STARTING OUT
Assessment & care plan
An independent account of care needs and the support required, with a written care plan.
Explore this supportNHS CHC SUPPORT IN ENGLAND.
CHC & care
funding support.
Make the care picture clear.
Understand your next step.
Independent social work support to prepare for NHS Continuing Healthcare (CHC) assessments, explain care needs and challenge decisions. Clear written work, practical advocacy and a fee agreed before you begin.
For adults, families and professional referrers in England.
THE STARTING POINT
A difficult process.
A clearer picture.
Bring the evidence together.
Our independent assessment and care plan underpin Nellie casework where specified in your new client package. Updates are included for the same continuing case; separate historical reconstruction is agreed first. The consultation is a separate, optional service.
You can use the NHS process yourself without paying Nellie. Paid support helps you organise the evidence and take part at the stage you need. We take no percentage of funding or repayment.
Talk through your situationFIND YOUR NEXT STEP
Start with what
you need help with.
Tell us what has happened, which documents you have and any meeting or decision date. We will identify the appropriate service.
ASSESSMENT
Checklist & DST
Prepare relevant evidence and get agreed meeting support for screening or full assessment.
Explore this supportCHALLENGING A DECISION
Review & appeal
Understand supported grounds, evidence gaps and the relevant review route before further work.
Explore this supportSPECIALIST SUPPORT
Urgent & retrospective
For urgent Fast Track consideration, contact the treating clinician promptly. Nellie does not complete the Fast Track tool. Past unassessed care needs a separate qualification review.
Explore this supportHONEST ANSWERS
The questions
people ask first.
Still unsure about something?
Speak with our team.
Is a particular funding outcome guaranteed?
No. The NHS decides eligibility. We prepare and present relevant evidence and explain its strengths and limits. Ask the team.
Is the fee a percentage of money recovered?
No. We agree fees for the specified work and take no share of funding or repayment. Ask the team.
What should I mention first?
Tell us your stage, the decision or meeting date and any deadline. If you need help understanding the next step, the optional consultation and written action plan is £336 including VAT. Ask the team.
Independent social work assessment, evidence and advocacy. We confirm the scope, written outputs, total fee and arrangements before instruction.
Published service informationMake your next CHC step clearer. Nellie Supports helps families and professionals in England prepare for assessments, present evidence and challenge decisions. You receive independent social work support, a clear written output and a fee agreed before work begins.
Independent social work assessment and advocacy through the CHC process in England.
Consultation and written action plan: £336 including VAT
Enquiries: Tell us any deadline
Service coverage: England only
Written work: Evidence and reasons explained
At a glance
Stages covered
• Checklist • Decision Support Tool • Reviews • Appeals • Independent Review Panel • Ombudsman • Retrospective claims
Framework
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, 2022 revision
Means tested
No. Savings, income and property play no part in the decision
Fees
Fixed fees for the agreed stage, confirmed in writing. No percentage of funding or repayment.
Coverage
England only. Wales has a separate Continuing NHS Healthcare framework.
What is NHS Continuing Healthcare?
NHS Continuing Healthcare, or CHC, is ongoing care arranged and funded entirely by the NHS for adults assessed as having a primary health need. It can cover care at home or in a care home.
CHC is not means-tested. Savings, income and property do not determine eligibility. What matters is the person's assessed needs and the support required to meet them.
What is NHS Continuing Healthcare?
CHC brings health and social care together where an adult has a primary health need. The NHS considers the person's needs as a whole, including how they interact and change. A diagnosis alone does not decide eligibility.
The test that decides eligibility
The NHS considers four characteristics across the person's total needs. The evidence should show what care is required, how often and what happens when needs change.
Nature
The kind of needs the person has, and the kind of interventions they require.
Intensity
How severe the needs are, how much support they demand and how continuously.
Complexity
How the needs interact, and the skill required to manage the whole picture.
Unpredictability
How far needs fluctuate, and the risk when changes are not anticipated.
A refusal is not the end of the process
A refusal can be reviewed. We examine the decision and records from the assessment period, explain any supported grounds for challenge and identify gaps before further work is agreed.
How the process runs
The usual route runs from screening to full assessment, a written decision and ongoing reviews. Some cases go directly to full assessment or through the urgent Fast Track route.
Checklist
A screening tool. A positive result does not award funding, it triggers the full assessment.
Decision Support Tool
A multidisciplinary team uses the DST to bring together assessed needs across twelve care domains. The multidisciplinary team considers the evidence and recommends whether the person has a primary health need.
ICB decision
The Integrated Care Board makes the eligibility decision and confirms it in writing.
Challenge
Check the review deadline in your decision letter. Local resolution normally comes before a request for independent review by NHS England.
Review
The care package is normally reviewed within three months, then at least annually, to check that it meets assessed needs.
Inside a Nellie Supports CHC submission
The output depends on the stage you instruct. Your scope explains which assessment, evidence review, submission or meeting support is included.
The instruction and the stage being addressed
Which service has been instructed, what decision or meeting it relates to and what the submission is asking for.
Records, care notes and correspondence reviewed
The relevant care notes, charts, decision documents and correspondence for the period under consideration.
An independent account of day-to-day needs
An independent account of care needs, drawing on the person, carers and records. Historical work reconstructs needs for the relevant period.
Evidence mapped to the twelve care domains
The evidence relevant to each care domain, with reasons for any level of need we suggest.
Analysis against the four key characteristics
What the nature, intensity, complexity and unpredictability of the total needs show about a possible primary health need.
Where the process or the evidence fell short
Any material gaps, inconsistencies or departures from the National Framework, explained with reference to the records.
Conclusion and professional opinion
A reasoned view of the evidence, its limits and the next step we recommend.
Reasoning you can follow
You can see the source of each significant point and ask us to explain it.
How CHC fees work
Each stage has its own scope and fee. The £336 including VAT consultation including VAT is optional. For casework, we confirm which assessment and review work is included in your package. We take no percentage of any funding or repayment. Travel is charged separately.
All travel is charged separately at £48 per hour including VAT (£40 excluding VAT). The travel cost and any additional work are confirmed in your written quotation before booking.
Independent Social Care Needs Assessment and Care Plan
Included where specified in the new client package. Updates are included for the same person and continuing case; historical reconstruction is agreed separately.
Case Review and Merits Assessment
£2,340 including VAT for the merits review. New appeal clients also need the independent assessment. We confirm the combined instruction before you commit.
Where are you in the process?
Start with the decision, meeting or period of care you need help with. We identify the relevant service and confirm what assessment work is needed.
Before a decision
A Checklist or Decision Support Tool is coming, or nobody has ever considered CHC
After a refusal
A not eligible decision has been made and you want it reconsidered
Funding already in place
A three-month or annual care package review is approaching, or a reassessment has been proposed.
For care already paid for
Care was funded privately during a period that was never properly assessed
How CHC support works in practice
The situation
A family is concerned that a refusal does not reflect the support their relative needed at the time of the DST.
The barrier
The decision describes a settled presentation, while the records also show night-time care and fluctuating needs.
How Nellie Supports helped
In this example, we would review the decision-period records, reconstruct relevant needs and explain whether the evidence supports a focused appeal.
Why it mattered
The family would have a clear account of the disputed points and their evidence. The NHS would remain responsible for the eligibility decision.
Illustrative example only. This does not describe a client or predict an NHS decision.
For solicitors, deputies, care providers and advisers
We agree a clear instruction and reporting arrangements before starting work.
Scope confirmed in writing
The stage, the fee and the timescale are confirmed in writing before instruction.
Evidence in the language of the framework
Needs are described against the twelve care domains and the four key characteristics, not in general terms.
Evidence and reasons explained
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
A reasoned next step
We explain where the evidence does not support further work and what other route may be relevant.
Why choose Nellie Supports for NHS Continuing Healthcare
Independent assessment, evidence review and advocacy, with the work matched to the CHC stage you have reached.
For families
We explain the terminology and the next step, so you can make an informed choice about support.
For professionals
A defined instruction, traceable evidence and written recommendations for the person or professional responsible for the case.
Why instruct Nellie Supports
Our social work approach connects everyday care needs with the evidence the CHC process requires.
Independent social work support
We assess, explain and present care needs while keeping the person's experience central to the work.
Published fees, never a percentage
We confirm your total fee and scope in writing. We take no share of funding or repayment.
One assessment, carried through
Updates are included for the same person and continuing case. Separate historical reconstruction is scoped before it begins.
A clear point of contact
You know who to contact, what work has been agreed and what needs to happen next.
Evidence and reasons explained
Written conclusions explain the evidence, reasoning and any limits on the view we can give.
Honest about outcomes
The NHS decides eligibility. We explain the strengths and weaknesses in the evidence without promising funding.
Frequently asked questions
Is CHC means-tested?
No. CHC eligibility depends on assessed needs, rather than savings, income or property. Local authority social care funding is a separate system.
Does a positive Checklist mean funding is awarded?
No. A positive Checklist means a full eligibility assessment is required. It does not award CHC funding.
How long do we have to challenge a decision?
Check the deadline in your decision letter and act promptly. Review requests are normally expected within six months, but the stage and correspondence matter. Tell us about any approaching or missed deadline.
Can you guarantee the person will be found eligible?
No. The NHS makes the eligibility decision. Our role is to prepare and present relevant evidence and explain the available options.
Do you charge a percentage of what is recovered?
No. We agree fees for the work before instruction and take no share of any repayment.
Can we claim back care fees already paid?
A previously unassessed period may be considered retrospectively. An earlier refusal uses the review route instead. We check the dates, assessment history and available records before recommending work.
Do you cover Wales?
Our CHC services cover England only. Wales uses a separate framework and health board process.
Guides to the CHC process
NHS Continuing Healthcare explained
What CHC is, who funds it, and why the decision never looks at the person's money.
CHC eligibility and primary health need
The test that decides eligibility, and the four characteristics it turns on.
The CHC assessment process
From the Checklist through the Decision Support Tool to the ICB decision.
Challenging a CHC decision
What a not eligible letter means, and the routes open to you afterwards.
Who pays for care fees
Where NHS funding ends and local authority or self funding begins.
Other support from our practitioners
If NHS funding is not the question you need answering, these areas may fit better. Each has its own hub and its own dedicated services.
Mental capacity assessments
Decision-specific capacity assessments for finances, property, care, residence and litigation.
Expert capacity reports and reviews
Independent expert reports and critical review of existing capacity evidence.
Lasting Power of Attorney services
Certificate provider services and capacity evidence for LPA decisions.
Our NHS Continuing Healthcare services
Choose the stage you need help with below. If you are unsure, tell us what has happened and any meeting or decision dates. We will explain the appropriate service, scope and fee.
Our CHC support
NHS Continuing Healthcare
Assessment, review, appeal and retrospective support across the CHC pathway in England.
Nellie Supports provides independent social work assessment, evidence and advocacy support in England. We do not provide regulated legal advice. We explain when a solicitor's advice is needed. You can use the NHS assessment and review process yourself without paying Nellie. Free information and advice are also available through Beacon. Paid support is your choice.
Not sure which stage you are at?
Tell us the stage you have reached, the documents you hold and any deadline. We will confirm the appropriate support and fee before paid work begins.
NHS Continuing Healthcare
11 assessments
CHC Consultation and Action Plan
An optional consultation and written action plan to help you understand the process and decide your next step. £336 including VAT.
Independent Social Care Needs Assessment & Care Plan
Independent assessment and a written care plan to support Nellie's casework. Included where specified in your new client package.
Case Review & Merits Assessment
Case review and written merits opinion, the first step for new clients before any appeal is instructed.
Checklist Advocacy and Attendance
Preparation and advocacy for screening, including attendance within the agreed scope. New client packages include the independent needs assessment and care plan.
CHC Assessment Support: DST and MDT Meeting
Evidence prepared across the twelve care domains of the Decision Support Tool (DST) and representation at the multi-disciplinary team (MDT) meeting.
CHC Review Support
Evidence and support for care package reviews, including a clear distinction between routine review and eligibility reassessment.
CHC Mediation
Representation at ICB mediation, where the ICB offers it.
CHC Appeal Support: Local Resolution
Written submission and representation at local resolution with the Integrated Care Board, the first stage of a CHC appeal. The Independent Review Panel is a separate service.
NHS Independent Review Panel
Application and representation at the Independent Review Panel, handled as one merged stage.
Ombudsman referral support
A clear, evidenced complaint to the Public Service Ombudsman about how a CHC case was handled.
Retrospective CHC Claims
Support for previously unassessed periods, starting with a £594 including VAT qualification review including VAT, credited against the full service if you proceed.
Where are you in the process?
| Assessment option | Suitable for | What is included |
|---|---|---|
| Before a decision | A Checklist or Decision Support Tool is coming, or nobody has ever considered CHC | Independent social care needs assessment and care plan; Checklist screening preparation and challenge; Decision Support Tool preparation; attendance and representation at the MDT |
| After a refusal | A not eligible decision has been made and you want it reconsidered | Case review and merits opinion; appeal application drafted and submitted; local resolution submission and attendance; mediation where the ICB offers it; Independent Review Panel application and representation; Ombudsman referral |
| Funding already in place | A routine care package review is approaching, or a full reassessment has been proposed | Current needs and care plan evidence; explanation of changes and ongoing interventions; agreed meeting support; a separate reassessment or challenge where required |
| For care already paid for | Care was funded privately during a period that was never properly assessed | Records review before any full claim; full retrospective claim prepared and submitted; published fees, never a percentage of any repayment |
Our approach to Care Act Care Funding Advice
The Nellie Standard is our own framework for clear, evidence-led assessment and advocacy.
For Care Act Care Funding Advice, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers Care Act responsibilities, eligibility, financial assessment issues, charging rules, records and the evidence needed to understand funding options. The written scope identifies the records and analysis included.
Under The Nellie Standard™, social care and care funding support should be clear, proportionate and transparent. Where the matter is complex, disputed or financially significant, the work may require fuller evidence gathering, careful separation of fact and opinion, identification of any limitations, and a reasoned explanation of what the evidence does and does not show.
Evidence before opinion. Correct framework first. Funding analysis. Supportive process. Clear conclusions.
Our approach to Care Home Top-Up Fee Advice
For Care Home Top Up Fees, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers top-up arrangements, affordability, choice of accommodation, local authority duties, written agreements and whether families have clear information before accepting liability. The written scope identifies the records and analysis included.
Our approach to CHC Eligibility Consultations
For CHC Eligibility Consultation, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers initial evidence review, likely CHC issues, eligibility indicators, process options and whether further evidence gathering may be justified. The written scope identifies the records and analysis included.
Our written conclusions explain the evidence, reasoning and limits of the position advanced. The NHS or relevant review body makes its own decision.
Evidence before opinion. Correct framework first. Eligibility analysis. Supportive process. Clear conclusions.
Our approach to CHC Funding Support
For Continuing Healthcare CHC Funding Support, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers the CHC process as a whole, including eligibility evidence, Checklist or DST stages, primary health need analysis and appeal strategy. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. Primary health need analysis. Transparent reasoning. Clear conclusions. Capable of scrutiny.
Our approach to Deprivation of Assets Reviews
For Deprivation of Assets Care Fees, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers financial chronology, intention, timing, asset transfers, local authority reasoning and the evidence needed to understand whether deprivation is properly alleged. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. Chronology. Transparent reasoning. Clear conclusions. Capable of scrutiny.
Our approach to Financial Assessments for Care Home Fees
For Financial Assessment for Care Home Fees, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers financial assessment records, assets, income, allowances, property treatment, local authority decisions and whether the calculation appears properly evidenced. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. Funding analysis. Transparent reasoning. Clear conclusions.
Our approach to Property Disregard Advice
For Property Disregard Care Home Fees, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers property ownership, occupation, disregard rules, local authority reasoning, family circumstances and records relevant to whether a property should be included or disregarded. The written scope identifies the records and analysis included.
Evidence before opinion. Correct framework first. Property analysis. Transparent reasoning. Clear conclusions.
Our approach to Care Funding Advice
For Who Pays for Care, we identify the question, the relevant period and the evidence needed before forming a view.
The work considers the distinction between self-funding, local authority funding, NHS Continuing Healthcare, top-ups and other routes for meeting care costs. The written scope identifies the records and analysis included.
Correct framework first. Evidence before opinion. Funding analysis. Supportive process. Clear conclusions.
Participation and communication in Care Act Care Funding Advice
You should be able to describe the care picture and your concerns in your own words. We explain what information is relevant and why.
We support the person's participation and communication, presume capacity and check any authority to act. Capacity concerns are decision-specific; the CHC eligibility question remains separate.
For Care Act Care Funding Advice, we agree suitable participation arrangements and explain the process in manageable steps.
We draw out clarify care and support needs, funding questions, eligibility, local authority processes and the evidence needed to understand the position.
Your documents organise the relevant evidence, explain significant gaps and set out the recommended next steps.
You can ask us to explain the written reasoning and anything you do not understand.
Participation and communication in Care Funding Advice
For Care Funding Advice, we agree suitable participation arrangements and explain the process in manageable steps.
We draw out families understand the difference between self-funding, local authority funding, NHS funding and other possible routes.
Participation and communication in Care Home Top-Up Fee Advice
For Care Home Top-Up Fee Advice, we agree suitable participation arrangements and explain the process in manageable steps.
We draw out families understand top-up fee issues, affordability, agreements, choices and what evidence or clarification may be needed.
Participation and communication in CHC Eligibility Consultations
For CHC Eligibility Consultations, we agree suitable participation arrangements and explain the process in manageable steps.
The conversation helps explain the relevant needs and interventions. Analysis remains grounded in the National Framework and the evidence for the period being considered.
Your documents organise the relevant evidence, explain significant gaps and set out the recommended next steps.
Participation and communication in CHC Funding Support
For CHC Funding Support, we agree suitable participation arrangements and explain the process in manageable steps.
Participation and communication in Deprivation of Assets Reviews
For Deprivation of Assets Reviews, we agree suitable participation arrangements and explain the process in manageable steps.
In this context, the conversation should carefully explore chronology, intention, timing, asset transfers and the evidence behind any local authority allegation. The conversation should draw out relevant needs, risks, records, family context and practical concerns without turning the process into a rigid checklist.
Participation and communication in Financial Assessments for Care Home Fees
For Financial Assessments for Care Home Fees, we agree suitable participation arrangements and explain the process in manageable steps.
We draw out clarify financial assessment issues, records, assets, income, property treatment and any local authority decision being questioned.
Participation and communication in Property Disregard Advice
For Property Disregard Advice, we agree suitable participation arrangements and explain the process in manageable steps.
We draw out clarify property circumstances, occupation, family context, local authority reasoning and the evidence relevant to disregard questions.
A downloadable toolkit for families who want to work through the NHS Continuing Healthcare process themselves. fee confirmed in writing.