NHS Continuing Healthcare: How to appeal a decision

Paying for a care home in the UK can be very expensive. NHS Continuing Healthcare (CHC) which covers the full cost of your health and social care can make a huge difference.

It’s estimated 77% of adults over 45 are not aware of NHS Continuing Healthcare. For those who do know about it, only around 33% of applications are accepted.

It’s no clear whether this is down to a lack of understanding amongst healthcare professionals or the complex application form. Nevertheless, it means many people are missing out on the support they are entitled to. 

In most cases, funding runs completely smoothly and those eligible will receive the support they are entitled to. However, in some cases people are missing out on financial support. This is due to mistakes that are out of their control. Or they are simply not aware of the help available. 

What is NHS Continuing Healthcare?

NHS Continuing Healthcare (CHC) is a care package. It’s available to people in England, Wales and Northern Ireland with primary health needs.

It is not means tested. So it doesn’t matter what amount of money, savings or capital you have. If you are eligible, the NHS will cover the full cost of your health and social care.

NHS CHC can be used to fund care in a whole host of settings. This includes your own home and in residential or nursing care.

Who is eligible for NHS Continuing Healthcare?

If you have a ‘primary health need’, you’ll be entitled to funding through CHC.

A primary health need is not defined by the condition itself, but rather how it impacts on your life. To be eligible, your health needs must be ongoing and impact your day-to-day life. 

Does NHS Continuing Healthcare cover dementia?

It’s not possible to give a definitive answer as to whether dementia will qualify a person for the funding. This is because the decision to award CHC isn’t based on a specific condition.

The decision will be based on how dementia affects the type and level of care a person needs.

The most important thing is to make sure you, or a loved one, have received a formal diagnosis of dementia.

A diagnosis will make sure that the impact dementia has on your health care needs is properly acknowledged. This can improve the likelihood of your being awarded CHC. 

Why are people missing out on NHS Continuing Healthcare?

Many people have been awarded CHC without a problem. However, there have recently been a worrying amount of reports of people, particularly those living in care homes, being incorrectly assessed by the NHS. This has meant they have missed out on the funding they are entitled to.

As a result, families are unnecessarily paying out for care home fees despite being eligible for 100% funding. At a time when most households are facing financial pressures, this has undoubtedly led to a huge amount of stress and hardship which could have been avoided.

There are a number of reasons this could be the case. This includes the rigorous application process and the complex NHS Continuing Healthcare assessment.

Lisa Morgan, partner and head of the nursing care recovery fee team at Hugh James, says:

“Despite the critical role of NHS Continuing Healthcare (CHC) in supporting individuals with significant ongoing health needs, recent data reveals concerning trends. Recent data by NHS England has shown a significant drop in the number of people eligible for CHC. Between March 2015 and 2025, the number of individuals deemed eligible for CHC funding declined by 18%, from 62,939 to 51,582. This decrease raises questions about the accessibility and consistency of CHC assessments across different regions.

“In addition, there has been a significant drop in the number of people being assessed for NHS Continuing Healthcare. Between 2023 and early 2025, the number of new assessments fell by nearly 15%. While the number of people over 65 in care homes has risen.”

Lisa Morgan has called for greater transparency and consistency in how local health bodies identify and assess those who may qualify.

“In addition, NHS England’s own figures indicate regional disparities in acceptance rates. This sometimes varies by over 20% depending on location. This ‘postcode lottery’ effect continues to be one of the most troubling aspects of the CHC system. As it often leaves families at the mercy of inconsistent interpretations of eligibility criteria.

“The CHC application process needs to be simplified and there needs to be investment in better training for assessors. The current Decision Support Tool (DST) used to evaluate applications has been described as overly technical and subjective. As it often relies on vague criteria that can be interpreted differently across regions. With an ageing population and rising care costs, it is more critical than ever that people understand their rights and the funding options available to them. Without this, families risk not only emotional strain but unnecessary financial hardship as well.”

‘Process can be lengthy and complicated’

Stephen Lowe, group communications director at Just Group, a retirement specialist, says:

“Continuing Healthcare was introduced to provide financial support for people suffering from ongoing significant physical and/or mental health needs. However, the system has been dogged by a low level of understanding among patients and health professionals, a complicated application and assessment process, and a postcode lottery on implementing the framework. 

“It is little wonder that the package has remained the NHS’ best kept secret despite the enormous potential value of a successful application.”

If you have not yet applied for CHC and think you could be eligible, Mr Lowe offers the following advice:

“Continuing Healthcare provides an important and highly valuable safety net for people. Given the significant sums of money at stake it’s certainly worth applying for, but the process can be lengthy and complicated. 

“People applying will often find themselves navigating a labyrinthine system when they’re already emotionally stretched, so it’s worth consulting a professional care adviser who understands the system and can help fight your corner.”

How to appeal NHS Continuing Healthcare assessment

If you think you, or a loved one, are eligible for NHS Continuing Healthcare and have had an application rejected or have not received funding, it is possible to claim back your entitlement retrospectively. 

If you have had an application rejected and disagree with the outcome, the first step should be to appeal the process. You can do this by speaking to the NHS Continuing Healthcare team, whose contact details you should have been provided during your application or assessment. 

To be successful, you will need to prove that you, or your loved one, are/were eligible for CHC. In most cases, you will be able to claim for a back payment of up to a year. 

However, you may be able to claim further back if one or more of the following applies:

• You were never told about NHS Continuing Healthcare
• You were not informed about the appeals process
• You were misled about the funding

You have six months to appeal

If you are appealing a decision, you have around six months from the date your claim was rejected to begin your appeal. 

You should bear in mind that medical records will be assessed if you go ahead with an appeal. Although the appeals process does go through the NHS and not the Courts, it could be worthwhile to speak to a solicitor who can act on your behalf.

Lisa Morgan manages the care home fee recovery team at Hugh James Solicitors.

She says: “Integrated Care Boards (ICB) in England will review unassessed periods of care back to April 2012. The authority will look back at someone’s care needs in the past to decide whether they should have received CHC care at the time. This is the case even if the person in care has since died. 

She warns: “Challenging Continuing Healthcare can be a hard and long slog. However, the Department of Health statistics show that 22% who challenge at ICB level are successful, with a further 30% at national level.“

Family of Kathleen Pearson refunded £40,000 

Hugh James Solicitors, successfully appealed in the case of Kathleen Pearson.

“Kathleen Pearson, the late mother of Paul Pearson, suffered from Alzheimer’s in the last few years of her life. She was moved to a care home where her son Paul and his wife Jill were told she would have to self-fund the care costs.

“Mrs Pearson’s health continued to deteriorate whilst in care and was unable to communicate, was totally dependent on staff for all activities of daily living, such as continence care, skin care and administration of medication. She demonstrated resistive and challenging behaviour. 

“The family requested a current assessment, but it was not forthcoming. Mr and Mrs Pearson contacted us and we proceeded with the current assessment and a retrospective review. Following significant delays, Mrs Pearson was deemed eligible, and the NHS met her ongoing care fees, which meant she did not pay the £2,500 per month in care fees. 

“A retrospective review was also completed and following a number of appeals, it was agreed Mrs Pearson had been eligible for NHS Continuing Healthcare for a year and refunded her estate over £40,000 in wrongly paid care fees and interest,” says Lisa Morgan.

Hugh James Solicitors offers families a choice of a ‘no win no fee’ Contingency Fee Agreement. They also offer an hourly rate basis. 

“The Contingency Fee Agreement is popular with our clients as it provides certainty; they know exactly what will be charged if we win the case and it makes no difference how much time is spent pursuing the claim to a successful conclusion. In addition, there is peace of mind that if they pursue the claim and lose, they do not pay us anything.”