If you are considering a CHC application without professional support, you should understand what is really at stake.
The National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care (July 2022) makes it clear: you are entitled to bring a representative or advocate to your CHC assessment and to any appeal if you are turned down.
This includes:
- The Multi-Disciplinary Team (MDT) assessment
- A Local Resolution appeal
- An Independent Review Panel convened by NHS England
Your representative can be anyone – a family member, friend, peer, nurse or solicitor. The choice is entirely yours.
Can you apply for CHC yourself?
Yes. Some families with stamina, determination and hundreds of hours to spare, do pursue an NHS Continuing Healthcare claim alone.
But applying for CHC yourself is not a simple form-filling task.
The financial stakes are significant. Securing CHC funding can mean the difference between paying thousands of pounds per month for care or paying nothing at all. So, getting it wrong can be costly.
The process is complex, technical, evidence-driven and governed by the NHS rulebook: The National Framework for NHS Continuing Healthcare Funding and NHS-funded Nursing Care. It is designed for NHS practitioners, not families – the clue is in the title.
Why the CHC Assessment Process is not a level playing field
Eligibility is assessed across 12 care domains. Interpretation is entirely subjective, which leads to nationwide variation in outcomes – often described as the “postcode lottery”. It is this subjectivity that enables Integrated Care Boards (ICBs) to reject a significant number of viable claims.
Families handling a CHC application without professional support often:
- Underestimate the evidential burden and complexity
- Become overwhelmed by paperwork/medical records
- Miss key evidence required by the Decision Support Tool
- Fail to present evidence of need against the four key characteristics (nature, intensity, complexity and unpredictability)
- Are outmanoeuvred by the ICB’s trained representatives and struggle at CHC assessment and appeal hearings
For guidance on MDT panel rights and advocacy, see our blog: Can The MDT Panel Refuse To Proceed If I Have An Advocate?
The consequence of getting it wrong? A legitimate claim may fail leaving families to fund the cost of care.
You don’t need to pay for help…
A recent article by Amy Roberts, Money Saving Expert (“Who’s eligible for this free care and why you shouldn’t pay to apply” dated 15/05/25) suggested families don’t need to pay for help because the process is designed for you and to be workable yourself.
In theory, yes.
However, in practice, preparing a strong NHS Continuing Healthcare case properly, especially for a retrospective appeal, typically involves:
- Analytically reviewing thousands of pages of care and medical records
- Laboriously mapping evidence directly to each care domain in the DST
- Identifying misleading information, inaccuracies and omissions (eg correcting paraphrased or part quotations)
- Drafting detailed evidenced-based coherent written submissions
- Preparing for and attending Local Resolution meetings and Independent Review Panels
This can sometimes take weeks or even months of work, depending on the volume of records under consideration. See Admirable Mathias’ story below.
Care records are often decisive. Explore this topic here:
Why Care Records Can Win or Lose Your Application for CHC Funding
What can I expect if going it alone without support
We know from our own experience from helping families navigate CHC for the last 15 years, that those who go it alone and actually succeed against the NHS, are a tiny percentage of all applications. Indeed, many of our readers have testified from their own personal shared experiences, that this is not a level playing field, and the system is designed against the individual ie to fail – and in favour the NHS.
What the NHS National Framework doesn’t do, is give you any practical guidance, templates, or know-how, as to what to do, how to present your CHC application, the ‘do’s and don’ts’ for success, and what to expect. It is supposed to provide guidance for everyone, but in reality, there’s little or nothing of any practical useful guidance in it – other than an outline overview of the CHC process. It doesn’t prepare you for the frustrations and hurdles you will encounter and how to overcome them and achieve CHC funding.
Retired Admiral Philip Mathias, who worked as a policy director on Britain’s nuclear deterrent, spent over 300 hours to recover over £200,000 in wrongly paid fees for his mother, said:
“In terms of complexity, the mental capacity required and the analysis skills needed, applying for CHC funding was as complex as some of the nuclear deterrent policy I worked on.”
“If someone with my experience and expertise found the process so difficult, my concern is that so many people who are applying for funding their loved one is entitled to will just decide it is not worth the stress, especially if they are also elderly themselves.”
Read his story to learn about his experience and the difficulties he faced when seeking CHC: “Fighting for NHS funding for my mother was as complex as my work on the nuclear deterrent”.
Incorrectly refused CHC funding can mean:
- Homes being sold to fund care
- Life savings depleted
- Retrospective claims becoming harder to evidence
When families are told by ICBs “you don’t need professional help”, the odds of success become even more slanted in their favour, and the financial exposure can be enormous.
Ask yourself honestly: do you have that time, expertise, and emotional resilience to battle against the NHS and their professionally trained assessors, whose remit is to support the NHS, not you?
Is CHC Advocacy Worth It?
Investigations reported by The Telegraph (reported 18/02/26) have highlighted concerns about certain unsavoury ICB practices, caught paying a third party to systematically reject potentially viable CHC claims – a policy that has saved them millions in care costs, at the individual’s expense. We anticipate a plethora of appeals once word circulates about this scandalous policy. See our Care To Be Different website for multiple articles on how to appeal.
Meanwhile, we pity those families who have wrongly been refused CHC and have had to sell homes and assets, and watch life savings disappear, to pay for a loved-one’s care.
All while being told: “You don’t need professional help.”
A specialist CHC nurse advocate or solicitor can:
- Interpret the National Framework accurately (often better than the NHS appointed assessors!)
- Identify evidential weaknesses immediately
- Understands how appeal panels really operate
- Prepare structured and persuasive submissions aligned to the four key characteristics
- Challenge flawed reasoning by NHS assessors
- Represent you robustly at appeal
- Bolster your chances of success
Yes, they have the same formal status as any representative. But they bring expertise, strategy and experience and can ensure the process is done fairly and robustly – giving you the best chance of success.
Farley Dwek Solicitors, working alongside specialist nurses, have represented families for years – and will not take cases without reasonable prospects of success.
Professional representation does not guarantee success. However, it significantly increases the likelihood of presenting a strong, properly evidenced case.
Should You Go It Alone?
You are absolutely entitled to representation in your CHC assessment and appeal. Don’t let anyone tell you otherwise!
If you choose to fight your ICB application alone, we genuinely wish you luck!
If you choose to proceed without professional support, do so fully aware of:
- The evidential burden
- The time commitment. It’s a technical, complex, daunting and time-consuming
- The adversarial nature of some assessment and appeal hearings
- The life-changing financial consequences of refusal
When care costs can exceed several thousand pounds per month, investing in specialist support may ultimately provide far greater rewards.
For more reading around the subject:
We recommend that you also read our blogs, here’s a small selection from hundreds, to help you:
Can The MDT Panel Refuse To Proceed If I Have An Advocate?
Appealing a Negative CHC Decision: What You Need to Know!
Need Specialist Support?
If you require one-to-one assistance with your CHC application or appeal, visit www.farleydwek.com for further information.
If you have applied for CHC yourself and wish you had approached things differently, consider sharing your experience to help others.
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