Reviews, Changes in Need, and How to Prepare after you’ve been approved for NHS Continuing Healthcare
Have you been approved for NHS Continuing Healthcare (CHC) funding? Are you wondering what happens next? Many people are not aware that NHS CHC is not guaranteed for life. In this article, we cover what steps need to be taken after NHS CHC has been granted. We’ll walk you through what to expect after CHC approval, how reviews work, what triggers reassessment, and how to prepare so your loved one’s care remains uninterrupted.
Being approved for NHS Continuing Healthcare funding can be life-changing for individuals with complex health needs. It ensures that the NHS covers the full cost of care, whether at home or in a care facility.
But what happens after the funding is approved? Many families are left in the dark about the next steps, especially when it comes to reviews, changes in condition, and the risk of funding withdrawal.
What Is NHS Continuing Healthcare?
NHS Continuing Healthcare is a package of care arranged and funded solely by the NHS for individuals with a primary health need. It’s not means-tested, and it covers care costs in full, including accommodation if the person lives in a care home.
Once approved, the Integrated Care Board (ICB) takes responsibility for managing and funding the care package.
What Happens Immediately After You've Been Approved for NHS Continuing Healthcare?
After CHC funding is granted, the following steps should take place.
Written confirmation: You should receive a formal letter confirming the decision, along with a copy of the Decision Support Tool (DST) used during assessment.
Care planning: A care plan should be developed in collaboration with the individual, their family, and healthcare professionals. If the care arrangements in place are already suitable, then they will continue unchanged and the ICB should fund the cost.
Provider arrangements: The NHS will coordinate with care providers to ensure the agreed services are delivered.
Top-up fees: Unlike local authority care, CHC does should not allow families to pay top-ups for preferred services, though concerningly we are seeing increasing examples of this taking place.
CHC Reviews - What to Expect
CHC funding is not guaranteed for life, and the NHS is required to review the care package within 3 months of the initial decision. The primary purpose of ongoing reviews should be whether the care arrangements remain appropriate, rather than to re-assess eligibility. Where there is reason to suggest that the individual no longer meets the criteria, such as because of a material change or improvement, the ICB may reconsider whether the individual still meets the criteria for CHC. The review process includes a reassessment of health needs using the DST. It also requires input from a multidisciplinary team (MDT) and a consultation with the individual and/or their representative.
Important: The review should not have the primary focus reassessing eligibility. If at the review a material change of needs is identified, then the ICB may arrange a reassessment, and this may result in funding withdrawal if the NHS determines that the primary health need no longer exists.
Changes in Need and Risk of Funding Withdrawal
CHC funding is based on the principle of a “primary health need.” If the individual’s condition improves or stabilises, the NHS may decide that they no longer meet the criteria.
Common triggers for reassessment include:
- Recovery after hospital discharge
- Reduced interventions or skill in meeting needs
- Changes in medication or treatment plans
- Changes in care domain levels on the DST
If funding is withdrawn, the individual may be referred to social services for means-tested support. This can result in significant financial implications for families.
How to Prepare for CHC Reviews
Being proactive is key to maintaining CHC funding. Here are practical steps to help you prepare:
1. Keep Detailed Records
Maintain a daily log of care needs, incidents, and changes in condition. Include:
- Medication changes
- Hospital admissions
- Falls or injuries
- Behavioural changes
- Specialist interventions
This documentation can be invaluable during reviews and appeals.
2. Attend Review Meetings
Ensure that you or a legal representative attends all review meetings. Challenge any inaccuracies in the DST or care documentation. Ask for copies of all review materials.
3. Understand the Criteria
Familiarise yourself with the four key indicators used in CHC assessments:
Nature: The type and complexity of needs
Intensity: The quantity and severity of needs
Complexity: How needs interact and require skilled management
Unpredictability: How needs fluctuate and require rapid response
Understanding these can help you frame your case effectively.
4. Seek Legal Advice Early
If you suspect that funding may be withdrawn, consult a legal expert in NHS CHC. They can help you prepare for reviews, challenge decisions, and navigate the appeals process.
5. Know Your Appeal Rights
If CHC funding is removed, you have the right to appeal. This usually involves:
Local resolution: Challenge the decision with the ICB
Independent Review Panel (IRP): Escalate to NHS England if local resolution fails
CHC Support in Leeds and Yorkshire
Our law firm offers specialist support for NHS Continuing Healthcare reviews and appeals. We understand the local ICB procedures and can advocate effectively on your behalf.
Whether you’re preparing for a review or facing funding withdrawal, our team is here to help you protect your loved one’s care.
Contact a member of the CHC team today. Call 0113 320 5000 or email jub@winstonsolicitors.co.uk.
Quick Answers to Common Questions
Q: How often is CHC funding reviewed?
A: Within 3 months of approval and at least annually thereafter.
Q: Can CHC funding be withdrawn?
A: Yes, if the NHS determines that the individual no longer has a primary health need.
Q: What can I do to prepare for a CHC review?
A: Keep detailed records, attend meetings, understand the criteria, and seek legal advice.
Q: Is there an appeal process if funding is removed?
A: Yes. You can appeal locally and then escalate to NHS England.
