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. 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 whether a person can refuse an NHS Continuing Healthcare assessment. It covers the consent required for the process and for information sharing, the right to decline, the financial consequences of refusing, the position where a person may lack capacity to consent, best interests decision making, the role of advocacy, and what to do where refusal appears to be against the person's interests.
Can someone refuse a CHC assessment
Consent and capacity arise at different points in the CHC process. Separate participation in the eligibility process, physical examinations or interventions, information sharing, and care or treatment decisions. The lawful basis and capacity question can differ for each activity.
Consent is required
The National Framework does not reduce the whole CHC eligibility process to one consent question. The person should be involved and supported to participate. Decision-specific capacity and the appropriate representative or best-interests process must be considered where relevant, while lawful handling of information and delivery of care require their own analysis.
The consequence of refusing
Declining an assessment means the NHS Continuing Healthcare question is not answered, so the local authority route applies and means testing follows. That is a significant financial consequence, and it should be explained clearly before any decision is taken. People sometimes decline because they have been told the process is intrusive, without being told what it might be worth.
Where capacity is in doubt
Where a person may lack capacity to decide about the assessment, capacity should be considered in relation to that specific decision at that time, in accordance with the Mental Capacity Act 2005. A person is assumed to have capacity unless established otherwise, and should be supported to make the decision themselves before anyone concludes they cannot.
Best interests decisions
Where the person lacks capacity to consent to the process, a best interests decision should be made and recorded. That decision should take account of their past and present wishes, their beliefs and values, and the views of those close to them. Proceeding without either consent or a recorded best interests decision is a procedural weakness worth raising.
Attorneys, deputies and advocacy
An attorney under a health and welfare lasting power of attorney, or a deputy with the relevant authority, may be able to make the decision on the person's behalf. Where there is nobody appropriate to consult, an independent mental capacity advocate should be considered. Bring any authority document, as it clarifies who can decide and who receives information.
Where refusal seems against their interests
This is genuinely difficult. A person with capacity may decline an assessment that would benefit them financially, and that decision must be respected even where family disagree. Where the refusal appears to stem from misunderstanding, the useful step is ensuring they have accurate information, not overriding the decision.
Key takeaway
A person with capacity can decline, and the financial consequence should be explained first. Where capacity is in doubt, assess it for that specific decision and record a best interests decision if needed. Proceeding without consent or a recorded best interests decision is a procedural defect.
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Do not treat refusal or lack of capacity as an automatic transfer to council means testing. Record the particular decision, support for participation, information-sharing basis and any authority held by an attorney, deputy or representative.
Frequently asked questions
Can someone refuse a CHC assessment?
Yes, where they have capacity to make that decision. Consent is required for the process and for information sharing, and a refusal should be respected and recorded.
What happens if they refuse?
The NHS Continuing Healthcare question is not answered, so the local authority route applies and means testing follows. That financial consequence should be explained clearly before any decision is taken.
What if the person lacks capacity?
Capacity should be assessed for that specific decision at that time under the Mental Capacity Act 2005. Where they lack capacity, a best interests decision should be made and recorded, with advocacy considered where there is nobody to consult.
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.