Retrospective CHC Support for Previously Unassessed Care

Nellie Supports is an independent social work practice. Our retrospective NHS Continuing Healthcare work helps families and professionals in England explain care needs and present relevant evidence.

What a retrospective claim is

Support asking the ICB to consider CHC for a past period that was not assessed at the time, using the available historical evidence.

A previously unassessed period of care, often called PUPoC, concerns a past period when the person paid all or part of their care costs and potential CHC eligibility was not considered.

We check whether this route applies before recommending full work. The initial qualification review and any later instruction have clearly stated fees.

The ICB considers the assessment history and evidence of needs for the dates in question. Requests are generally considered for care from 1 April 2012 onwards, subject to the guidance and circumstances.

An earlier eligibility decision normally uses the review route, not a new PUPoC request. Different periods in the same case can need different routes. A request can also concern someone who has died, with appropriate authority to act.

Care fees were paid privately

The person paid all or part of the care costs during a period when CHC was not considered.

The assessment history is unclear

You cannot find a Checklist, DST or relevant review for the period.

The person has since died

An appropriately authorised representative may be able to pursue the period for the estate.

A care home placement went unassessed

Nursing needs were met privately for months or years.

You are reviewing past care funding

An attorney, deputy or personal representative needs to establish the relevant route and authority.

An earlier claim was rejected

You want to know whether anything remains open.

We consider the available care records, clinical correspondence and relevant accounts of needs during the period. Missing records can limit the view, so we identify what is available and what may still be obtained.

Daily care records covering the period being claimed

Charts: medication, food and fluid, repositioning and continence

Incident and accident records, including falls and choking episodes

GP, district nursing and hospital correspondence from the period

Any Checklist, assessment or review carried out at the time, or evidence that none was

Who was paying for the care, and under what arrangement

Older records may be incomplete. The qualification stage identifies the available evidence, the assessment history and any reason full work may not be appropriate.

We begin by checking the period and available evidence rather than assuming that privately paid care means CHC should have been awarded.

The question is whether the person had a primary health need during the period under consideration. The present-day care picture cannot substitute for evidence of those historical needs.

We reconstruct the care picture from relevant records and accounts, then consider the nature, intensity, complexity and unpredictability of the needs together.

National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care; DHSC and NHS England guidance on previously unassessed periods of care from 1 April 2012.

Read the supporting guidance

Nature of the needs during the period

Intensity of the needs during the period

Complexity of the needs during the period

Unpredictability of the needs during the period

The work focuses on the relevant period, assessment history and evidence that can still be obtained.

What records survive

Care home notes, GP records, hospital notes and charts for the period.

The period claimed

Start and end dates, settings and who was paying.

Evidence of need

What the records show about the person’s needs at the time.

Any assessment history

Whether a Checklist or DST was ever completed.

The funding position

Invoices, contracts and what was actually paid.

Whether a claim has substance

An honest view on whether the surviving evidence can support a claim.

The qualification review is £594 including VAT. If you proceed to the full service, it is credited against that fee. We confirm the review findings, the period and the full scope before further work begins.

Qualification review

• Sample analysis of the care records from the period
• The care period, funding history and relevant earlier assessments checked
• A written view of whether further work is justified and what information is missing
• The fee is credited in full against the claim if you proceed

£594 including VAT, credited if you proceed

Full support for a previously unassessed period

• Full historic records analysis
• Retrospective needs mapping against the domains
• Structured claim submission to the ICB
• Follow-up within the agreed scope to the written outcome

£8,340 including VAT for the first 12 months; £600 including VAT for each additional 12-month period

A personal representative is reviewing a late relative's care costs and cannot find evidence that CHC was considered for part of the period.

In this example, we would first check authority, the care dates, assessment history and available records. A written qualification view would explain whether full work was justified.

If instructed, the later work would reconstruct relevant needs and support the ICB assessment. Eligibility and any reimbursement would remain for the NHS to determine.

The benefit would be a reasoned decision about progressing the work and a clear historical account, with its evidence and limitations identified.

Illustrative example only. This does not describe a client or predict an NHS or Ombudsman decision.

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.

A qualification stage, clearly priced work and an independent account of historical needs, without a share of any repayment.

For families

You have someone to explain the process, organise the relevant evidence and help you put the person's needs into words. The work and fee are agreed before we start.

For professionals

We agree the instruction, authority to act, evidence required, reporting arrangements and timetable with you. Written work links each point to its source.

Eligibility during the period of care

What the historical records show

For more, read our guide: Retrospective CHC claims explained

Acting as a professional deputy or attorney? Read: Re ACC and CHC appeals: what the ruling means for professional deputies

The Nellie Standard is our own framework for clear, evidence-led assessment and advocacy.

For Retrospective CHC Funding Appeal, we identify the question, the relevant period and the evidence needed before forming a view.

The work considers historical care records, chronology, domain evidence, periods under review, gaps in records and the limits of retrospective analysis. 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. Retrospective analysis. Correct framework first. Transparent reasoning. Limitations identified. Capable of scrutiny.