NHS Continuing Healthcare
Retrospective CHC Claims for Periods of Care That Were Never Assessed
A retrospective NHS Continuing Healthcare claim asks the Integrated Care Board to assess a past period of care that was never assessed for CHC eligibility at the time. Where the records show the person had a primary health need during that period, care fees paid during it can be repaid. Nellie Supports starts every retrospective case with a £495 records review, credited in full against the claim fee if the family proceeds, so you know whether the evidence supports a claim before committing to one.
A records review first, credited in full if you proceed, so you know the records support a claim before you commit
At a glance
Role
Retrospective claims for periods of care that were never assessed
Framework
National Framework for NHS CHC (2022 revision); previously unassessed periods of care
Format
records review, then full claim preparation and submission
Deliverable
A written view on the records and, where it is worth pursuing, a submitted claim
Coverage
England. Wales runs its own Continuing NHS Healthcare framework
£6,950
Fee plus VAT, never a percentage of recovery
One working day
Response to your enquiry
England
Cover throughout the country
Social work led
Registered professionals
Plain-English explanation
What a retrospective claim is
A claim for a past period when a person paid for their own care and was never properly assessed, beginning with a records review of the surviving records.
A retrospective claim, often called a previously unassessed period of care or PUPoC, looks at a past period when a person was paying for their own care and was never properly assessed for CHC.
It runs in two stages: a records review first, so nobody pays for a full claim that the surviving records cannot support, and then the full claim if it is worth bringing.
A claim depends on the records that still exist
Retrospective work is only as good as the surviving care notes, charts and correspondence. That is why we begin with a records review rather than taking on a full claim the evidence cannot support.
Common situations
When a retrospective claim may apply
Some people paid for their own care during periods when NHS Continuing Healthcare was never considered: no Checklist, no assessment, no eligibility decision. A retrospective claim asks the Integrated Care Board to assess that unassessed period now, on the records from the time.
This is different from appealing a decision. Where an eligibility decision was made and you disagree with it, the appeal route applies. Retrospective claims are for the periods where the assessment simply never happened, including periods of care for someone who has since died.
Care fees were paid privately
The person funded their own care and CHC was never considered.
No Checklist was ever done
Nobody screened the person at the point the needs arose.
The person has since died
The estate may still be able to pursue the period.
A care home placement went unassessed
Nursing needs were met privately for months or years.
A deputy or executor is reviewing the estate
Past care funding needs checking before the estate is settled.
An earlier claim was rejected
You want to know whether anything remains open.
What the records must show
What a retrospective claim depends on
A past period is decided on documents that already exist. Nothing can be created now, which is why the records review comes before any full claim and why some periods cannot be pursued however strong the family’s account is.
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
No records, no claim
Care providers are not required to keep records indefinitely, and many do not. This is the single most common reason a retrospective period cannot be pursued, and it is the reason we look before you commit to a full claim.
1
The primary health need test
The question is the same one that decides any CHC case: did the person have a primary health need during the period in question. The difference is that the evidence is historic, so the claim stands or falls on the care records of the time.
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
2
How the judgement is made
A primary health need is judged by the nature, intensity, complexity and unpredictability of the person's needs. In a retrospective claim, those characteristics have to be demonstrated from records written years ago, which is why the records review comes first.
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); the primary health need test applied to the unassessed period; Integrated Care Board retrospective review processes
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 framework
What a retrospective claim tests
Initial enquiry and triage
Tell us who the person is, the period of care in question and where they were cared for. We respond within one working day.
Records review
For a fee agreed in writing, a registered professional examines a sample of the care records from the period and the funding position at the time.
An honest go or no-go
You receive a written view on whether the records support a claim. If they do not, we say so plainly and the matter ends there.
Full claim preparation
Where the evidence has substance, we analyse the full historic records, map the needs of the period to the domains and prepare the structured claim submission.
Submission and follow-through
We submit to the Integrated Care Board's retrospective route and stay with the case until the outcome is confirmed in writing.
What happens next
Our retrospective claim process
Evidence base
What we look at
Retrospective work lives or dies on the records that still exist.
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.
Deliverable
What you receive
The work is records based and staged, so you only ever pay for the next step the evidence justifies:
An honest written view on the records before you commit
Analysis of the historic care records for the period
The needs of the period mapped to the care domains
A structured retrospective claim submission to the ICB
Follow-through until the outcome is confirmed
A written outcome summary and next steps
Who we work with
For solicitors, deputies, care providers and advisers
Instruction is straightforward and the evidential standard is consistent whichever stage we are brought in at:
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.
Peer review as standard
A second qualified professional reviews the work before it is submitted.
Honest merits advice
Where a case has no realistic prospect, we say so before you spend anything further on it.
records review
£495 plus VAT, credited in full if you proceed
- Sample analysis of the care records from the period
- The funding position at the time confirmed
- An honest written view on whether a claim has substance
- The fee is credited in full against the claim if you proceed
Credited in full against the claim fee if you go ahead. Plus VAT.
Full Retrospective Claim (PUPoC)
£6,950 plus VAT up to 12 months, plus £500 per additional 12 month period
- Full historic records analysis
- Retrospective needs mapping against the domains
- Structured claim submission to the ICB
- Follow-through to the written outcome
One fee for the claim, agreed in writing before any work starts, plus VAT and travel. We never take a percentage of any repayment.
Transparent pricing
Records review first, full claim only where the records support it
Every retrospective case starts with the records review. It exists to protect families from paying for claims the evidence does not support, and the £495 fee is credited in full against the claim fee where we recommend proceeding.
For families
A clear fee, agreed in writing before we start, with no percentage of anything recovered. We explain what is happening in plain English and deal with the process so you do not have to.
For professionals
Scope, fee and timescale confirmed in writing before instruction. Evidence prepared against the twelve care domains and the four key characteristics, peer reviewed by a second qualified professional.
Provider evidence
Why choose Nellie Supports for a retrospective claim
Stated fees, never a percentage of any repayment, and an honest written view of the records before the full claim.
Why families choose Nellie Supports for retrospective claims
Honesty before commitment
The review stage exists to stop families paying for claims the records cannot carry. If the evidence is not there, we tell you at the first stage, not the last.
Never a percentage
Published fees, plus VAT. We take no share of any repayment, however large.
Records based, not hope based
A retrospective claim is won or lost in the care records of the time. That is where we do the work.
Social work led
Registered professionals who write professional assessments for a living read historic records the way the assessors of the time should have.
Peer reviewed as standard
Every records review and every submission is reviewed by a second qualified professional before it reaches you or the ICB.
A permanent employed team
A full-time, in-house multidisciplinary team with more than 11,000 assessments completed practice-wide.
A son contacted us about his late mother's four years in a nursing home. She had paid her own fees throughout, and going through her papers after she died he could find no sign that NHS Continuing Healthcare had ever been considered: no Checklist, no assessment, no decision letter. He did not want to launch a claim on a hunch, and he did not want a company taking a slice of whatever might come back.
We started where we always start, with the records review. A registered professional obtained a sample of the nursing home's daily notes and care plans from the period and read them against the primary health need test: what her needs were, how intense and unpredictable they became, and what it actually took to manage them. The review gave him a written, honest answer on whether the records could carry a claim, and only then did the full claim stage begin, at a fee he had seen in writing before saying yes.
Whatever the Integrated Care Board decides, the claim now rests on the records of the time, presented the way the Framework expects.
Records from a period years ago only become evidence when somebody qualified to assess need reads them as an assessor would. A registered professional went through the notes, the charts and the correspondence and produced an independent account of what his mother’s needs had been at the time, which is what a retrospective claim actually turns on.
This is an illustrative example. It does not describe any individual client.
How a retrospective CHC claim works in practice
Frequently asked questions
Frequently Asked Questions About Retrospective CHC Claims
Who can make a retrospective claim?
A family member or personal representative can pursue a claim for a period of care that was never assessed for NHS Continuing Healthcare, including care received by someone who has since died. Executors and attorneys commonly bring claims on behalf of an estate. If you are unsure whether you have standing to claim, tell us who you are acting for and we will confirm the position.
How is this different from an appeal?
An appeal challenges an eligibility decision that was made. A retrospective claim covers a period where no assessment happened at all. If a decision exists for your period, the appeal route is the right one and we will say so.
How far back can a claim go?
Cut-off dates have applied to some historic periods, so the answer depends on the dates of care involved. Some older periods are now closed to new claims, while more recent unassessed periods generally remain open. Confirming the position for your specific dates is part of the records review, and we will tell you plainly if a period cannot be claimed.
Do you take a percentage of what is repaid?
No, never. We charge stated fees only, set out in writing before each stage begins, and we never take a percentage of any repayment secured. Percentage arrangements are how claims companies price their work; we are not a claims company. Whatever is repaid following a successful claim belongs entirely to the person or their estate.
Can you guarantee the fees will be repaid?
No, and no honest provider can guarantee an outcome. What we do guarantee is a frank written view of the evidence at the records review stage, before you spend anything on full claim preparation. If the records do not support a claim, we say so plainly and the matter ends there, which protects you from paying for work that cannot succeed.
Is this legal advice?
No. Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work. In retrospective claims this means we prepare and present the evidence, while any question of legal action remains a matter for you and your legal adviser.
Retrospective CHC claims explained
What retrospective and PUPoC claims are, who can bring one and how the process runs.
The NHS Continuing Healthcare process explained
The standard route: the Checklist, the Decision Support Tool and the ICB decision.
Who pays for care fees
When the NHS pays, when the local authority pays, and where means-testing applies.
Re ACC and CHC appeals: guidance for professional deputies
What the Re ACC ruling means for professional deputies pursuing retrospective NHS Continuing Healthcare claims.
Supporting guidance
Related NHS Continuing Healthcare guides
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 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.
Other CHC support stages
Discuss your case
Wondering about a past period of care?
Contact Nellie Supports with the outline: who the person is, the period in question and where they were cared for. We will confirm whether the records review is the right next step and the fee in writing.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.