Retrospective CHC claims in England: getting past care fees assessed

What is a retrospective CHC claim?

A retrospective CHC claim asks the NHS to assess a past period of care that someone paid for. CHC, or NHS Continuing Healthcare, is care the NHS pays for in full. NHS continuing healthcare retrospective claims apply when the person should have been considered for CHC at the time, but wasn’t. They go to the integrated care board (ICB) that was responsible for the person then. The ICB is the NHS body that decides CHC funding for an area.

The rules are in guidance from the Department of Health and Social Care (DHSC), last updated on 19 March 2025. Its official name for a claim is a request for an assessment of a “previously unassessed period of care”, or PUPoC for short.

The guidance sets three conditions. Nobody considered the person’s eligibility for CHC during that period. The person “had funded that past period of care in full or in part”. And there’s appropriate, objective evidence that CHC should have been considered then.

If the person had a full assessment at the time and was found not eligible, that period counts as assessed. So it isn’t a previously unassessed period. The way to question that decision was the ICB’s review process at the time. Concerns about how a past Checklist or assessment was carried out go to the NHS complaints procedure. If CHC is new to you, our guide to how CHC funding works in England explains the funding and the assessment.

Can CHC funding be backdated?

Yes, in two situations, and they work differently.

The first is a delay on a current assessment. Sometimes the ICB takes longer than 28 days to decide after a positive Checklist, the short screening form for CHC. If there’s no good reason and the person is found eligible, the ICB should refund care costs from day 29 to the decision date. This rule is in the National Framework, the government’s rulebook for CHC (Annex E, pages 178 to 179). The Framework lists reasons a delay might be justified, such as waiting for records from someone else.

The second is a past period that nobody assessed, which is what the rest of this guide covers.

What period can a retrospective claim cover?

The DHSC guidance says ICBs “should generally only consider requests for assessments of a PUPoC for care provided from 1 April 2012 onwards”. For earlier care, the ICB should consider whether there are exceptional circumstances. The guidance expects those to be rare. Earlier periods, from 1 April 2004 to 31 March 2012, were covered by a “close down” announced on 15 March 2012.

Long claims are split up. The guidance says a claim that spans a number of years should be broken into manageable sections, for example of 12 months. The eligibility criteria are then applied to each one. So a four-year claim may become four separate decisions. Needs change over time, so a claim can succeed for some sections and not others.

Who can make a retrospective claim?

The person who received the care can apply themselves. If they have capacity, they can also ask someone else to apply for them and give their consent. If they lack the capacity to make the request, the guidance asks for a registered lasting power of attorney or a deputyship order. If neither exists, the ICB should consider whether to make a best interests decision under the Mental Capacity Act 2005. When the person has died, the claim is made for their estate.

It helps to be clear about who paid the fees and from which account. The claim is about money the person paid for their own care, and any refund goes to them or to their estate. Our guide to who pays for care home fees in England explains how responsibility for fees normally works.

Is there a deadline for NHS continuing healthcare claims?

We read the DHSC guidance again on 13 November 2026. It sets no national deadline for making a request. The time limits it does set apply once a request is under way, and they’re in the next section.

Records do get harder to find as the years pass, and the ICB relies on the evidence from the time.

What are the time limits once you apply?

Once a request is made, the guidance sets short limits for the applicant and longer ones for the ICB. In the table, “expectation” means the guidance says “should” rather than “must”.

Source: Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012, Department of Health and Social Care, updated 19 March 2025.

How is a past period assessed?

A retrospective assessment asks the same question as a current one: during that period, did the person have a primary health need? That means most of their care was about meeting or preventing health needs. The difference is that the evidence comes from records rather than from a person in the room. Our guide to the criteria for CHC funding explains the test the ICB applies. The DHSC guidance sets out the steps.

1. 1

   The ICB checks it’s the right one

   It confirms it was responsible for the person during the period. If it wasn’t, it should tell you and pass the request to the ICB that was.

2. 2

   You return the forms

   The application and consent forms, with proof of your authority to act if you’re applying for someone else.

3. 3

   The ICB gathers the records

   Care home, GP, hospital and social care records for the period, along with anything you send.

4. 4

   A needs portrayal is written

   A summary of the person’s needs over the period, which you’re asked to comment on.

5. 5

   A team completes the Decision Support Tool

   The Decision Support Tool (DST) is the form for a full CHC assessment. After any Checklist screening, a multidisciplinary team (MDT) uses the needs portrayal to complete it for the period. The team then makes a recommendation.

6. 6

   The ICB decides and writes to you

   It should give its reasons in writing. If it agrees the person was eligible, it works out the repayment.

The team must include at least two professionals from different healthcare professions, or one healthcare professional and one person who assesses care and support needs. The ICB should follow its recommendation except in exceptional circumstances (DHSC guidance).

When you comment, look for needs that were well managed, because records written at the time can understate them. The National Framework says “well-managed needs are still needs” (page 51). The family often remembers what the files leave out.

What evidence helps a retrospective claim?

The ICB collects the main records itself, but you can add a lot. Useful evidence includes:

• care home records for the period, such as care plans and reviews, daily notes, and charts for turning, fluids, food, falls and behaviour
• GP and hospital records, including discharge letters and specialist reports
• the council’s social care assessments and care plans
• proof of what was paid, such as invoices, receipts and bank statements
• the care home contract and any letters about fees or funding
• your own notes, emails, diaries and photos from the time, which can show what a typical day involved

What happens if the claim succeeds?

If the ICB finds the person was eligible for all or part of the period, it repays the care fees for that time. The payment goes to the person or their estate. The DHSC guidance says the aim is to restore them to the financial position they would have been in. It says the ICB “should therefore reimburse the individual for the care costs incurred for the relevant period, plus interest”.

NHS England’s 2015 redress guidance advises compound interest at the Retail Price Index, using the average rate for each year whose care costs are being repaid. It also says redress, meaning the repayment, should be paid promptly once eligibility is decided. Payment of the parts nobody disputes shouldn’t be held up by an argument over the rest.

If the ICB decides the person wasn’t eligible, it should explain why in writing. You can ask the ICB to review the decision. Then you can apply to NHS England for an independent review. After that, you can complain to the Parliamentary and Health Service Ombudsman (DHSC guidance).

Can funded nursing care be backdated?

NHS-funded Nursing Care (FNC) is the lower NHS award, paid to care homes with nursing. For a retrospective claim, what matters is whether CHC was considered at all during the period. The DHSC guidance says that where someone received FNC with regular reviews that considered CHC, the period counts as already assessed. Sometimes a person received FNC “but there was no prior consideration of eligibility for NHS CHC”. Then the period should be treated as a possible PUPoC and looked into. The National Framework says CHC should be considered before any decision about FNC (page 9).

Where do you start?

Here’s a practical order of work.

1. Write to the ICB you think was responsible at the time. Say you want to request an assessment of a previously unassessed period of care. Give the person’s name, where they were cared for and the dates. If it isn’t the right ICB, it should pass the request on.
2. Get your authority ready. For a living person who has capacity, that’s their consent. If they lack capacity, it’s a registered lasting power of attorney or a deputyship order. After a death, it’s proof that you’re the executor or administrator.
3. Gather what you hold, such as invoices, bank statements, the care home contract and your own notes from the time.
4. Put every time limit from the table above in your diary.

If you’d rather hand it over, our help to reclaim care home fees means we build and run the claim for you.