Appealing an NHS Continuing Healthcare decision
Many Continuing Healthcare refusals are overturned on challenge. This guide walks through the appeal stages, the deadlines, and how to build the strongest case.
If CHC is refused you normally have six months to ask the integrated care board for a local review of the decision. If that fails, you can ask NHS England for an independent review panel, and after that you can take the case to the Parliamentary and Health Service Ombudsman. Appeals succeed most often where families obtain the full assessment records, show that domains were underscored against the day-to-day care evidence, and argue the overall picture of nature, complexity, intensity and unpredictability rather than single scores. Families can also claim retrospectively for periods when someone paid for care that CHC should have funded.
At a glance
- Stage 1Local resolution with the integrated care board
- Time limitNormally six months from the written decision
- Stage 2Independent review panel via NHS England
- Stage 3Parliamentary and Health Service Ombudsman
- CostFree at every stage, advocacy support available
- Back claimsPossible for wrongly self-funded periods
Should you appeal a CHC refusal?
An appeal is worth serious thought if the written decision does not match the reality of the person's needs. Strong grounds include domains scored lower than the care records support, evidence that was not considered, a multidisciplinary team that lacked the right professionals, a family excluded from the process, or a decision that leant on cost or diagnosis rather than need. Weak grounds are disappointment alone or a diagnosis without evidence of the needs it creates.
Be realistic about the test. CHC turns on whether needs amount to a primary health need, judged by their nature, complexity, intensity and unpredictability. The appeal succeeds by showing the evidence meets that test, not by showing the outcome feels unfair.
Stage one: local resolution
Write to the integrated care board that made the decision, normally within six months, saying you want to challenge it. Ask for the complete assessment file first: the Decision Support Tool, the checklist, the care records the team relied on and the eligibility rationale. Compare the scores against daily care notes, medication charts, falls and behaviour logs, district nurse records and specialist letters, then set out domain by domain where you say the scoring went wrong and why.
Care homes must keep daily records and you are entitled to relevant records through a subject access request. The pattern that wins appeals is specific: this domain was scored moderate, these dated entries show severe level need, so the score should change and the overall picture changes with it.
Stage two: the independent review panel
If local resolution upholds the refusal, you can ask NHS England for an independent review. A panel with an independent chair, an integrated care board representative and a local authority representative re-examines whether the process was followed and whether the eligibility decision was sound. Families attend, can bring an advocate, and panels do overturn decisions or send them back for reassessment.
Stage three: the Ombudsman, and retrospective claims
If the independent review fails and you believe the process or decision was still wrong, the Parliamentary and Health Service Ombudsman can investigate. It is free, though it expects the earlier stages to have been used first.
Separately, families can pursue retrospective claims where someone paid for care during a period when they should have had CHC, for example where no assessment was ever done despite clear needs. A successful previously unassessed period claim refunds fees paid, which can be substantial after a long self-funded stay. Specialist advocates and solicitors handle these, some on a no win no fee basis; charities such as Beacon offer free initial advice.
- Keep every decision letter, assessment document and care record
- Meet the six month deadline for local resolution, or explain any delay
- Ask for needs to be reassessed at any time if they worsen
- Use the fast track route where someone is deteriorating rapidly
- Get free advocacy support before paying for representation
Appealing an NHS Continuing Healthcare decision: common questions
How do I appeal an NHS continuing care decision?
Start with local resolution: write to the integrated care board within six months of the decision, request the full assessment records, and set out domain by domain where the scoring conflicts with the care evidence. If that fails, request an independent review panel through NHS England, and after that the Parliamentary and Health Service Ombudsman.
Is it worth appealing a CHC assessment?
Often, yes, where the records support higher scores than the assessment gave. A meaningful share of challenged decisions are revised at local resolution or by independent review panels. Appeals grounded in dated care evidence do far better than appeals based on diagnosis or disappointment.
How long does a CHC appeal take?
Local resolution commonly takes around three months and an independent review panel several months more, so a full appeal can run six to twelve months. Care funding arrangements continue meanwhile, and a successful appeal is backdated, with fees refunded where eligibility is established for an earlier period.
Can I claim back care home fees already paid?
Possibly. Where CHC should have funded a period that the person paid for, a retrospective claim can recover those fees. Claims for previously unassessed periods are made to the integrated care board with the care records as evidence. Specialist advice helps, and reputable advisers will assess the prospects before charging.
Can a CHC decision be reassessed instead of appealed?
Yes. If needs have worsened since the decision, ask for a new checklist and assessment rather than appealing the old one. The fast track route applies where someone has a rapidly deteriorating condition that may be entering a terminal phase, and it can put funding in place within days.
Need help with your own situation?
We can introduce you to an FCA-authorised care funding specialist who will look at your circumstances and the options.