Why ICBs Are Refusing CHC Assessments
For families caring for a loved one with long-term or complex health needs, the NHS Continuing Healthcare (CHC) system can feel confusing at the best of times. But in recent months, a troubling trend has emerged across England: some Integrated Care Boards (ICBs) are refusing to assess people for CHC eligibility at all.
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This refusal to assess prevents families from accessing the support they may be entitled to and can leave them paying significant care costs unnecessarily. Here we explore what is happening, why it matters, and what you can do if your local ICB declines to assess your loved one’s eligibility for NHS Continuing Healthcare funding.
What’s Happening and Why It Matters
The usual process for NHS Continuing Healthcare involves an initial Checklist assessment. This is followed by a full assessment using the NHS Decision Support Tool (DST), if the checklist indicates potential eligibility. However, some ICBs are bypassing or delaying this process altogether, often telling families that a full assessment is unnecessary or that the person’s needs are “social” rather than “health-based.”
This is deeply concerning because a refusal to assess is not the same as being found ineligible. When an ICB fails to carry out an assessment, it denies the individual the right to have their needs properly considered and removes the opportunity to challenge a decision through the appeal process. Families are effectively locked out before the process has even begun.
Research from the Nuffield Trust and reports from Community Care suggest this problem is growing, with regional inconsistencies in how ICBs interpret the CHC framework. In some areas, eligibility rates are significantly lower, and delays are common.
Why Are ICBs Refusing to Assess?
There is no single reason, but financial and systemic pressures appear to be driving this behaviour. Many ICBs are under intense pressure to control budgets. There is evidence that some are using CHC assessments as a financial management tool. By refusing or delaying assessments, they can reduce the number of people formally found eligible for funding.
Inconsistent application of national CHC guidance also plays a role. The CHC Framework is meant to provide a standardised approach. But, in practice, each ICB has some discretion over how it applies the criteria. This has created what has been described as a “postcode lottery” in care funding. In some regions, people with identical care needs receive full funding. In others, they are denied even the opportunity for an assessment.
Staffing shortages and lack of specialist assessors have also contributed to the problem. Many ICBs are struggling to complete assessments promptly, leading to indefinite delays. In addition, families are often not kept informed or are given vague explanations for inaction, leaving them unsure of how to proceed.
How This Affects Families
When an ICB refuses to assess someone for NHS Continuing Healthcare, the consequences can be serious. Without a CHC assessment, the person may be placed in means-tested social care instead of receiving fully funded NHS care. This means that families could be required to sell assets or use savings to pay for care that the NHS might have been responsible for. Importantly, it may also have the effect of shifting responsibility to fund care to equally cash-strapped local authority social care departments.
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The emotional toll is just as significant. Families caring for vulnerable relatives often describe feeling powerless and frustrated, especially when their loved one’s needs are clearly medical. The lack of transparency can lead to confusion and mistrust in a system that is meant to protect people with the greatest needs.
Red Flags to Watch For
There are several signs that an ICB might be avoiding its responsibilities. If you are told that your relative “does not need an assessment,” or that their needs are “social rather than health-based” without a written explanation, this may be a cause for concern. Similarly, if the ICB agrees to carry out a Checklist but fails to follow up with a full assessment, or if the process drags on for months without updates, it’s time to seek advice.
A refusal to provide written reasons for declining an assessment is another red flag. Every decision should be recorded, and families have the right to request copies of all documentation used to make it. Where assessments are delayed far beyond the 28-day guideline, the ICB should provide a clear explanation and expected timescale for completion.
How Winston Solicitors Can Help
Our specialist NHS Continuing Healthcare solicitors help families challenge unfair or unlawful refusals to assess. We understand how frustrating it can be to navigate this process while managing a loved one’s care. We’re here to take the pressure off your shoulders.
We can review whether your local ICB has acted correctly, advise you on your legal rights, and formally request that an assessment be carried out. If the ICB continues to delay or refuse, we can escalate your case through the NHS complaints process or, discuss the possibility of taking legal action.
Our team can also help you gather the medical and care evidence needed to support your case. By presenting your loved one’s needs clearly and in line with the CHC eligibility criteria, we strengthen your chances of securing the full assessment. This ultimately is more likely to lead to the funding they deserve than going it alone.
What to Do Next
If your ICB has refused or failed to assess your loved one for NHS Continuing Healthcare funding, don’t give up. Begin by asking the ICB for a written explanation of its decision, including who made it and under what guidance. Gather care records, GP notes, and daily care logs that illustrate the complexity and unpredictability of your relative’s condition.
It’s also important to act promptly. Delays can make it harder to gather evidence and may reduce the chances of success. A specialist CHC solicitor can help you request the assessment formally, ensure procedures are followed correctly, and challenge any inappropriate refusals or delays.
Don’t Be Disheartened that ICBs are Refusing CHC Assessments
The growing trend of ICBs refusing to assess CHC eligibility is leaving vulnerable people without the support they are entitled to. Families should not accept an informal “no” without a proper assessment or written decision. If this happens to you, seek legal advice as soon as possible. ICBs must continue to be held accountable, even in times of financial hardship.
Our CHC solicitors are committed to ensuring fairness and accountability within the CHC system. Our experienced team can help you challenge assessment refusals, appeal unfair outcomes, and secure the funding your loved one deserves.
Call Winston Solicitors on 0113 320 5000 or email jub@winstonsolicitors.co.uk to speak to a CHC expert today.
