Retrospective Reviews
What is a Continuing Healthcare Retrospective Review?
You can request a retrospective Continuing Healthcare (CHC) assessment to be undertaken if you have been paying for your care but have not been previously assessed for NHS CHC. A retrospective assessment of a ‘previously unassessed period of care’ (PUPoC) can apply to both current patients and people who are deceased.
The ICB can consider undertaking assessments from 1 April 2012, as the opportunity to claim for a period before this date has now passed.
Requests for a retrospective (PUPoC) review should be sent to:
Level 3, Christ Church Precinct
County Hall
Fishergate Hill
Preston
PR1 8XB
The Retrospective Review Process
Upon request, you will be asked to complete a questionnaire and provide documentation concerning your authority to act. The ICB will need to undertake the necessary checks to confirm that the review period was previously unassessed and (in cases where you are not the individual in receipt of the care) that you are legally entitled to act on their behalf.
In order to undertake a review of a PUPoC, evidence will be obtained from all parties involved in the individual’s care for the claim period (this can include care provider, GP, Hospital and Community Health services). Legal representation is not required however if you choose to employ someone to represent your case the NHS will not reimburse you this cost.
The evidence will be reviewed and collated by a clinical assessor and a document detailing the individual’s health and care needs throughout the review will be shared with you to review. An NHS CHC Checklist will then be completed. If the outcome of the Checklist indicates that a full assessment is not indicated, we will inform you of this, provide you a copy of the Checklist and your case will be closed. You will be informed how you can challenge this decision if you disagree with the outcome.
If the outcome of the Checklist indicates that a full assessment is required, the retrospective review will proceed. It is possible that only part of the period may result in a positive checklist, and this will form the claim period.
A multi-disciplinary team (MDT) will use the evidence collected to produce the retrospective Decision Support Tool(s) (DST). The DST(s) will contain a recommendation on the individual’s eligibility for NHS CHC funding for the review period.
You will be sent a letter detailing the retrospective review’s outcome. The outcome will be one of the following:
- The individual was eligible for CHC funding throughout the Retrospective Review.
- The individual was eligible for CHC funding for part of the period of the Retrospective Review
- The individual was not eligible for CHC funding for any part of the period of the Retrospective Review
If the individual was eligible for CHC funding for all or part of the period under consideration, reimbursement arrangements will be made.
If you disagree with the outcome of the Retrospective Review, you can notify the Retrospective Team within 6 months of the date of the outcome letter that you wish to appeal the decision.
Why would a request to complete a retrospective review be declined?
When we have checked an application, it is not always be possible to go ahead with a retrospective review, for reasons such as:
- The period of care requested may have been previously assessed for CHC eligibility.
- We cannot get all the care records we need; this may be because they have been destroyed by the record holder. There is guidance about retention of records needed to be held by NHS organisations, but these do not apply to private companies such as Nursing Homes who will have their own guidance.
- The individual may be registered under a different ICB and therefore NHS Lancashire and South Cumbria Integrated Care Board (ICB) would not be able to review this but can direct your information to the correct ICB.
We will always explain to you the reason for not going ahead with a retrospective review.