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: 21 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. Parliamentary and Health Service Ombudsman. Available at: https://www.ombudsman.org.uk
4. Data Protection Act 2018, c. 12. Available at: https://www.legislation.gov.uk/ukpga/2018/12/contents
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
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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 Integrated Care Boards decide claims covering past periods of NHS Continuing Healthcare. It covers the initial check on whether the period is claimable, the records-based review, how needs are reconstructed against the Decision Support Tool, the decision and reimbursement calculation, timescales, what to do if the claim is refused, and how interest is treated.
How retrospective CHC decisions are made
A retrospective decision reconstructs what a person's needs were during a period that has passed, using only the records. Understanding how the Board approaches that makes it much clearer what a submission needs to do.
The first check is the window
Before anything else the Board establishes whether the period claimed for can still be considered. If it falls outside a claimable window, the claim ends there regardless of merit. Getting a clear written answer on this at the outset saves considerable effort, and it is reasonable to ask for it before submitting a full case.
Gathering the records
The Board will seek records for the period from the care provider, the GP, any hospital and the local authority. Its gathering is often incomplete, particularly for night records and provider daily notes. Submitting your own bundle, paginated and indexed, materially improves what the decision is made on.
Reconstructing the needs
A reviewer works through the records and reconstructs the person's needs across the twelve care domains as they were during the period. This is a desk exercise, so anything not written down effectively did not happen. That is why the quality of contemporaneous recording matters more here than in any current assessment.
Applying the test
The same primary health need test applies, analysed through nature, intensity, complexity and unpredictability, using the framework in force at the time of the period rather than necessarily the current one. Where needs changed during the period, the Board may find eligibility for part of it rather than all of it.
The decision and the calculation
Where the claim succeeds in whole or part, the Board calculates reimbursement based on what was actually paid during the eligible period. Provide invoices, contracts and bank records, because the calculation depends on evidence of payment as much as on evidence of need. Check the calculation rather than assuming it is right.
Timescales and interest
These claims take a long time, frequently well over a year, and delay is common at every stage. Interest may be added to reimbursed sums, and the basis on which it is calculated should be set out. Ask about it explicitly rather than waiting to see, since it is not always volunteered.
If the claim is refused
Ask for the reasons and the reconstructed assessment in writing. The Board's own review process applies, and the Ombudsman is available where the complaint concerns how the matter was handled rather than the eligibility conclusion. Check first whether records were missing from what the Board considered, since that is a common and remediable defect.
Key takeaway
Get the window confirmed in writing first. Submit your own indexed bundle rather than relying on the Board's gathering. Provide payment evidence alongside needs evidence, check the calculation, and ask about interest explicitly.
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Frequently asked questions
How does the Board decide a past period?
By reconstructing the person's needs across the twelve care domains from the records, then applying the primary health need test using the framework in force at the time of the period.
Should we submit our own records?
Yes. The Board's gathering is often incomplete, particularly for night records and provider daily notes. A paginated, indexed bundle materially improves what the decision rests on.
Can they find eligibility for only part of the period?
Yes. Where needs changed over the period, the Board may conclude the person was eligible for part of it rather than all of it, and reimbursement follows accordingly.
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.