About this guide
When a loved one needs long-term nursing care, it’s never easy. While the focus is always on their comfort and wellbeing, for many families, getting the right care for their loved one also brings a heavy financial burden.
37% of Britain’s 380,000 care home residents are self-funding their care. And care home fees can quickly mount up, often reaching thousands of pounds a month. Many families end up selling their loved ones home or using their life savings to cover these costs.
What many people don’t realise is that, under the NHS Continuing Healthcare (CHC) scheme, the NHS may be responsible for covering those care costs in full. If your relative’s care needs are primarily health-related, you should never have had to pay for their nursing care.
Unfortunately, thousands of families across England and Wales are still paying unnecessarily, either because they were never told about CHC funding, or because their loved one’s eligibility was incorrectly assessed. The good news is that it’s possible to reclaim those fees, even for care paid years ago.
This guide will explain what a nursing recovery claim is, how NHS Continuing Healthcare works, and how you can make a claim yourself.
What is a Nursing Recovery Claim?
A nursing recovery claim is a process through which you can reclaim care home fees that should have been paid by the NHS under the Continuing Healthcare (CHC) scheme.
In other words, if your loved one’s care was primarily for a health need, rather than just social or personal care, then the NHS should have covered the entire cost. If they didn’t, you may be entitled to a refund of the care fees you or your family paid.
Examples of situations where you might be eligible to claim include:
- A relative was in a nursing home receiving ongoing medical or nursing care.
- The family paid the care home fees privately.
- The NHS did not carry out a CHC assessment or did so incorrectly.
If the NHS later accepts that your loved one should have been eligible, you can claim a retrospective refund of the wrongly paid care costs.
The NHS Continuing Healthcare (CHC) Scheme
NHS Continuing Healthcare (CHC) is a package of care arranged and fully funded by the NHS for adults with significant ongoing healthcare needs.
CHC covers the full cost of care, whether that care is provided:
- In a care home (including nursing homes),
- In your own home, or
- In another care setting.
This funding is not means-tested. That means your relative’s savings, income, or property value do not affect eligibility. Instead, it depends entirely on their health needs, not their finances.
Eligibility criteria
To qualify for NHS Continuing Healthcare, your loved one’s primary need must be a health need.
Eligibility is based on four main factors:
- Nature: What type of care and support does your relative need?
- Intensity: How severe or frequent are their health needs?
- Complexity: How complex is the interaction between different needs?
- Unpredictability: How much risk is there that their condition could suddenly change and require urgent care?
During the assessment, the NHS will look at areas such as:
- Mobility and physical health
- Nutrition and hydration
- Continence
- Breathing
- Skin integrity (e.g., pressure sores)
- Medication needs
- Cognition and communication
- Behaviour and psychological needs
If the assessment finds that the nature, intensity, complexity, or unpredictability of these needs is primarily health-related, the NHS should fund the care in full.
How far back can you claim?
The retrospective claim route is for periods where no assessment was ever conducted, not for appealing a decision you disagreed with at the time.
For claims in England, you can generally only claim for previously unassessed periods of care back to April 1, 2012. (The government set this deadline that closed claims for care periods before March 31, 2012.)
For periods from April 1, 2012 onwards, there is no official fixed deadline to start a retrospective claim for a previously unassessed period of care. However, it is advisable to make the request as soon as possible as evidence like medical and care records can become harder to gather over time.
If you are appealing a past decision, there is a strict time limit of six months from the date you received the original negative eligibility decision to lodge an appeal.
In Wales, retrospective claims for NHS Continuing Healthcare are generally limited to the 12 months prior to the date of the application for review.
How to make a claim yourself
You can apply for NHS Continuing Healthcare or request a review of a past decision yourself, without using a solicitor. Here’s how:
Step 1: Contact Your Local Health Authority
- In England, contact your local Integrated Care Board (ICB).
- In Wales, contact your Local Health Board (LHB).
You can find contact details on the NHS website or by searching online for your local ICB/LHB.
Step 2: Request an assessment or review
- Ask for a Continuing Healthcare assessment if your loved one is still receiving care.
- If they have passed away, you can ask for a retrospective review of whether they should have qualified for CHC during their lifetime.
Make your request in writing (email or letter), including:
- The person’s full name, date of birth, and NHS number (if known).
- The name and address of the care home.
- Dates of care and any supporting documents (e.g., invoices or medical reports).
- A clear statement that you believe they were eligible for NHS Continuing Healthcare funding.
Step 3: Complete the checklist assessment
The first stage is a CHC Checklist Assessment, usually carried out by a nurse, doctor, or social worker. This determines whether the person should move to a full assessment.
If the checklist indicates potential eligibility, the ICB/LHB will arrange a Full Assessment using the Decision Support Tool (DST).
Step 4: Full assessment
The assessment team usually includes healthcare professionals familiar with the person’s needs – they will gather medical evidence and discuss each area of need.
You can attend the assessment and provide your input as a family representative.
Step 5: The decision
After the assessment, the ICB/LHB will decide whether your loved one qualifies for CHC.
- If approved, the NHS will fund care costs going forward (and may refund past costs).
- If refused, you can request a review or appeal. You have the right to challenge the decision if you disagree.
Step 6: Claiming a refund
If the NHS accepts that your relative should have been eligible for CHC, you can claim back care home fees that were wrongly paid.
This can cover months or even years of care costs, depending on when the NHS error occurred.
How to get help
Making a CHC or nursing recovery claim can be time-consuming and emotionally demanding. The process involves detailed medical records, multiple assessments, and lengthy correspondence with NHS bodies.
If you prefer expert support, Hugh James can manage the claim for you.
As one of the UK’s leading care fee recovery law firms, Hugh James’ expert team of lawyers work alongside leading charities supporting older people and carers. Since 2006, they have recovered over £250 million in wrongly paid care fees.
You can start by completing their free online questionnaire (link) to check your eligibility. It only takes a few minutes, and their initial assessment is completely free with no obligation to proceed.
If you decide to move forward, Hugh James makes the process much easier for families by offering transparent costs and funding options, including “no win, no fee” arrangements for legal costs, meaning you won’t pay legal fees if the claim is unsuccessful. Their team handles everything from obtaining medical records and reviewing eligibility to challenging past assessments and negotiating refunds from the NHS.
Start a claim now
Whether you choose to apply yourself through your local health authority or seek help from specialists like Hugh James, don’t let a potential claim go unexamined.
The CHC system can be complex, but every family deserves to know whether their loved one’s care should have been free under NHS rules. Take the time to check: it could mean recovering thousands of pounds in wrongly paid fees.