What is a Previously Unassessed Period of Care assessment?

A Previously Unassessed Period of Care (PUPoC) assessment looks at whether a person may have been eligible for NHS Continuing Healthcare (CHC) in the past, where this was not considered at the time.


This may apply if:

  • no CHC assessment took place during the period of care
  • the care was paid for in full or in part by the individual, rather than the NHS
  • eligibility for CHC was not considered at the time

 

For more information about Previously Unassessed Periods of Care, visit: Dealing with requests for assessments of previously unassessed periods of care from 1 April 2012

Important information

We can only assess care provided from 1 April 2012 onwards. A PUPoC assessment does not cover retrospective Funded Nursing Care (FNC) claims. For more information about FNC, visit: NHS-Funded Nursing Care 

Who can apply and what to send

What you need to send depends on whether the person is living, has capacity, or is deceased.

Proof of identity for all applications

For all applications, send two forms of certified identification. At least one must include a photograph, and the documents must show the current name and address.

If you are acting for someone else, send identification for both of you.

If the person is living and has capacity

If the person can make their own decisions, send:

  • a signed Application Form
  • a signed Consent Form
  • certified identification for the individual and anyone helping with the application

 

Important information

If the person has capacity, they must give written consent. Legal authority, including LPA, does not replace consent.

Without valid consent, we cannot process the application.

If the person is living and does not have capacity

  • a completed Application Form
  • proof of legal authority, such as LPA for Property and Finance or a Court of Protection Deputyship Order
  • two forms of certified identification
  • evidence that the person lacks capacity
  • If the person is already known to the NHS Continuing Healthcare team, we may already hold relevant capacity information.

If the person is deceased

  • a completed Application Form
  • a certified copy of the Death Certificate
  • Grant of Probate or Letters of Administration, or proof you have applied
  • if probate is not yet granted, a certified copy of the will showing the executor or administrator

 

Important

  • If there is more than one executor or administrator, all must sign an authority to act form and provide identification.
  • We cannot process the application without proof of legal authority.

Returning your application

Return your completed application and supporting documents within 28 days of receiving the pack.

  • If you do not return the documents within 28 days, your application may be withdrawn.
  • If you need more time, contact us before the deadline. An extension may be possible in some circumstances.

What happens after you apply?

Step 1: Application review


When we receive your application, we will:

  • check that all required forms and documents have been provided and contact you if anything is missing or unclear
  • check that NHS Surrey and Sussex ICB is the responsible commissioner
  • review the information provided and decide whether it meets the PUPoC criteria under the national guidance

 

The application may be:

  • accepted
  • rejected
  • reduced
  • extended

 

We will write to you to confirm the outcome of the application review.

Step 2: Gathering records and evidence

If your claim meets the criteria, we will request records from all relevant health and social care providers involved during the period of care.

We aim to collect records within 40 days, although this may take longer, particularly for older records.

Important information

  • Some records may have been securely destroyed after seven years, in line with legal requirements.
  • If insufficient evidence is available, a CHC Clinical Practitioner will review what is available to decide if a robust assessment can proceed.
  • In some cases, once records are received, it may be determined that the claim no longer meets PUPoC criteria. If this happens, the case will be withdrawn.

 

We will inform you if any of the above situations apply.

Step 3: The assessment process

Individual Needs Portrayal (INP)

An Individual Needs Portrayal (INP) brings together all available evidence to give a clear overview of the person’s needs during the period being reviewed.

  • Evidence is organised chronologically and by care domain
  • It highlights key changes in needs, rather than providing a day-by-day account

 

The Practitioner will:

  • review all records and evidence
  • produce the INP

 

You will be sent a copy of the INP and given 28 days to:

  • provide comments
  • submit additional evidence

 

If no response is received, the process will continue to the next stage.

Decision Support Tool (DST)

If a full assessment is needed, a Multi-Disciplinary Team (MDT) will complete a Decision Support Tool (DST). The MDT will include either:

  • at least two professionals from different healthcare disciplines, or
  • one healthcare professional and one social care professional

The decision

The completed DST is reviewed and verified by a Senior Practitioner to ensure:

  • the correct process has been followed
  • the decision is appropriate and robust

 

We will then write to you with the outcome and provide copies of the DST.

  • If the person is eligible for NHS CHC funding, we will explain the next steps, including reimbursement (where applicable).
  • If the person is not eligible, we will explain how to appeal.

Timeframes

Integrated Care Boards set reasonable and proportionate timescales for PUPoC requests. These depend on:

  • the length of the care period
  • how easily records can be accessed

 

As a guide, the PUPoC team aims to complete:

  • Up to 1 year of care: within 6 months
  • More than 1 year of care: within 12 months

 

Longer timeframes may apply in exceptional circumstances.