NHS Continuing Healthcare
CHC Review Support: Protecting Funding That Is Already In Place
Once NHS Continuing Healthcare is awarded, the Integrated Care Board should review the care package within 3 months and then at least once a year. The purpose of a review is to check that the care arrangements still meet the person's needs. In most cases it should not reopen the question of eligibility. However, where there is evidence that needs have changed significantly, the ICB can decide to carry out a full reassessment, and that is the point at which funding can be reduced or withdrawn. CHC Review Support puts an independent, current assessment of the person's needs in front of that meeting, written in the language the care domains are scored in, so that a well managed condition is not mistaken for a reduced one. The fee is £900 plus VAT for returning clients and £1,100 plus VAT for new clients, with travel charged separately.
Independent evidence for three month and annual reviews, prepared before the meeting rather than argued during it
At a glance
Role
Independent evidence for a three month or annual CHC review
Framework
National Framework for NHS CHC and NHS-funded Nursing Care, 2022 revision
Format
Assessment at home or in the care setting, then a written evidence summary
Deliverable
A current account of needs mapped to the twelve care domains
Coverage
England. Wales runs its own Continuing NHS Healthcare framework
£900
Fixed fee, plus VAT
One working day
Response to your enquiry
England
Cover throughout the country
Social work led
Registered professionals
Plain-English explanation
What CHC review support is
A current, independent assessment of the person’s needs, produced before the review meeting and written in the language the process scores, so the decision is made on evidence rather than on impressions formed on the day.
Once funding is awarded, the Integrated Care Board reviews eligibility at three months and then at least annually. It is asking whether the person still has a primary health need, and it can reduce a package or withdraw it.
Most reviews are conducted on the care provider’s records and the existing care plan. If nothing independent has been written since the original decision, nobody in the room is describing the needs from the person’s side.
Well managed needs are still needs
The commonest reason funding is lost at review is that the care package has worked. A person who is stable because four calls a day, night supervision and timed medication keep them stable has not stopped needing any of it. The framework does not permit funding to be withdrawn because the care is doing its job.
Common situations
When you need review support
Funding awarded is not funding kept. The care package should be reviewed within 3 months and then at least annually. Most reviews confirm that the arrangements still meet the person's needs, but where the ICB sees evidence of a significant change it can move to a full reassessment, and a reassessment can reduce a package or remove it altogether. The person whose needs are well managed by the care they receive is the person most at risk at that point, because a settled picture reads as a smaller need.
The review is carried out by the Integrated Care Board, usually working from the care provider's records and the existing care plan. If nothing independent has been produced since the original decision, the review is conducted entirely on other people's documents.
A review date has arrived
Three months after the award, or annually after that.
You have been told it is a formality
That is usually said before a review that is not.
The person seems more settled
Stability produced by the care package is routinely read as reduced need.
Needs have increased
A review can go the other way, and the evidence has to show it.
The care provider has changed
A new provider’s records may not carry the history the review needs.
Funding was reduced at the last review
You want the next one approached differently.
What is assessed
What the review will look at
A review revisits the same ground as the original decision, on current evidence. These are the areas where a package is most often lost, and where an independent account makes the difference.
Whether the needs themselves have changed, as opposed to the presentation
What the care package is currently doing, and what would happen without it
Night-time needs and interventions, which are routinely under recorded
Fluctuation and unpredictability since the last review
Incidents, admissions and near misses in the period
Whether the original domain levels are still supported by the records
A review is not a fresh application
The person does not have to prove eligibility again from scratch. The question at a review is whether the care arrangements still meet the person's needs, and a full reassessment of eligibility should only follow where there is clear evidence that needs have changed.
1
The primary health need test
Reviews sit within the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, 2022 revision. The question at review is whether the person still has a primary health need, judged on the same four key characteristics as the original decision.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
2
How the judgement is made
A review that reduces or removes funding has to be reasoned in the same way as an eligibility decision, and recorded in writing. Well managed needs are still needs: the framework does not permit a package to be withdrawn because the care being provided has made the person stable.
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); the primary health need test; Integrated Care Board review and decision-making
For more, read our guide: The Decision Support Tool and the 12 care domains
The framework
The framework a review applies
Initial enquiry and triage
Tell us the review date and what has changed. We confirm whether review support is the right route within one working day.
Scope and fee
We confirm the scope, the fee plus VAT and any travel charge, in writing before you commit to anything.
The assessment
A registered professional assesses the person where they live, reads the current care records and speaks to the people providing day-to-day support.
The evidence written up
Needs are written up against the twelve care domains, showing what the package is managing and what the risk is without it.
Into the review
You go into the meeting with a current, independent account of need. Where the outcome is wrong, we explain the challenge routes and the timescales.
What happens next
Our review process
Evidence base
What we look at
A review is about the current picture, so the evidence base is the period since the last decision.
Time with the person
Where they live, at their pace, seeing the day as it actually runs.
Current care records
Daily notes, charts and handovers since the last review.
The people providing the care
Family carers and care staff who know what a bad night looks like.
Incidents and admissions
Falls, choking, infections, hospital episodes in the period.
The existing care plan
What it says, and where it has fallen behind the person.
The original decision
The domain levels awarded, and whether the records still support them.
Deliverable
What you receive
Everything is prepared before the review meeting, not during it:
A current independent assessment of day-to-day needs
Needs mapped to the twelve care domains
What the care package is managing, and the risk without it
A written care plan, where the higher tier applies
Checklist evidence included at no additional charge
Peer review by a second qualified professional
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.
Returning clients
£900 plus VAT
- A current care assessment by a registered professional
- Needs written against the twelve care domains
- The evidence prepared before the review meeting
- Attendance at the review meeting
- Checklist evidence included at no charge
One fee, agreed in writing before any work starts, and never a percentage of what is retained. Most CHC support is charged by the hour or as a share of the outcome, so the cost is unknown when you commit and grows the longer the case runs. Ours is stated up front, plus VAT and travel, and does not change if the case turns out to be harder than expected.
New to Nellie Supports
£1,100 plus VAT
- Everything in the returning price
- A written care plan alongside the current care assessment
- Charged once and carried through every later stage
The care assessment and care plan is an independent professional record of what the person needs, written in the language the twelve care domains are scored in. If the review goes against you, it is already the foundation of the appeal.
Transparent pricing
Two prices, depending on whether we already have your case
The work is the same. What differs is whether a written care plan is needed alongside the assessment. New clients receive the care assessment and care plan together, and it carries through every later stage of the case.
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 CHC review
A review is decided on current evidence of need. We are a practice that assesses and writes that evidence, rather than one that comments on somebody else’s.
Why families and professionals choose Nellie Supports
Social work led, not a claims company
Registered professionals prepare and present the evidence of need. We are not a call centre and not a no-win-no-fee operation.
We write our own assessments
A review usually hears one professional account of the person. We put a second, independent one in front of it.
Published fees, never a percentage
The whole price is published and confirmed in writing before instruction.
A permanent employed team
A full-time, in-house multidisciplinary team, not an ad hoc panel of associates.
Peer reviewed as standard
Everything we prepare is reviewed by a second qualified professional before it is used.
Honest about outcomes
The review decision is the Integrated Care Board’s. We never promise a result.
A daughter rang three weeks before her father's annual review. He had been eligible for two years, the package was working, and she had been told the review was "just a formality". What worried her was the sentence that followed it: that he seemed much more settled than last year.
He was more settled. He was more settled because four calls a day, night-time supervision and carefully timed medication had made him so. Nothing about the underlying needs had changed, and none of that was written down anywhere in a form the review would read.
A registered professional assessed him at home, read the current care records, and produced an account of his needs in the language of the twelve care domains, showing what was being managed and what would happen if it were not. The review had that in front of it alongside the provider's records.
The Integrated Care Board makes the decision at a review, as it does at the start. What changed here was that the meeting was looking at the needs rather than at the calm produced by meeting them.
This is an illustrative example. It does not describe any individual client.
How review support works in practice
Frequently asked questions
Frequently Asked Questions About CHC Reviews
Can NHS funding really be taken away at a review?
Yes, though not at every review. The Integrated Care Board should review the care package within 3 months and then at least annually, and the main purpose is to check that the care arrangements still meet the person's needs. Where there is evidence that needs have changed significantly, the ICB can arrange a full reassessment, and that is where funding can be reduced or withdrawn. That is why a review is worth preparing for rather than attending cold.
They said the review is just a formality. Is it?
Sometimes it is. But the outcome is a decision about whether a primary health need still exists, and it is made on the evidence in front of the meeting. If that evidence is only the provider’s records, the outcome depends on how well those records happen to have been kept.
He is much better than last year. Does that mean he will lose it?
It should not. Needs that are well managed are still needs. The framework does not permit funding to be withdrawn because the care package has made the person stable, but that reasoning has to be made explicit, and it rarely is unless someone puts it there.
What if the review goes against us?
A review decision can be challenged through the same routes as any eligibility decision, starting with local resolution. Everything prepared for the review carries forward, which is part of why the care plan tier exists.
Do you attend the review meeting?
Tell us the date at enquiry. Attendance is arranged case by case depending on how the Integrated Care Board is running the review, and any travel is confirmed in writing before booking.
The NHS Continuing Healthcare process explained
A plain English guide to the Checklist, the Decision Support Tool, the MDT and the ICB decision.
The Decision Support Tool and the 12 care domains
How the DST scores needs and why the domain language matters.
Challenging a CHC decision
What a decision letter means, and the routes open to you afterwards.
Supporting guidance
Related NHS Continuing Healthcare guides
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.
Independent Social Care Needs Assessment & Care Plan
Included in the new client price of every CHC service and charged once. Independent needs assessment and written care plan, also available on its own.
Other CHC support stages
Discuss your case
Is a review coming up?
Tell us when the review is, what has changed since the last one and who is carrying out the assessment. We will confirm the right level of support and the fee in writing.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.