The 7 mistakes families make at CHC assessments — and how to avoid every one.

Why are 80% of CHC applications rejected?

NHS Continuing Healthcare (CHC)is fully-funded NHS care for people with a “primary health need.” If your loved one qualifies, all their care costs — including residential care home fees — are paid by the NHS. It's not means-tested. For many families, the annual value is £50,000+.

The problem? The assessment process is complex, poorly explained to families, and — critics argue — designed to minimise the number of people who qualify. Integrated Care Boards (ICBs) face enormous budget pressure, and CHC is one of their biggest cost lines.

The result is that most rejections aren't because the person doesn't have significant health needs. They're because the family didn't know the rules, didn't prepare properly, or accepted a flawed decision without challenge. Every mistake below is preventable.

Most families only discover NHS Continuing Healthcare exists after they've already been paying care home fees for months — sometimes years. The hospital may have mentioned a “financial assessment” and a care home list, but nobody mentioned that the NHS might pay for everything.

This isn't an accident. Hospitals and social workers are not required to proactively tell you about CHC. The NHS National Framework says screening “should” happen, but there's no enforcement mechanism. Many discharge teams are under pressure to move patients out quickly, and a CHC screening adds time and complexity.

The CHC Checklist is the initial screening tool — a relatively quick assessment across 11 care domains. If two or more domains are scored as “A” (highest level), or five or more as “B” or above, the Checklist is positive and triggers a full DST assessment.

When the result is negative, many families accept it and move on. But the Checklist is frequently completed incorrectly. Common problems include: completing it without family input, scoring based on hospital observations (where needs are managed by ward staff) rather than needs at home, and under-scoring cognition and behaviour for people with dementia.

The Decision Support Tool (DST) meeting is the most important stage of the CHC process. A multidisciplinary team (MDT) assesses your loved one across all 12 care domains and determines whether they have a “primary health need.” The decision made here determines whether the NHS pays for care or your family does.

Families who arrive unprepared are at a serious disadvantage. The MDT panel may only have hospital or care home records — which often understate the true level of need because professional care staff manage problems before they escalate. Without your evidence of what actually happens day-to-day, the panel has an incomplete picture.

This is the single most common — and most frustrating — reason CHC is refused. The ICB argues that because your loved one's needs are being “well-managed” by their current care package, they don't demonstrate a primary health need. In other words: the care is working, so they don't need it.

This argument is legally flawed. The landmark Coughlan case (1999) established that needs must be assessed as they are — not as they appear when managed by a care package. The 2022 National Framework reinforces this at paragraphs 162–163: “The decision-making rationale should not marginalise a need just because it is successfully managed: well-managed needs are still needs.”

If CHC is refused after the DST meeting, you have the right to request a local review from your ICB. This is your first opportunity to challenge the decision with additional evidence. Many families don't know this right exists, or they miss the window because they're exhausted and overwhelmed.

The NHS Framework doesn't set a strict deadline, but most ICBs expect a request within 6 months. After that, they may refuse to consider it. If the local review upholds the refusal, you can escalate to an Independent Review Panel (IRP) through NHS England — but this is a longer process and the sooner you start, the better.

If your loved one should have been screened for CHC at the time of discharge but wasn't — or if they were screened but the process was flawed — you may be entitled to a retrospective assessment. If the review finds they should have been eligible, the NHS must refund the care fees your family paid during that period.

Many families assume it's too late, or that retrospective claims are too difficult. In reality, you can request a retrospective review at any time. Under the Limitation Act 1980, claims can cover up to 6 years of wrongly-paid care fees. For families who've been paying £800–£1,200 per week, this can mean refunds of tens of thousands of pounds.

The CHC process is complex by design. ICBs have teams of trained assessors, panel members, and administrators who handle these cases daily. Families going through it for the first time are at a significant disadvantage — especially when they're simultaneously dealing with the emotional and practical demands of a loved one's declining health.

You don't have to do this alone. At minimum, take someone with you to every meeting and keep detailed notes. Better still, consider working with a specialist CHC advocate who understands the framework, knows the common arguments ICBs use to refuse funding, and can help you build a strong evidence pack.

What to do next

If you're navigating the CHC process — or suspect your family has been paying for care the NHS should cover — here are three practical next steps:

Frequently asked questions about CHC applications

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