NHS Continuing Healthcare and your LPA

How the process runs

1. Ask the GP, hospital discharge team or social worker for a CHC checklist.
2. If the checklist screens in, a multidisciplinary team completes the Decision Support Tool.
3. The integrated care board decides eligibility, in principle within 28 days.
4. If refused, request the written rationale and use the local resolution then independent review process.

What attorneys should do

• Attend the DST meeting — a health and welfare attorney is the donor's representative.
• Send the LPA in advance and ask for all correspondence to come to you.
• Keep a daily needs diary: nights, falls, medication, behaviour, skin, nutrition.
• Challenge domains where the evidence in the record is thinner than the reality.

A worked example

Consider Bernard, whose wife Joan holds his health and welfare LPA. Bernard's care needs are complex — unpredictable behaviour linked to advanced dementia, a swallowing difficulty and frequent falls. Joan requests a CHC checklist through Bernard's GP, keeps a two-week diary of every fall and every episode of distress before the Decision Support Tool meeting, and sends the LPA to the multidisciplinary team a week beforehand so they know she is entitled to attend and speak. At the meeting, the notes in Bernard's file understate how often he needs two staff to manage a wash; Joan's diary supports raising that domain from moderate to high. The team's overall recommendation goes to the integrated care board with Joan's evidence attached, rather than relying solely on a single ward assessment.

Why it matters financially

If the assessment is refused

A refusal is not the end of the process. Ask in writing for the completed Decision Support Tool and the panel's rationale, then use the local resolution process before escalating to an independent review panel if the answer does not change. Refusals are common at first assessment, and a well-documented appeal — supported by a care diary, GP letters and specific examples tied to each of the twelve care domains — genuinely does change outcomes. Attorneys should not assume the first decision is final, particularly where needs have clearly changed since a previous, lower-scoring assessment.

Common questions

Read next

• Choosing a care home as an attorney
• LPAs and care home fees
• What can a health and welfare attorney actually decide?