If your loved one has paid for their care, they may be entitled to retrospective NHS Continuing Healthcare Funding. We can help you to review funding eligibility.

If your loved one has paid for their care for a while and their eligibility for NHS Continuing Healthcare Funding was not assessed in that time, it’s possible to seek a retrospective review of their eligibility.

A retrospective NHS Continuing Healthcare Funding claim can be made on behalf of an individual who is alive or deceased. What’s important is that there’s a Previously Unassessed Period of Care (PUPoC). In other words, a period of care for which the individual has not had their eligibility assessed.  

In such cases, you can ask the NHS Integrated Care Board (ICB) to retrospectively assess eligibility. If your loved one is eligible, the ICB will have to refund the fees which were paid for the period of eligibility.

To begin assessing retrospective NHS Continuing Healthcare Funding, the appropriate NHS body needs to be identified. Then a formal request for retrospective assessment needs to be made.

Unless the individual making the request is the patient in question, the person making the request must prove they have proper legal authority to do so on the patient’s behalf.

The ICB will gather evidence about the individual’s needs during the retrospective NHS Continuing Healthcare Funding claim period. You should be given an opportunity to make representations.

The documentation will be passed to a multi-disciplinary team (MDT) to make a recommendation to the ICB about your loved one’s eligibility for retrospective NHS Continuing Healthcare Funding for the period in question. The ICB will then decide if the individual is eligible.

If the ICB decides that the individual is eligible for retrospective NHS Continuing Healthcare, you will then be asked to submit evidence of the care fees paid. The ICB will produce a reimbursement proposal, which should include an appropriate level of interest.

If the ICB decides you are not eligible, then you will have a right to appeal that decision.

It is also possible that the ICB may decide that the individual in question was eligible for some, but not all, of the period considered. In such cases, you can claim a refund for the period of eligibility and pursue an appeal in relation to the period of ineligibility.

The appeals process involves “Local Disputes Resolution” with the ICB which made the decision, and thereafter, you can ask NHS England to convene an Independent Review Panel hearing if you remain dissatisfied.

The retrospective PUPoC claims service ensures that past periods of care are assessed where no assessment previously took place. This is not meant to be a chance to challenge an ICB’s decision about your eligibility again. You must appeal the decision within the specified time limit.

However, things aren’t always so clear-cut. For instance, an individual may have been previously assessed, but not as often as needed. Or perhaps you were not even aware of previous assessments. In any case, it’s worth getting professional advice for Retrospective NHS Continuing Healthcare funding.

It is the responsibility of the executors of the deceased person’s will (or the administrators of their estate if there is no will) to decide whether to bring a retrospective NHS Continuing Healthcare claim. It may still be possible to bring the claim if you’re not the executor or administrator. 

Whatever the situation, you should act promptly. This is because clinical records are not kept indefinitely, and any unavailability will cause problems.

Back in 2012, the Secretary of State for Health in England announced a “close down” of retrospective claims in relation to any claims which apply to periods of care from 1 April 2004 to 31 March 2012.

This means that the earliest date from which you can ask for your eligibility to be retrospectively assessed is 1 April 2012.

Please be aware that rules in Wales are different. You can only seek a retrospective assessment of the 12-month period prior to the date of your request.

We have years of experience of dealing with retrospective NHS Continuing Healthcare Funding claims. Whilst it is possible to bring the claim yourself, it can be reassuring to know that we have the expertise to present your case in the best possible way. We are also well placed to head off any problems before they arise.

We will always consider whether we can act for you on a “No Win No Fee” basis. If your claim is successful, we will charge 25% of the refund, plus VAT. Whether we can offer this will depend on a risk assessment of your case.

If a “No Win No Fee” agreement is not suitable in your case, or you’d prefer to pay privately, then we will provide you with clear fee estimates in advance. You’ll only pay us for the time we spend.

Before embarking on a retrospective NHS Continuing Healthcare Funding claim, we may recommend that you instruct us to obtain and consider care home and medical records. This will help us to advise you about your loved one’s eligibility, so that you know where you stand before embarking on a claim.

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Here are some hands-on examples of retrospective NHS Continuing Healthcare Funding cases. Our work speaks for itself.

I instructed them to bring a retrospective Continuing Healthcare claim on behalf of my late mum. Mum lived in a nursing home for the last 5 years of her life before she passed away. Initially the ICB said she wasn’t eligible, and I was ready to throw in the towel. They told me that they firmly believed that there was intensity, complexity and unpredictability associated with my mum’s needs. Mum had Alzheimer’s dementia, and she had no awareness of her condition and was completely disorientated. She wandered endlessly around the care home, lashing out at the carers and other residents. She was prescribed a medication called Haloperidol to help, and they were  firmly of the view that the level of skill needed to meet my mum’s medication and behavioural needs meant that she was eligible and he persuaded me to appeal the decision.  

At the first stage of the appeal, the ICB reconsidered its decision and agreed my mum had a Primary Health Need and agreed to refund £249,000 worth of wrongly paid care home fees and interest to my mum’s estate. My family and I will be eternally grateful to them for their tenacity.

My mother has dementia and receives care at home from two permanent live-in carers. I can’t imagine she could be any worse. The ICB assessed her as ineligible, and I instructed them to appeal against the decision. We had to go all the way to an NHS England Independent Review Panel to get justice, but that’s exactly what they helped me to do. They advised that following our success at the Independent Review Panel, the ICB would need to reimburse the care fees we had paid whilst the appeal was ongoing. The ICB was very difficult to deal with and, having been through a legal dispute in the past, I found the appeals process very different, and I was relieved to have the guiding hand of an expert to keep things on track.