NHS Continuing Healthcare Funding & Refunds of Care Fees

What is NHS Continuing Healthcare?

People whose social care is primarily related to a disease, illness, injury or disability can apply for free care funded by the NHS. It is not means-tested, unlike local authority-funded care, and it must be sufficient to cover all your needs. Like all NHS care, it is free at the point of use.

Many people don’t know about NHS CHC funding - often they aren’t informed by their medical professionals that it exists. When they do find out about it, they are sometimes told that there is no point in applying because they "won't qualify". But this is not necessarily the case.

To qualify for NHS CHC you must pass the “primary health need” test – it sounds simple but it is anything but. Having a primary health need does not depend on a particular diagnosis or health condition but on the severity of your physical, cognitive and psychological needs and their effects on your daily living.  

What can go wrong?

Integrated Care Boards (the local NHS organisations that commission local health services), must assess you for NHS CHC if it seems you may need it. A full assessment involves a multidisciplinary team (MDT) of health and social care professionals who should gather evidence of your care needs in various different "domains" and assess their intensity, complexity and unpredictability. They should then make a recommendation to the ICB about your eligibility within 28 days.

ICBs must have regard to national guidelines when assessing eligibility for NHS CHC. But in many cases, they fail to follow these fully – often the impact of care needs are not accurately assessed, evidence is disregarded and families’ views on the level of care ignored.

In addition, NHS CHC is often withdrawn even when there has been no change in needs, leaving vulnerable people's care packages at risk.

Why do so many families need expert help?

There is an appeals system to challenge decisions on NHS CHC, but it can be complex to navigate, meaning families need expert help to ensure the right outcome.

This is where Just Caring Legal can help. As a niche business specialising in NHS CHC for over a decade, we deal with these cases day after day, year after year. We will provide an honest, detailed assessment of your case and provide as much support in fighting your case with the ICB as you need, holding your hand every step of the way.

Our specialist solicitor Rosalind Hughes will use her extensive knowledge of the NHS CHC system and her litigation expertise to draft and submit the in-depth medico-legal arguments required to unlock the many thousands of pounds of NHS Continuing Healthcare funding that these families are entitled to. The refunds she has secured for clients have regularly run into six figures.