Guides · Past care fees
Retrospective CHC claims, explained
If someone paid for care that the NHS should have assessed for Continuing Healthcare funding, their family can ask the NHS to look at that past period now. The official route is a request for an assessment of a previously unassessed period of care, and it can cover care paid for from 1 April 2012 onwards.
Can you reclaim care home fees that were already paid?
Yes, in a defined situation. NHS Continuing Healthcare (CHC) is the NHS funding for adults whose main need for care is a health need, and it should be considered before anyone is left to pay for that care themselves. If CHC is new to you, our guide to what NHS Continuing Healthcare is explains the funding and who it is for.
Sometimes the assessment never happened. A person paid for their care, in full or in part, during a period when there is evidence they should have been considered for CHC at the time but were not. The official guidance calls that period a previously unassessed period of care, shortened to PUPoC. A family can ask the integrated care board (ICB) to assess that past period now. If the person is found to have been eligible, the question of repaying the fees for that period then arises.
This page is about that route. It is a different mechanism from the refund the National Framework describes when an ICB takes too long over a current assessment after a positive Checklist. That refund has its own rules and its own trigger. A PUPoC request deals with a period that was never assessed at all.
Many families first meet this subject after a death, while sorting out an estate and finding years of care invoices. If that is you, take this at your own pace. The guidance sets no national deadline for starting a request, and the sections below set out exactly what it does and does not say about time.
What period can a retrospective claim cover?
The guidance draws one clear line. It says ICBs "should generally only consider requests for assessments of a PUPoC for care provided from 1 April 2012 onwards" (PUPoC guidance, "Relevant dates regarding requests").
Care before 1 April 2012 can only be considered where exceptional circumstances apply, and the guidance adds: "It is expected that these instances will be rare." So a claim reaching back before April 2012 is possible in principle but unusual in practice, and you should not build a case around it without advice.
What about a deadline in the other direction, the date by which a family must ask? The guidance does not state a national deadline for making a PUPoC request for care from 1 April 2012 onwards. That is the honest position: no cut-off date is written down. The firm boundary the guidance does set is the one above, the period the claim can cover. Once a request is under way, specific deadlines do apply to the applicant, and those are set out in the deadlines section below.
Who can make a claim?
Three situations come up, and the guidance handles each one.
The person who received the care can make the request themselves, if they are alive and able to. They will be asked to return application and consent forms, and the guidance gives 28 days for that.
A third party can make the request on someone else's behalf. That third party must prove their authority to act, for example under a power of attorney. The guidance gives 28 days to produce that proof, and if it does not arrive the ICB closes the case and a new application is needed (PUPoC guidance, "Requests from a third party").
When the person has died, the request is made for their estate, and the applicant must show they have the right to deal with it. The guidance gives 8 weeks to provide proof of executor or administrator status, extendable in exceptional circumstances. In practice that usually means the grant of probate or letters of administration. Fees paid from the person's own money are the usual subject of a claim, so it helps to be clear about who actually paid and on what basis. Our guide to who pays for care home fees explains how liability for fees normally sits.
What are the deadlines?
Two sets of timescales run through a PUPoC request: the deadlines on the applicant, and the timescales the ICB works to. The guidance words each one carefully, so the table keeps its wording. "Expectation" means the guidance uses should rather than must.
| Step | Timescale | How firm is it? |
|---|---|---|
| Applicant returns the application and consent forms | 28 days | Expectation |
| Third party proves authority to act | 28 days, or the ICB closes the case and a new application is needed | Expectation with a stated consequence |
| Proof of executor or administrator status when the person has died | 8 weeks, extendable in exceptional circumstances | Expectation |
| Applicant comments on the needs portrayal document | 28 days, "where possible" | Expectation |
| ICB completes the request, care period of one year or less | 6 months from receipt of the completed forms | Best practice example |
| ICB completes the request, care period over one year | "should not take longer than 12 months to complete, except in exceptional circumstances" | Expectation |
Notice the shape of this. The deadlines on the family are short, weeks rather than months, while the ICB works to timescales measured in months. If a form or a piece of proof will take longer than the period allowed, tell the ICB in writing before the time runs out and ask for an extension, rather than letting the case close.
How is a past period assessed?
A retrospective assessment asks the same core question a current one does: during that period, was the person's main need for care a health need? The answer is reached through the eligibility criteria, applied to the records from the time rather than to a person in the room. Our guide to the CHC eligibility criteria explains what those criteria look for.
Long periods are not judged in one sweep. The guidance says: "If a claim period spans a number of years, then the claim period should be broken down into manageable sections - for example, 12 months - with the eligibility criteria applied to each separate timeframe." So a four-year claim becomes a series of shorter periods, each with its own eligibility question. It is normal for the answer to differ between sections, because needs change over time, and a claim can succeed for some sections and not others.
To apply the criteria, the ICB builds a picture of the person's needs in each period from the records: care home notes, GP and hospital records, and anything the family can add. That picture is set out in a needs portrayal document, and the applicant should be given the chance to comment on it, within 28 days "where possible". Use that chance. The records may understate needs that were well managed, and the family often holds detail the files never captured.
Where do you start?
Here is the practical path.
- Write to the ICB for the area where the person's care was arranged and ask to make a request for an assessment of a previously unassessed period of care. Name the person, the care setting and the dates you believe were never assessed.
- Gather your proof of standing before the clock starts: power of attorney for a living relative, or the grant of probate or letters of administration after a death.
- Collect the paper trail for the period: care fee invoices and statements, the care home contract, care plans and reviews, and any assessments that did happen.
- Return the application and consent forms within the 28 days, and diarise every deadline in the table above.
- When the needs portrayal document arrives, check it against your own knowledge of the person and comment on anything missing or understated.
One thought before you sign anything. Some firms charge for handling this process, sometimes as a share of any refund. The request itself goes to the NHS through its own published process, and a family can make it themselves. A family can make the request, supply the evidence and comment on the assessment without paying anyone to do it. If a claim is complex or the sums are large, independent advice can still be worth having, but it is a choice, and it should be an informed one.
This page is legal information, not legal advice.
Common questions
Is there a deadline for making a retrospective CHC claim?
The guidance does not state a national deadline by which a family must make a request. The firm line it does draw is the period a claim can cover: ICBs should generally only consider care provided from 1 April 2012 onwards, with earlier periods expected to be rare exceptions.
Can I make a claim after my relative has died?
Yes. The executor or administrator of the estate can make the request. The guidance gives 8 weeks to provide proof of executor or administrator status, and that period can be extended in exceptional circumstances. If a third party acts instead, they have 28 days to prove authority to act.
How long will the ICB take to decide a retrospective claim?
For a care period of one year or less, the guidance gives 6 months from receipt of the completed forms as a best practice example. Where the period of care exceeds one year, the request should not take longer than 12 months to complete, except in exceptional circumstances.
Do I need a claims firm to make a retrospective claim?
No. The request goes to the NHS through its own published process, and a family can make it themselves. Some firms charge for handling it, sometimes as a share of any refund, so read any agreement carefully before signing. A family can complete the forms and supply the evidence themselves.