What to do when CHC funding is withdrawn
A decision to withdraw NHS Continuing Healthcare funding can be distressing for families, particularly when care needs are significant and the future feels uncertain. If CHC funding is removed following a reassessment, it can raise immediate questions about how care will be funded, whether the decision is correct and what steps you can take next.
In this guide, we look at this topic in more detail – what to do when CHC funding is withdrawn, and how to challenge the decision if you believe it is wrong.
Can CHC funding be withdrawn?
CHC funding can be withdrawn, although there is a specific process the ICB must adhere to, according to the National Framework for NHS Continuing Healthcare.
The ICB first needs to undertake a review, which considers the person’s needs and care package, to determine if anything has changed. Comparison should be made with the most recently completed Decision Support Tool, to help identify any significant changes.
If there is evidence of a significant change in needs, such that eligibility for CHC funding may be affected, a full reassessment will be required. This is separate to the review, and involves completion of a new Decision Support Tool by a multidisciplinary team (MDT), which may result in funding being withdrawn.
It’s important to note that a routine review should never result in funding being removed This can only happen after a full reassessment, and completion of a new DST.
More importantly, reassessment should only occur if the person’s needs have genuinely reduced or altered in a way that is likely to affect the primary health need test. Reassessment should not take place simply because care is being well-managed, or the current placement or service is meeting the needs effectively.
If the review states that needs have reduced, this should be supported by clear evidence, and if it is not, the decision may be subject to challenge. To dispute the outcome of a review, you will need to make a formal complaint to the ICB, setting out why you believe the decision is incorrect. You should focus on demonstrating that the person’s care needs have not changed significantly since the most recent Decision Support Tool. A successful complaint may prevent the ICB from proceeding to reassessment.
To minimise the chance of reassessment, you may want to consider our Review Advocacy Service. You can also read more about NHS Continuing Healthcare funding here: What is CHC?
Why would CHC funding be withdrawn?
NHS CHC will be withdrawn if the NHS considers the person no longer has a primary health need.
In practice, that typically means the assessors conclude that the person’s needs have stabilised and/or reduced and are now within the scope of social services.
The NHS will argue that the nature, intensity, complexity, and unpredictability of the needs no longer justifies CHC funding.
That said, families often dispute these decisions, especially in cases where a person may appear more settled because they are receiving the right care, close supervision and consistent support – which does not necessarily mean their underlying needs have reduced. It may simply mean those needs are being managed properly.
Concerns can also arise when assessments don’t fully reflect the available evidence, the Decision Support Tool has not been completed properly, or the impact of well-managed needs is overlooked. These are just some of the reasons families seek CHC funding advice when funding is withdrawn.
If you’re unsure whether the decision to withdraw CHC funding is correct, you may benefit from appeal advice.
Can you appeal the CHC funding decision?
If you believe funding has been wrongly removed, you can appeal the CHC funding decision.
The first stage is local resolution with the Integrated Care Board, which allows you to challenge the decision and explain why you believe the assessment or review was inaccurate. If the matter is not resolved at that stage, it can then be escalated to an Independent Review Panel at NHS England.
A strong appeal depends on evidence describing the daily care needs, such as medical records, care home notes, risk assessments, behaviour records, support plans, medication charts, previous assessment documents and the current review paperwork.
Farley Dwek can offer families both CHC appeals representation and CHC appeals advice in these circumstances.
Does CHC funding continue during an appeal after withdrawal?
Usually, no. If CHC funding has been withdrawn, it won’t normally continue while the appeal is ongoing, which can create immediate financial pressure for families, especially when care fees are significant.
Depending on the person’s financial circumstances, they may need to self-fund during that period, or the local authority might contribute following a financial assessment. This is often one of the most difficult parts of the process, because the dispute may still be unresolved while payment arrangements must be made.
So, what happens if CHC funding is withdrawn? In many cases, the person’s care continues, but the funding stream changes unless and until the decision is overturned.
If you are facing that situation, you can find more advice in our article on Paying for care home fees before CHC
Can CHC funding be backdated if the decision was wrong?
The short answer is yes, but it depends on the facts, the evidence and the outcome of the appeal or review. CHC funding will be backdated if it’s later decided that funding was wrongly withdrawn, which means reimbursement of care fees paid during the disputed period.
In other words, if a successful appeal shows that the person should have remained eligible for NHS CHC funding, the NHS will have to repay the cost of care that should have been covered.
CHC funding advice from Farley Dwek
When CHC funding is withdrawn, it’s not always easy to tell whether the decision is justified or not.
The reviews and reassessment processes can be complex, and the correct application of the National Framework for NHS Continuing Healthcare, the Decision Support Tool, and the test for a primary health need all make a significant difference to the outcome.
If you believe funding has been wrongfully removed, it’s important to seek advice as early as possible. Farley Dwek can help you understand the decision, assess whether there are grounds to challenge it and also advise on the next steps.
The first step is to speak to one of our friendly and experienced team about how we can support you. Contact us online or call us on 0161 272 5222.
