How to Claim NHS Continuing Healthcare for Dementia in Wales Without a Solicitor

The Process Is Administrative, Not Legal

NHS Continuing Healthcare is a package of care funded entirely by the NHS for individuals whose primary need is a health need rather than a social care need. In Wales, CHC is governed by the 2021 National Framework for Implementation, administered by the seven Local Health Boards. It is non-means-tested — your parent's savings, property, and income are irrelevant to eligibility.

The CHC application process is fundamentally administrative. It involves completing standardized screening forms, gathering clinical evidence, participating in a Multidisciplinary Team assessment, and — if necessary — filing an appeal within a strict deadline. None of these steps requires legal representation. What they require is organized evidence, knowledge of the framework's rules, and awareness of the specific arguments Local Health Boards use to deny funding.

Specialist CHC solicitors in Wales charge £200–£350 per hour for this work, or 25% plus VAT on contingency for retrospective claims. For a first-time application, most families can handle the process themselves with the right preparation.

Step 1: Request the Checklist Screening

The CHC process begins with a preliminary Checklist screening, which can be completed by a nurse, doctor, or social worker. The Checklist is a brief assessment that determines whether your parent's needs are complex enough to warrant a full assessment.

You have the right to request a Checklist screening at any point. Common triggers include a hospital admission, a significant deterioration in your parent's condition, or a care review meeting. If a healthcare professional tells you that a screening is not necessary or that your parent "wouldn't qualify," ask them to complete the Checklist anyway and document the request in your communication log. A refusal to screen can be escalated through Llais, the statutory health advocacy body in Wales.

The Checklist looks at broad need areas. A positive Checklist result moves your parent to the full Decision Support Tool assessment. A negative result can be challenged — the screening itself is not an eligibility decision, and you can request a reassessment if circumstances change.

Step 2: Prepare Your Evidence Before the DST Assessment

The Decision Support Tool is the 12-domain assessment that determines CHC eligibility. Each domain is scored from "No Needs" up to "Severe" or "Priority" (Priority is limited to four domains: breathing, behaviour, drug therapies and medication, and altered states of consciousness). A primary health need is typically established with at least one Priority, two Severes, or a complex combination of multiple Highs and Moderates.

The 12 domains are: behaviour, cognition, communication, psychological and emotional needs, mobility, nutrition (food and drink), continence, skin integrity (including tissue viability), breathing, drug therapies and medication, altered states of consciousness, and other significant care needs.

Before the Multidisciplinary Team convenes, you need to prepare a written statement for each domain describing your parent's needs on their most difficult days. The critical mistake most families make is allowing the assessment to capture an average day. Dementia is characterised by severe fluctuations — a parent who is calm and cooperative during a 45-minute assessment visit may have been agitated, distressed, or at physical risk the previous night.

How to gather this evidence:

Request copies of all daily care logs from the current care provider. Ask specifically for incident reports, behavioural charts, medication administration records, and any safeguarding referrals. Request the GP's full clinical record using a Subject Access Request (the GP surgery must respond within 30 days under UK GDPR). If your parent is in a care home, ask the home's registered manager for a written statement of the nursing interventions they provide.

Map every piece of evidence against the relevant DST domain. For cognition, document wandering incidents, episodes of disorientation, inability to recognise family members, and the supervision level required to prevent harm. For behaviour, document agitation, resistance to personal care, verbal or physical aggression, and the de-escalation techniques staff use. For each domain, the question the assessor should be answering is: what would happen if the current care package were removed?

Step 3: Attend the MDT Assessment With Prepared Evidence

The Multidisciplinary Team assessment is a meeting where the DST is completed by a group of professionals — typically a nurse assessor from the Local Health Board, a social worker, and clinical staff familiar with your parent's care. You have the right to attend and contribute.

Bring your domain-by-domain evidence statements, copies of care logs, and your communication log. Present the evidence calmly and domain by domain. The most important thing you can do in this meeting is ensure the assessor records the full range of your parent's needs, including fluctuations, rather than a snapshot of how they present on one particular day.

If the assessor suggests that a need is "well-managed" and therefore does not count, challenge this directly. The Welsh CHC framework explicitly states that well-managed needs must still be considered — the test is the nature, intensity, complexity, and unpredictability of the need, not whether it is currently being successfully managed. A parent whose severe dementia-related behaviours are controlled by skilled nursing care still has a complex health need. The management is evidence of the need's severity, not evidence that the need has resolved.

Step 4: Understand the Timeline

Under the Welsh framework, the Local Health Board has up to 42 days from the initial Checklist screening to issue a final eligibility decision. This is longer than England's 28-day window.

If the LHB decides your parent is not eligible for CHC, you will receive a written decision letter. From the date you receive that letter, you have 28 days to notify the LHB in writing that you intend to appeal. This deadline is strict. Mark it in your calendar the day the letter arrives and send your notice of appeal well within it.

The appeal is an Independent Review Panel hearing. You can present your case, submit additional evidence, and bring an advocate. You do not need a solicitor to attend, but you do need to be organised: bring the same domain-by-domain evidence, highlight where you believe the DST was incorrectly scored, and identify any evidence the original panel failed to consider.

Step 5: Know When to Escalate

If the Independent Review Panel upholds the denial and you believe the process was fundamentally flawed — for example, the LHB refused to consider evidence you submitted, or the DST was completed without your input — you can escalate to the Public Services Ombudsman for Wales. The Ombudsman investigates maladministration (procedural failures), not clinical judgment, so the complaint needs to be framed around process rather than outcome.

This is also the point where some families decide to bring in a solicitor. If the denial stands after the panel and you believe your parent genuinely qualifies, a specialist CHC solicitor working on contingency can pursue the claim further. Having completed the initial application and appeal yourself — with organised evidence and a documented timeline — means the solicitor inherits a case file rather than starting from scratch. That reduces their workload and, if they are billing hourly, reduces your costs.

The 2026 CHC Direct Payments Reform

From 1 April 2026, CHC recipients in Wales can receive NHS funding as a direct payment for the first time. This means that instead of the Local Health Board arranging and commissioning care on your parent's behalf, the family can receive the funding directly and arrange care independently. This creates employment responsibilities — you become an employer if you hire a personal assistant directly — but it also gives families significantly more control over the care their parent receives. The guide covers the operational details of this reform, including when to use a managed account agency instead of managing the payment yourself.

Frequently Asked Questions

What is the "well-managed needs" trap and how do I avoid it?

The well-managed needs argument is the most common reason LHBs deny CHC funding for people with dementia. The assessor observes that your parent's needs are currently stable — their behaviour is managed, their medication is administered on schedule, their skin integrity is maintained — and concludes that the needs are social rather than health-related. The counter-argument is that the stability exists precisely because skilled nursing care is being provided. Ask the assessor to document what would happen if that care were removed. If the answer involves clinical deterioration, hospital readmission, or serious harm, the evidence supports the nature, intensity, complexity, and unpredictability test even when the need is currently stable.

Can the Local Health Board refuse to do a Checklist screening?

They should not, but some do. If a healthcare professional declines to complete the Checklist, put the request in writing — a letter or email to the LHB's CHC team specifically requesting a screening and citing the 2021 Welsh National Framework. If the LHB still refuses, contact Llais (the statutory health advocacy body that replaced Community Health Councils in Wales) and ask them to intervene. Document every refusal in your communication log with dates and names.

How long does the entire CHC process take in Wales?

From initial Checklist screening to final decision, the Welsh framework allows up to 42 days. In practice, the process often takes longer — particularly if the MDT assessment needs to be rescheduled or additional evidence is requested. If CHC is denied and you appeal, the Independent Review Panel adds several more months. A retrospective claim for previously paid care fees can take one to three years through legal channels, which is why specialist solicitors work on contingency for those cases.

Is CHC funding permanent once granted?

No. CHC eligibility is reviewed at regular intervals — typically with an initial review within three months of services beginning, then at least annually. If a review determines that your parent's primary need is no longer health-related (which is unusual for progressive dementia but can happen if the framework's interpretation shifts), funding can be withdrawn. You have the same 28-day appeal right against a withdrawal decision as against an initial denial.

The Dementia Care in Wales: Funding, Support & Rights toolkit includes a CHC Evidence Mapping Grid, a CHC Appeal Timeline Tracker, and the full procedural guide covering the Welsh CHC framework from screening to appeal.

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