Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
Copywright
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Abstract
This guide explains the 28-day timescale in the NHS Continuing Healthcare process, covering what the period runs from and to, why delay so often occurs, whether a missed timescale invalidates a decision, how backdating of funding works where delay has caused private payment, and the most effective ways to raise delay with an Integrated Care Board.
The 28-day CHC timescale and what to do when it is missed
The National Framework expects the NHS Continuing Healthcare process to be completed within 28 days in most cases. In practice delay is common and can run to months, often at the point when a family is under most pressure. This guide explains what the timescale covers and what you can do when it slips.
What the 28 days covers
The period runs from the point at which the Integrated Care Board receives a positive Checklist, or is otherwise notified that a full assessment is needed, through to the eligibility decision being made. It therefore covers convening the multidisciplinary team, gathering records, completing the Decision Support Tool and the Board reaching its decision. It is an expectation set by the Framework rather than a statutory deadline, but Boards are expected to work to it and to explain when they cannot.
Why delay happens
The most common causes are difficulty convening a multidisciplinary team, waiting for records from several providers, hospital discharge pressures pushing assessments back, and staffing gaps in Board continuing healthcare teams. Delay is also common where the person moves between settings during the process, since the assessment may effectively restart. None of these are the family's responsibility, but they do explain what is happening, and knowing the cause tends to make chasing more effective.
What happens to care during the delay
Care must continue. Nobody should be left without provision while responsibility is being determined. In practice the local authority or the person themselves may be funding the package in the interim, and that is where the financial consequence of delay bites. If you are being asked to pay privately while a decision is outstanding, make clear in writing that the payment is being made pending the outcome, so that the position is documented if backdating becomes relevant.
Backdating and reimbursement
Where a decision is delayed and the person is later found eligible, funding should generally be backdated to the point at which the decision should have been made. That is usually taken as 28 days from the positive Checklist, though the position depends on the circumstances. Where care has been privately funded during that period, reimbursement should be addressed as part of the decision rather than left as a separate argument, and it is worth raising it explicitly when the outcome arrives.
Does delay invalidate the decision
No. A missed timescale does not make the eventual decision unlawful and it is not, by itself, a ground of appeal on eligibility. It is a service failure rather than a reasoning failure. It can, however, be raised through the complaints process, and it becomes materially important where it has produced financial loss, because that loss is something the Board or ultimately the Ombudsman can address.
How to chase effectively
Put it in writing to the continuing healthcare team, reference the date of the positive Checklist, ask for the current expected decision date and ask what is outstanding. Requesting a named contact tends to help. If there is no meaningful response, escalate to the Board's complaints team with a short chronology of dates and contacts. A factual chronology is considerably more effective than a general expression of frustration, because it gives the Board something specific to answer.
When delay follows hospital discharge
Assessments are frequently deferred where someone is being discharged, on the basis that needs should be assessed once the person has settled. That approach has support in the Framework, since assessing at a point of crisis can produce an inaccurate picture. It becomes a problem when the deferral is indefinite or when the person is placed in a setting they are then charged for. Ask for the deferral and the intended assessment date to be recorded in writing.
Escalating further
If delay is not resolved through the Board's complaints process, the Parliamentary and Health Service Ombudsman can consider maladministration, including unreasonable delay and any financial consequence flowing from it. The Ombudsman will normally expect the Board's complaints process to have been exhausted first, so keeping the written record from the outset makes that route considerably easier if it becomes necessary.
Key takeaway
The 28 days runs from positive Checklist to decision and is an expectation rather than a statutory deadline. Delay does not invalidate the outcome, but it can justify backdating and it can be pursued as a complaint. Keep a dated written record throughout, and raise reimbursement explicitly when the decision arrives.
Frequently asked questions
When does the 28 days start?
It runs from the point the Integrated Care Board receives a positive Checklist or is otherwise notified that a full assessment is required, through to the eligibility decision being made. Ask the Board to confirm the date it holds as the start point.
Can I refuse to pay while waiting?
Care must continue and should not be interrupted, so refusing payment risks the placement rather than the Board. The better approach is to pay under protest in writing, stating that payment is made pending the outcome, so the position is documented for any later reimbursement.
Will funding be backdated?
Where a person is later found eligible and the decision was delayed, funding should generally be backdated to when the decision should have been made, usually 28 days from the positive Checklist. Raise reimbursement explicitly when the outcome is communicated.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.