What happens if NHS Continuing Healthcare funding is withdrawn?

Can NHS Continuing Healthcare funding be withdrawn?

NHS Continuing Healthcare, usually referred to as CHC, is not necessarily awarded for life. Eligibility can be reassessed where a person’s needs have changed.  

However, there is an important difference between reviewing a care package and reassessing eligibility.  

A person receiving for CHC should have their care package reviewed within three months of the original decision, then at least annually. These reviews ensure care arrangements remain appropriate and should not automatically trigger a new eligibility assessment. 

The most recent Decision Support Tool (DST) should be available for reference. If the review finds a significant change in needs that could affect CHC eligibility, the ICB may arrange a full reassessment. 

Funding should not therefore be withdrawn merely because:  

• an annual review is due;  

• the person has been stable for a period;  

• there have been fewer recorded incidents;  

• care staff are managing the risks effectively;  

• the person has moved to a different care setting;  

• the cost of the care package has increased.  

Decisions should be based on an assessment of the person’s current health needs and the care required to manage them. 

What may justify the withdrawal of CHC?

The relevant question is whether the person continues to have a “primary health need”. This is the test used to determine whether responsibility for the complete package of care rests with the NHS.  

A withdrawal may be justified where reliable evidence shows that the person’s needs have genuinely and sustainably reduced. Examples might include:  

• an intervention previously required is no longer necessary;  

• the frequency or severity of episodes has materially reduced;  

• a significant risk has permanently diminished;  

• skilled monitoring is no longer required at the previous level;  

• several interacting needs have reduced so that the overall care required is less intensive or complex.  

The ICB must identify specific changes since the previous eligibility decision. General statements such as “stable” or “well settled” do not sufficiently explain why someone no longer qualifies. 

Any reduction in levels recorded in the Decision Support Tool (DST) must be clearly supported by evidence. The DST should be completed using detailed assessments and supporting records to ensure consistent, evidence-based recommendations. 

Well-managed needs are still needs

A common difficulty arises where the reassessment focuses on the person’s current presentation without properly considering the care that keeps them stable.  

A person’s needs may seem less severe when care is effective. Reassessments should distinguish between a true reduction in need and needs that are still present but well managed through ongoing intervention, supervision, or treatment. 

For example, your relative may have fewer falls because staff supervise every transfer. Their skin may remain intact because they are repositioned regularly. Distress or challenging behaviour may be controlled through medication, familiar routines and skilled intervention.  

In each case, apparent stability may rely on ongoing care. The assessment should consider what support is needed to maintain this stability and what risks could return if care is reduced or removed. 

These are not necessarily examples of needs disappearing. They may demonstrate that substantial needs are being successfully managed.  

The assessment should consider:  

• what care and monitoring are required each day;  

• what would be likely to happen without that support;  

• how quickly staff must respond when problems arise;  

• whether apparently separate needs interact;  

• what skill, oversight and judgement are needed to manage the risks.  

A single assessment meeting may not reflect the true level of need. Daily care notes, incident records, and clinical evidence over time are often more informative. 

What process should the ICB follow?

Where a review identifies a possible eligibility-changing reduction in needs, the ICB should arrange a full reassessment.  

This process should involve a multidisciplinary team (MDT) with professionals who understand the person’s needs. The MDT should complete a new DST and recommend whether the person remains eligible. 

Evidence should be gathered

The reassessment should draw on relevant care, nursing and medical records. Depending on the needs involved, these may include:  

• current and previous care plans;  

• daily care notes;  

• medication administration records;  

• behavioural monitoring charts;  

• falls and incident records;  

• nutrition, weight and swallowing records;  

• continence records;  

• skin integrity and repositioning charts;  

• risk assessments;  

• GP, consultant and specialist nurse evidence.  

The MDT should consider patterns of need over time, not just the person’s condition on the day of assessment. The usual evidence period is three months, but this should not be used proscriptively to exclude relevant information.  

The family should be involved

The person and, where appropriate, their representative should have a meaningful opportunity to contribute.  

You should be able to explain the daily realities of care, identify inaccuracies, and provide additional records. If your relative lacks mental capacity, the ICB must address arrangements for representation, consent, and information sharing. 

The primary health need test should be applied

The MDT should consider the totality of the needs, including their nature, intensity, complexity and unpredictability.  

Eligibility is not determined by the levels of need alone. The MDT must also consider how needs interact and what they indicate about the overall quality and quantity of care required. 

A reasoned decision should be provided

The ICB makes the final decision. You should receive:  

• the completed DST;  

• the eligibility decision;  

• a clear explanation of the reasons;  

• details of how to challenge the outcome.  

The ICB’s decision-making should not be treated as a financial approval process. Its purpose is to determine whether the MDT’s recommendation correctly applies the National Framework to the evidence. 

What happens when CHC funding is withdrawn?  

A decision that your relative no longer qualifies for CHC does not mean their need for care has disappeared. Rather, it means that the ICB considers that responsibility for meeting those needs is no longer the sole responsibility of the NHS.  

The local authority may need to assess your relative’s care and support needs. Unlike CHC, local authority support is means-tested, so your relative may need to contribute to their care depending on their finances. 

Where the person lives in a nursing home, they will likely be considered for NHS-funded Nursing Care (FNC). This is a payment towards the registered nursing element of the placement and is different from full CHC funding.  

The ICB and local authority should plan future arrangements before the current CHC package ends to prevent any avoidable gap in essential care. 

You should ask for written confirmation of:  

• the date on which CHC funding will end;  

• who will take over responsibility for arranging care;  

• whether a local-authority assessment has been arranged;  

• whether NHS-funded Nursing Care has been considered;  

• whether the existing provider and care package will continue;  

• what charges, if any, are expected.  

Sometimes, families receive a withdrawal letter before alternative arrangements are confirmed. Do not assume responsibility will transfer automatically. Contact both the ICB and local authority promptly and request written confirmation of the arrangements. 

Are Fast Track cases different? 

Fast Track CHC is used where a person has a rapidly deteriorating condition and may be entering a terminal phase. A clinician completes the Fast Track Pathway Tool so that an immediate CHC package can be arranged without first completing the usual Checklist and DST process.  

Fast Track funding can be reviewed, but living longer than expected does not justify withdrawal in and of itself. The fact a person is no longer rapidly deteriorating does not necessarily mean they are no longer eligible for CHC funding. 

Before Fast Track CHC is withdrawn, the person’s ongoing eligibility should be considered through the usual multidisciplinary assessment process, including completion of a DST. The assessment should examine all current needs, including the care and treatment responsible for any apparent stability.  

If the person continues to deteriorate rapidly and appears to be entering a terminal phase, reassessment will not be appropriate and CHC should continue until the end of their life. The process should be handled sensitively and must not disrupt essential end-of-life care. 

How can you challenge the withdrawal decision?

The decision letter should explain the ICB’s local appeal or resolution procedure and the deadline for responding.  

You should request the documents used to make the decision, including:  

• the review that triggered the reassessment;  

• the previous and current DSTs;  

• the MDT’s recommendation;  

• the assessments and records considered;  

• any panel or ratification notes;  

• the ICB’s written rationale.  

Carefully compare the previous and current DSTs. Identify any domain levels reduced without evidence, overlooked records, or statements that mistake well-managed needs for reduced needs. 

A focused challenge should always demonstrate:  

1. what parts of the assessment are inaccurate;  
2. what evidence was omitted or misunderstood;  
3. why the care required remains substantial;  
4. how the needs interact;  
5. why the overall needs may still amount to a primary health need;  
6. whether any procedural failures affected the reliability of the decision.  

The challenge will usually begin through the ICB’s local resolution process. If the dispute is not resolved, the person or their representative may request an independent review through NHS England. The ICB should explain this right in its final decision letter.  

Do not submit an appeal automatically in every case. The likelihood of success depends on the records, the quality of the reassessment, and whether the evidence supports continued eligibility. 

How Farley Dwek can help 

A CHC withdrawal appeal requires more than demonstrating your relative is still unwell. The key issue is whether the reassessment was justified, if the DST accurately reflects their needs and whether the ICB correctly applied the primary health need test. 

Farley Dwek’s specialist solicitors and experienced Nurse Assessors can review previous and current DSTs, analyse care and medical records, identify unsupported reductions in need, and advise whether there are reasonable grounds to challenge the decision. 

Where appropriate, we can also prepare written appeal submissions and support families through local resolution or an Independent Review Panel.  

If the withdrawal decision does not reflect your relative’s care needs, contact our team for an initial discussion about the reassessment and available appeal options.