A Growing Scandal – Concerns Intensify Over Access to “Shrinking” NHS Continuing Healthcare Funding

The NHS’ Continuing Healthcare (CHC) scheme is intended to meet the full cost of care for adults with significant ongoing healthcare needs, but with approval rates falling at a time when applications are growing; and reviews by external providers sometimes unjustly resulting in previously awarded funding being withdrawn; James Urquhart-Burton of Winston Solicitors says the whole picture is nothing short of a growing scandal. 

James, who is Head of CHC Claims at Leeds-based Winston Solicitors, said: “The need for CHC comes at the worst of times for any family, but the process they face to receive the monies thousands of them are legally entitled to is gruelling. It can be lengthy, complex and at times inconsistent – and worse; the way the process operates can, and often does, limit the number of people who successfully receive funding.” 

“The issues surrounding the provision of CHC are very well and recently documented. The topic was debated in Parliament in March, while a Nuffield Health report in September 2025 grimly dubbed it an all or nothing scheme – but despite this, still nothing has been done to fix it.” 

James, who’s been working on CHC claims for 15-years, reports that the numbers coming to him to appeal rejected claims or fight for retrospective monies following a loved one’s death are growing at an astonishing rate. And what makes it even more concerning is that it is really only those who can afford private representation that are coming to him; with those that don’t have the means to pay for professional support left to navigate the complex and technical appeals process alone. 

“The NHS is meant to provide healthcare for all, but when it comes to CHC, we’re finding vital care funding withheld for spurious reasons; or withdrawn based on personal opinion and without clinical evidence,” explained James. “We’ve also witnessed an increasing number of decisions being made that do not clearly align with the available clinical evidence or the National Framework for CHC.” 

Amongst a recent slew of cases that have left James absolutely staggered are: 

• A case where the initial screening assessment showed the patient required a full eligibility assessment for CHC, but the assessor incorrectly interpreted the report they had produced. As a result, a full assessment wasn’t carried out and the incorrect report was then relied upon for every annual review. The patient died without ever receiving a proper assessment. 

• A case where the patient (a young man) was completely bedbound, with little hope of recovery, requiring 24/7 support and monitoring.  He was deemed eligible for CHC following a Multidisciplinary Team (MDT) assessment, but the Integrated Care Board (ICB) responsible for this case rejected the recommendation, convened multiple additional panels until the desired decision was reached and ultimately deemed that he was not eligible for funding. 

• A case where the ICB refused to reassess CHC eligibility for a patient with a progressive neurological condition that had deteriorated significantly since the initial assessment in August 2024. Instead of conducting a thorough reassessment to see if her needs had genuinely changed, the board repeatedly used routine nursing reviews failing to pick up on the gravity of these changes and avoiding a full multidisciplinary evaluation of her eligibility. The family were also misinformed about their rights; being told that they could appeal, but when they tried, told they couldn’t. This has happened repeatedly,  caused confusion and denied the family the ability to exercise any meaningful rights in relation to the original 2024 assessment. 

• A case where a lady with a chronic and debilitating disease had been granted CHC and had received it for two years. She was reviewed by a private nursing agency hired by the ICB, who recommended a full re-assessment of her eligibility despite there being no improvement in her condition. 

“This is just the tip of the iceberg – the full extent of which is scandalous; especially when looked at in the context of an ageing population that will undoubtedly lead to the numbers qualifying for CHC growing significantly over the next few years.” 

“The situation urgently needs to be addressed and rectified so that those who qualify for funding receive monies that will not only make a big difference to the care they receive, but protect their children and other relatives from financial hardship due to spiralling care costs. And in many cases, the issue preventing the funding decision being made is not the legal framework itself, but how it is applied in practice.” 

Photograph provided by Winston Solicitors

Alicia Ward