and assess whether the person's needs at the time met the CHC threshold — i.e., whether they had a 'primary health need'. This assessment uses the same Decision Support Tool (DST) domains as a current assessment.
What is the DST? →If they refuse to review, or the review goes against you
If the ICB refuses to carry out a review, or carries one out and decides CHC would not have applied, you can escalate to the Independent Review Panel (IRP) — the same body that hears current CHC appeals. The IRP can direct the ICB to carry out a review.
How the IRP works →What could be at stake?
Use the calculator below to get an illustrative sense of the figures involved. This is not a formal assessment — it is a tool to help you understand the scale of what a successful review might mean.
Estimate what could be at stake
Enter the date care began and the weekly fee to see an illustrative figure.
Common questions
How far back can a CHC retrospective claim go?
The NHS National Framework (2022) allows retrospective reviews to cover periods going back up to 6 years from the date of the request, subject to the availability of clinical records.
Who can request a retrospective CHC review?
The individual, their family, a legal representative, or their estate (if the person has died) can request a retrospective review. The request is made in writing to the relevant Integrated Care Board (ICB).
What is the ICB legally required to do when asked for a retrospective review?
The ICB must consider the request and carry out a retrospective assessment if there is evidence that the individual may have had a primary health need during the period in question. They must respond in writing.
Is a retrospective CHC claim the same as an appeal?
No. An appeal (via the Independent Review Panel) challenges a recent CHC decision. A retrospective review applies to past periods where no proper assessment was carried out — for example, if a person was placed in a care home without a CHC Checklist being completed.
Take the next step
Ready to build your evidence pack?
Our Case Strength Report uses AI plus expert review to identify the strongest grounds in each DST domain — including whether a retrospective review is likely to succeed.