Route A
No CHC consideration for the period
A retrospective review may be appropriate where the relevant past period was not assessed and there is objective evidence that CHC should have been considered.
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Care home fee recovery · England
Can you reclaim care home fees from the NHS?
Yes, in some cases. If a past period of care should have been funded through NHS Continuing Healthcare, reimbursement may be due. The correct route depends first on whether that period was genuinely unassessed or whether CHC was already considered and refused.
Reviewed by Paris Theodorou, Solicitor & Principal · Theodorous · SRA 809508 · Updated 26 September 2026
First: was the period ever assessed?
This is the most important distinction. A Previously Unassessed Period of Care (PUPoC) is not simply a second attempt at a CHC decision that has already been made.
Route B
CHC was considered and refused
The route is normally review, local resolution, complaint or independent review, depending on the history and timing. See the CHC appeal process.
What happens if the retrospective review finds eligibility?
Where an ICB determines that the person was eligible for CHC for all or part of the period, the government guidance provides for reimbursement of the relevant care costs. Redress guidance also addresses interest so that the person, or where appropriate the estate, is put as closely as possible into the financial position they would have been in had the correct funding decision been made at the time.
What does the NHS actually assess?
The underlying eligibility question is still whether the person had a primary health need. That analysis looks at the totality of needs, including nature, intensity, complexity and unpredictability. It is not decided by diagnosis, savings or whether the person lived in a care home.
If you are unsure whether the needs were potentially high enough, start with who qualifies for NHS Continuing Healthcare and then compare the evidence with the 12 Decision Support Tool domains.
What evidence matters in a retrospective case?
The strongest cases are built from records created at the time. Current PUPoC guidance identifies sources such as care-home records, GP records, hospital records, social-care assessments and records from other NHS services.
Care plans and reviews from the relevant period.
Daily notes, night records and incident or falls records.
Medication administration records and monitoring instructions.
Nutrition, skin, mobility and behaviour records where relevant.
Professional entries from GPs, community teams, mental-health services and therapists.
Evidence also needs to capture care that was successfully preventing deterioration. See why well-managed needs still count in CHC.
How does a PUPoC request progress?
01
Identify the exact period
Work out the dates, who paid the fees and whether there was any CHC assessment during that time.
02
Contact the relevant Integrated Care Board
The ICB can provide its process and forms for a previously unassessed period.
03
Gather contemporaneous evidence
The records should build a picture of the person’s needs across the claimed period rather than rely only on later recollection.
04
Screen and assess where required
The ICB may use the CHC Checklist and, where appropriate, undertake a full retrospective assessment.
05
Receive a reasoned decision
If eligibility is established, reimbursement should follow for the eligible period. If not, the reasons and review route should be explained.
How long should a retrospective review take?
There is no single universal completion period. Current guidance says ICBs should set reasonable and proportionate timeframes. It gives six months as an example of best practice for a claim period of one year or less, while a longer claim should generally not take more than 12 months except in exceptional circumstances. These are process expectations, not guarantees.
Can an estate reclaim fees after death?
Potentially, yes. Current PUPoC guidance expressly contemplates reimbursement to an individual or their estate where retrospective eligibility is established. The personal representative will need appropriate authority. See our detailed guide to reclaiming care home fees after someone has died.
Do you need a solicitor?
No. An individual or authorised representative can approach the ICB directly. Specialist representation may be useful where the period is long, the evidence is incomplete, earlier decisions overlap with the period, the needs are complex, or a refusal needs to be challenged.
Related care-fee recovery guidance
Follow the evidence, not just the bill
Retrospective CHC claimsHow PUPoC reviews work and what an unassessed period means.Claiming after deathAuthority, evidence and estate-specific practical points.Primary health needThe test that sits underneath every CHC eligibility decision.Decision Support ToolHow the 12 domains and overall needs analysis fit together.Care home fees calculatorEstimate the care fees paid over the relevant period.Already assessed and refused?Use the appeal route rather than treating it as an unassessed period.