NHS Continuing Healthcare (CHC) fully funds care for people with a primary health need — but a large share of applications are refused at the first checklist or full assessment stage. A refusal is a starting point for challenge, not a final answer.
Understand why it was refused first
Ask for the full decision-support tool documentation used in the assessment, not just the outcome letter. This shows how each care domain (behaviour, cognition, mobility, nutrition, and others) was scored, and refusals often turn on one or two domains being marked lower than the family believes is accurate based on day-to-day reality.
The local resolution stage
The first step of a challenge is usually a local resolution meeting with the Integrated Care Board (ICB) responsible for the assessment. Bring specific, dated evidence — care notes, GP letters, incident records — that supports a higher score on the domains in dispute. General statements ("she needs a lot of help") carry less weight than documented specifics.
Independent Review Panel
If local resolution does not change the outcome, you can request an Independent Review Panel, run by NHS England rather than the local ICB — a genuinely independent second look. This has to be requested within a set time limit after the local resolution decision, so do not let the deadline lapse while gathering evidence.
Retrospective claims
If a relative was self-funding care that, in hindsight, should have been NHS-funded, you can request a retrospective review and potential reimbursement — this is a real, if lengthy, route worth pursuing if the clinical picture at the time supports it.
Getting help with the process
Age UK, and some specialist CHC advocacy services, can help build the case file and represent the family at panel stage. This is a genuinely technical process — a well-prepared submission materially changes the odds.
How to use this guide in practice
Don’t read this as general information — use it as a worksheet. Write down the details of the person who needs care, the current limits of the situation at home, the monthly budget, the documents you already have, whether a local-authority financial assessment may apply, and who you’ve already spoken with. Then turn every unclear point into a specific question. A family that arrives with a clear picture usually gets more useful answers than one calling under stress with scattered information.
Keep one simple rule: anything about admission, cost, funding, timelines and whether a care home fits must be confirmed directly with the care home or the competent authority serving your area. This guide prepares the search — it does not replace official decisions.
Want a clear shortlist before you start calling?
If you don’t know which care homes to contact first, Curalune Care Help can prepare an ordered shortlist of 3–5 suitable options — with CQC ratings, contacts, useful links and a ready-to-send inquiry.
The service helps you organise the search.£69, one-off. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. It does not replace the care home’s own assessment and does not guarantee admission, price or bed availability.
Important limit
Curalune offers practical help with the search and orientation. Admission, pricing, bed availability and the final assessment always rest with the care homes and the competent authorities (the local authority, the NHS, the Care Quality Commission).
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