How a Retrospective CHC Review Could Secure the Care Funding Your Loved-One Deserves

What is CHC — and Why It Matters

When someone has long-term, complex health needs, the NHS may provide fully funded care under NHS Continuing Healthcare (CHC). That means the NHS pays for both health and personal care, which can include community nursing, specialist therapy, care home fees, or care at home.

Importantly, eligibility for CHC isn't based on a specific diagnosis, but on whether a person has a “primary health need”, this is determined by looking at the nature, intensity, complexity, and unpredictability of their care needs (This will be discussed in more detail later).

What Is a Retrospective CHC Review?

Sometimes, individuals or families retrospectively realise that care they paid for privately might actually have qualified for CHC funding. This could happen due to mis-assessment, lack of awareness, or changes in health status. A retrospective review (sometimes called a Periods of Unassessed Care, or “PUPoC” review) enables past care periods up to 12 months to be assessed for CHC eligibility.

If the review finds that during that past period, the person had a primary health need, then the NHS may repay some or all of the previously incurred care costs.

Why Many People Miss Out , And What You Can Do

Because eligibility depends on a full assessment by a multidisciplinary team (MDT), many people never get the right paperwork or are incorrectly told they don’t qualify.

Even after eligibility has been awarded, care plans should be reviewed, normally within three months of the decision and at least annually to make sure needs are still being met.

What this means for carers or family members:

• Keep thorough records (GP notes, MAR charts, care home records, hospital admissions, incidents, photographs, etc.).

• If care needs were significant in the past and funding was self-funded, consider requesting a retrospective review.

• If you disagree with a decision, know that appeals (or further review) may be possible.

How I Can Help

Having completed many years working as part of a quality team specialising in Continuing Healthcare and ensuring due process is followed, I’m very familiar with the documentation, evidence standards, and often-missed nuances.

If you are a carer or family member exploring CHC, I can help you:

• Understand the 12 domains used in the official Decision Support Tool (DST).

• Make a compelling chronology of care: frequency of nursing input, hospital admissions, deterioration in cognition or mobility, episodes of acute illness, medication needs, and more.

• Ensure care home, GP, nursing, hospital and therapy records are gathered and organised effectively.

• Draft appeals or supplementary submissions if clinical or procedural errors occurred.

Why This Matters

CHC is not just a “benefit” for many, it is the only realistic way to guarantee quality and continuity of care without being financially ruined. Many families simply don’t know retrospective claims are possible.

By spreading knowledge about retrospective CHC reviews and helping people understand the eligibility criteria and the importance of evidence, we can empower carers and families to challenge past decisions