We helped a family successfully challenge a negative NHS Continuing Healthcare (CHC) funding decision, securing full NHS funding and backdated funding without the need for a Local Resolution Meeting.
The challenge
Our team attended the Decision Support Tool (DST) assessment in November 2024 after the family sought expert support with their NHS Continuing Healthcare assessment. Despite the seriousness and complexity of our client’s needs, the outcome was negative and they were found not eligible for CHC funding.
This left the family facing uncertainty over how their loved one’s care would be funded, as well as the emotional and financial pressure that often follows a refused NHS Continuing Healthcare decision.
How we helped
After carefully reviewing the assessment outcome, we advised the family that they had strong grounds to pursue an NHS Continuing Healthcare appeal. We prepared detailed written representations to the Integrated Care Board (ICB), setting out the nature, complexity, intensity and unpredictability of our client’s needs, and explaining why they met the test for a primary health need.
Our written appeal was so strong that the ICB overturned the original decision without requiring a Local Resolution Meeting.
In its final outcome, the ICB accepted that our client was eligible for full NHS Continuing Healthcare funding, placing particular emphasis on their challenging behaviours, the risks involved, and the high level of supervision needed to maintain safety.
The outcome
The ICB confirmed eligibility for backdated NHS Continuing Healthcare funding from the date of the original assessment in November 2024 through to the present day.
This meant the family secured both ongoing CHC funding and reimbursement for care costs that should have been covered by the NHS, giving them financial certainty and peace of mind.
Louis Seymour, Legal Services Director at Compass CHC said:
“This case is unusual because NHS Continuing Healthcare appeals are more commonly decided after an appeal meeting has taken place. It shows how powerful well-prepared written appeal representations can be. In the right circumstances, they can secure the correct outcome without the added stress of attending an appeal meeting.”
Learn more: How do I appeal an NHS Continuing Healthcare funding decision?
If you are self-funding care and are unsure whether NHS Continuing Healthcare may apply, we can help you understand your options and support you through the assessment and appeal process. Contact us to discuss your situation confidentially.
