Tens of thousands of UK families have paid care home fees of £50,000 to £400,000 that should have been funded by the NHS under Continuing Healthcare (CHC). When a person's primary need is for healthcare rather than social care, the NHS must pay the full cost — including in a private nursing home. This guide explains how to identify a wrongly paid claim, the evidence required and how to recover money paid in past years.
NHS Continuing Healthcare is non-means-tested, fully NHS-funded care for adults whose 'primary need' is health-related. The legal test, set out in the National Framework, looks at the nature, intensity, complexity and unpredictability of the person's needs across 12 'care domains' — behaviour, cognition, mobility, continence, skin integrity, breathing and others.
If a person scores 'severe' in one domain, 'high' in two, or any combination crossing the threshold, CHC funding should be awarded. Crucially, this applies regardless of whether the person lives in a nursing home, residential home or their own home — and regardless of their financial situation.
CHC assessments are routinely missed at hospital discharge. Families are told to find a care home and self-fund — without anyone mentioning that an NHS assessment is mandatory before any social care decision is made.
Many initial assessments use the wrong tool (the brief 'Checklist' rather than the full Decision Support Tool) or are conducted by social workers without the clinical input the framework requires. Refusal rates have been climbing year on year as ICBs face budget pressure, and the appeals system is the main route to a fair outcome.
You can claim retrospectively for periods of care from 1 April 2012 onwards (earlier periods now closed). Claims can be made by the person who paid (usually the resident or their attorney) or, after death, by the estate.
The current ICB (Integrated Care Board) covering the area where the care was received handles the claim. There's no statutory deadline once you're inside the 2012+ window, but ICBs increasingly impose internal cut-offs, so don't delay.
Request the full GP records, hospital records, care home daily notes and any previous CHC paperwork under data protection law (free, 30 days). Care home daily notes are the gold-standard evidence — they record falls, behaviour, medication changes and continence in real time.
Map the evidence to the 12 domains. Show how the person scored at the time funding should have started, with dated examples from the records. A skilled CHC advisor or specialist solicitor can do this in 20-40 hours; doing it yourself takes longer but is achievable for a determined family member.
Submit a Previously Unassessed Periods of Care (PUPoC) request to the ICB. They acknowledge within 3 months and (in theory) decide within 12 months — in practice 18-36 months is common.
If refused, escalate to an Independent Review Panel (IRP) hosted by NHS England. If still refused, the Parliamentary and Health Service Ombudsman is the final route. About 30-40% of well-evidenced retrospective claims succeed at some stage; awards routinely exceed £100,000 plus interest at 8% p.a.
Not legally — the process is designed to be navigable without one. A specialist CHC advocate (often no-win-no-fee at 20-30% of recovery) materially improves success rates on borderline cases.
Claims are still valid via the estate. The executor or administrator submits the PUPoC and any award goes to the estate.
Refunds are returned to whoever paid the fees — usually rebuilding savings/property value that would otherwise have been depleted.
How NHS Continuing Healthcare works in 2026, who qualifies, how the checklist and DST assessments work, what's funded and how to appeal a decision.
Read guideHow UK care home fees are funded in 2026: means-tested local authority support, capital limits, third party top-ups, deferred payment agreements and self-funder rights.
Read guideWhat an LPA is, the two types (property and finance, health and welfare), how to register with the OPG, costs and the risks of leaving it too late.
Read guide