An NHS Continuing Healthcare award is normally followed by a review of the care package within three months, then further reviews as required and at least annually. The review should begin with whether the care plan and arrangements still meet the person’s needs. It is not automatically a fresh eligibility assessment. If needs have changed enough to affect eligibility, the integrated care board may arrange a full reassessment using the proper process. Families should prepare evidence of current needs and delivery problems without treating every review as a battle to preserve the old package unchanged.
Ask which process the ICB is starting
Request the invitation, purpose, participants and papers in writing. Is this a routine package review, an urgent review after a change, or a full reassessment of NHS CHC eligibility? Those processes overlap but are not interchangeable. A routine review can adjust how assessed needs are met. A potential eligibility change should trigger the full reassessment safeguards, not a brief meeting followed by an unexplained funding decision.
For the underlying eligibility pathway, use this guide to applying for NHS Continuing Healthcare. At review, the question is not whether a diagnosis still exists. The record should show the nature, intensity, complexity and unpredictability of current needs and whether the commissioned package manages them.
Build a needs-and-delivery evidence pack
Obtain the latest decision support tool, eligibility rationale, care plan, provider plan, medication records, incident reports, clinical reviews and recent assessments. Create a short chronology covering changes since the award: falls, infections, seizures, distress, skin breakdown, swallowing problems, night interventions, hospital attendance, staffing changes and equipment needs. Include stable periods as well as crises.
Distinguish need from successful management. A person may appear stable because trained staff, supervision, equipment and rapid interventions are working. Record what staff actually do, how often, what skill is required and what could happen without it. Avoid inflating frequency or severity; inconsistencies weaken a review. Ask the resident how they want to participate and identify an authorised representative or advocate where needed.
Use the previous decision support tool as a reference, not a ceiling. Add a one-page change map for every care domain: unchanged, increased, reduced or newly uncertain. Beside each entry, name the evidence and date. That format helps reviewers see genuine evolution while preserving the interaction between needs, such as cognition affecting medication safety or mobility affecting skin integrity.
Test whether the current package is being delivered
A review should consider whether arrangements remain appropriate, not simply whether the person remains eligible. Compare funded hours, nursing input, therapies, equipment, continence support, behaviour planning and transport with actual delivery. Record missed visits, agency gaps, unsuitable equipment or repeated reliance on unpaid family help. A nominally adequate plan can still fail operationally.
Ask the care home and ICB to identify each action, owner and completion date. If the provider says it needs a higher rate or different staffing, request the care rationale separately from commercial negotiation. The resident should not be left between organisations while they debate responsibility. Genuine optional extras are a different issue from services required to meet assessed CHC needs.
Recognise when a full reassessment is proposed
If reviewers believe the person’s needs may have changed enough to affect eligibility, ask for the written reasons and the full reassessment timetable. The multidisciplinary process should examine the complete pattern of need, not one improved domain or a lower incident count in isolation. Obtain the new assessment and decision rationale, check factual accuracy and submit corrections with supporting evidence.
A recommendation to reduce or end eligibility should not be implemented as though the routine review itself settled the question. Neither the NHS nor the council should withdraw from an existing care or funding arrangement without a joint reassessment of needs, consultation with the person, and alternative funding or services being put into effect.
Challenge the decision through the correct route
If the dispute is about unmet actions or poor delivery, use the ICB and provider complaint routes and request urgent risk management. If it concerns the eligibility decision, request the review or appeal information and meet the stated deadline. This step-by-step NHS CHC appeal guide explains how to organise grounds and records.
State precisely what is disputed: factual errors, missing evidence, domain descriptions, the primary-health-need analysis, consultation, or the absence of a safe replacement package. Keep the resident’s care needs central. A large bundle without a chronology is less useful than targeted evidence connected to the decision.
Leave the meeting with a written transition plan
Before the meeting ends, summarise what remains unchanged, what will change, who approves it, and when. Ask for the minutes, updated care plan, funding letter and named contact. If a provider change or move is proposed, confirm assessment, records transfer, equipment, medicines, staffing and contingency arrangements before any end date.
The UK care-home directory and planning hub can help identify alternatives if a move becomes necessary. It does not establish CHC eligibility or reserve a place. The ICB must confirm funding and commissioning, and each home must confirm current availability and whether it can safely meet the assessed needs.
Can an ICB stop CHC at a routine review?
A routine package review is not itself a substitute for a full eligibility reassessment. If needs may have changed enough to affect eligibility, the ICB should use the proper reassessment and decision process. Existing NHS and council arrangements should not simply disappear before needs are jointly reconsidered, the person is consulted and alternative funding or services are ready.
What if the resident looks more stable now?
Stability may reflect effective care rather than reduced need. Show the interventions, supervision, skill and contingency planning that maintain it. Reviewers can consider genuine changes, including improvement, but should not ignore well-managed needs. Use accurate records across ordinary and difficult days, and explain what would happen if an intervention were withdrawn rather than relying on diagnosis alone.
Who makes the final review and placement decisions?
The responsible ICB reviews the commissioned package and makes any NHS CHC eligibility decision through the required process; the council decides any social-care funding that may replace or complement it; clinicians assess health needs; and the care home decides whether it has a suitable place and can deliver the plan. A scheduled review guarantees neither continued funding nor a move. No arrangement should change until the responsible authorities confirm a safe, funded alternative.
