When NHS Continuing Healthcare is Refused - Why Families Need a Fairer, More Transparent System
When NHS Continuing Healthcare is Refused
Winston Solicitors’ NHS Continuing Healthcare expert, James Urquhart-Burton, has featured in a Yorkshire Post report examining concerns around when NHS Continuing Healthcare is refused or withdrawn, including the financial and emotional impact on families.
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For families caring for someone with complex and serious health needs, NHS Continuing Healthcare can make a life-changing difference.
CHC is NHS-funded care for adults whose needs are primarily health-related. Where someone is found eligible, the NHS funds their assessed health and social care needs. Where they are not eligible, families may instead face substantial care costs through the means-tested social care system.
That makes CHC eligibility one of the most consequential decisions facing families dealing with long-term care.
Concerns About Consistency in NHS Continuing Healthcare
The Yorkshire Post article highlights concerns about falling CHC eligibility rates, regional variation and the complexity of the assessment process.
Figures reported in the article show that the number of people eligible for standard CHC has fallen significantly as a proportion of those assessed. In October to December 2024, 18.6% of people assessed were found eligible, compared with 31.2% in April to June 2017. The number of people deemed eligible also varied considerably between Integrated Care Boards (ICBs).
James has specialised in Continuing Healthcare claims for 15 years and told the Yorkshire Post that he regularly sees families appealing decisions of ineligibility or seeking retrospective funding after a loved one has died. He said concerns often arise about whether the National Framework has been correctly applied, or whether an assessment should have taken place in the first place.
In his experience, there can also be differences in how the eligibility criteria are applied by assessors across England.
The National Framework requires assessors to consider the nature, intensity, complexity and unpredictability of a person's needs. James explained that the element of professional judgement involved can create scope for variation, while also highlighting concerns about whether multidisciplinary recommendations are always reflected in the final decision.
The Human Cost of CHC Decisions
Behind the statistics are families facing extremely difficult circumstances. The Yorkshire Post spoke to families who described selling their homes and using significant amounts of their savings to pay for care, only later discovering that NHS Continuing Healthcare might have been available.
One family featured in the article said their mother entered a care home during the Covid-19 pandemic and that nobody involved in her care discussed the possibility of NHS funding. They later obtained legal advice from James, which resulted in the NHS accepting that she should have received CHC funding for the final year of her life. The family is now pursuing an appeal concerning earlier periods.
Another family described spending hundreds of thousands of pounds on care after they say their mother did not receive the full CHC assessment that her initial Checklist indicated she should have progressed to.
These experiences demonstrate why awareness of CHC is so important. Families should not assume that having savings or owning a property means their loved one cannot receive NHS Continuing Healthcare.
What Does the Government Say?
The Government has acknowledged the importance of CHC and the need for a clear and transparent assessment process.
In response to concerns raised in Parliament, the Minister for Care, Stephen Kinnock, said that CHC provides critical support to people with some of the highest needs and that the Government wants the assessment process to be as smooth, clear and transparent as possible. He also pointed to the existing dispute resolution process, which includes local review, an NHS England Independent Review Panel and, ultimately, the Parliamentary and Health Service Ombudsman.
There is clearly an ongoing conversation about how the system can work more consistently and effectively.
For families, however, the important point is that if a loved one has complex healthcare needs, it is worth understanding whether they should be assessed for CHC, whether an existing decision can be challenged, or whether there may be a basis for a retrospective claim.
The full Yorkshire Post article explores these issues in greater detail, including the experiences of families affected by CHC decisions and James' concerns about the way the system operates.
Or head over to The Yorkshire Post
