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. Mental Capacity Act 2005, c. 9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents
3. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
4. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains how the NHS Continuing Healthcare process operates where a person has no family or friends able to represent them. It covers advocacy and when it should be instructed, who makes best interests decisions, the role of professionals already involved, the risk of an assessment proceeding without challenge, deputyship where no one can act, and how professionals can safeguard the person's position.
CHC where there is no next of kin
People with nobody to speak for them are the least likely to have an assessment questioned, and the most likely to need it questioned. The safeguards exist, but they have to be actively requested.
Why this matters
Most challenges to NHS Continuing Healthcare decisions come from families. A person without family is therefore far less likely to have a thin assessment identified, an error raised or a decision appealed. That is not a criticism of any individual, it is a structural feature, and it is the reason the safeguards need to be actively used.
Advocacy
Where a person lacks capacity and has nobody appropriate to consult, an independent mental capacity advocate should be considered, and there are circumstances in which instruction is required. Advocacy should be raised at the outset of the process rather than at the point of dispute. Ask the Integrated Care Board and the local authority directly whether it has been considered.
Who makes best interests decisions
Where there is no attorney or deputy, decisions are made in the person's best interests by the relevant decision maker, usually the professional responsible for the particular decision. That decision should take account of the person's past and present wishes, beliefs and values so far as they can be established, and should be recorded with reasoning.
Professionals already involved
The GP, district nurse, social worker, care home manager and any specialist team all hold information and can raise concerns. Where nobody else is looking at the assessment critically, a professional who knows the person is well placed to ask whether the record reflects what they see. That is within their role rather than an overstep.
The risk at assessment
Without a family member present, the assessment is more likely to proceed on records alone, and thin records produce thin assessments. Where you are a professional involved, providing a written summary of the person's needs before the assessment is the single most useful thing you can do, and it works exactly as a family submission would.
Deputyship where nobody can act
Where a person lacks capacity, has no attorney and has nobody willing to act, an application to the Court of Protection for a deputy may be appropriate, and a local authority can apply. A property and affairs deputy could then pursue a funding claim. This is slow, so it is worth considering early rather than once a problem has arisen.
Key takeaway
The safeguards exist but must be requested. Ask whether advocacy has been considered, ensure best interests decisions are recorded, and where you are a professional involved, submit a written summary of needs before the assessment. Nobody else will do it.
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Frequently asked questions
Who represents someone with no family?
An independent mental capacity advocate should be considered where the person lacks capacity and has nobody appropriate to consult, and in some circumstances instruction is required. Ask the Board and local authority directly.
Who makes decisions in their best interests?
Where there is no attorney or deputy, the professional responsible for the particular decision, taking account of the person's wishes, beliefs and values so far as they can be established, with the reasoning recorded.
Can a professional raise concerns about an assessment?
Yes, and it is within their role. A professional who knows the person is well placed to ask whether the record reflects what they see, particularly where nobody else is looking at it critically.
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.