NHS Continuing Healthcare
CHC Appeal Support: Local Resolution with the Integrated Care Board
CHC Appeal Support covers local resolution, the first stage of challenging an NHS Continuing Healthcare eligibility decision. There is a six month window to challenge a decision. A registered professional reviews the care records and the Decision Support Tool, prepares a structured written submission to the Integrated Care Board and represents the family at the local resolution meeting. The fee is £3,950 plus VAT for returning clients and £7,000 plus VAT for new clients, with travel charged separately. If local resolution does not resolve it, the NHS England Independent Review Panel is a separate service with its own fee.
Evidence, a structured written submission and representation at local resolution, the first stage of a CHC appeal
At a glance
Role
Submission and representation at local resolution with the Integrated Care Board
Framework
National Framework for NHS CHC and NHS-funded Nursing Care, 2022 revision
Format
Written submission, then attendance at the local resolution meeting
Deliverable
A submitted appeal and representation at the meeting
Coverage
England. Wales runs its own Continuing NHS Healthcare framework
£3,950
Fixed fee, plus VAT
One working day
Response to your enquiry
England
Cover throughout the country
Social work led
Registered professionals
Plain-English explanation
What appeal support is
Preparation, submission and representation through local resolution, the stage of the appeal where most decisions that change, change.
Local resolution is the first stage of the appeal, held by the Integrated Care Board. It is a meeting about evidence, and it is where most decisions that change, change.
We prepare and submit the case, then attend and present it, so the family is not arguing their own case against a room of professionals.
Most decisions that change, change at local resolution
Local resolution is not a formality before the real appeal. It is the stage with the best odds, and it is decided on how well the evidence of need is assembled and presented.
Common situations
When you need local resolution support
A decision that a person is not eligible can be challenged within six months. The first stage, local resolution, is handled by the Integrated Care Board that made the decision. Many families attempt this stage alone, without the records analysis that gives a challenge substance.
Local resolution is where most decisions that change, change, and it is decided on how well the evidence of need is assembled and presented. If it does not resolve the dispute, the next stage is the NHS England Independent Review Panel, which we provide as a separate service with its own fee, and beyond the panel sits the Parliamentary and Health Service Ombudsman.
Local resolution has been listed
A date has been set and the case needs presenting.
You do not want to attend alone
The meeting is with the people who made the original decision.
The appeal has stalled
Months have passed with no meeting and no decision.
A previous appeal was refused
The next stage needs a different approach.
The case is document heavy
Years of records need reducing to a submission that can be followed.
You are instructing on behalf of a client
A deputy, attorney or solicitor needs representation at the meeting.
1
The primary health need test
The question on appeal is whether the person's overall needs meet the primary health need test under the National Framework, and whether the process that produced the decision followed the Framework correctly.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
2
How the judgement is made
A primary health need is judged by the nature, intensity, complexity and unpredictability of the person's needs. The appeal examines how the Decision Support Tool scored those needs against the evidence in the records.
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); Integrated Care Board local resolution procedure; the six month challenge window
For more, read our guide: The NHS Continuing Healthcare process explained
Acting as a professional deputy or attorney? Read: Re ACC and CHC appeals: what the ruling means for professional deputies
The framework
What an appeal actually tests
Initial enquiry and triage
Send us the decision letter. We gather the key details and respond within one working day.
Honest viability first
We review the decision letter and the Decision Support Tool and tell you plainly whether the records support a challenge before you spend more.
Records analysis and submission
A registered professional analyses the full care records against the DST scoring and prepares a structured written submission to the Integrated Care Board for local resolution.
If local resolution does not resolve it
We tell you honestly whether the case has grounds for the NHS England Independent Review Panel. That is a separate service with its own fee, and everything prepared at local resolution carries forward into it.
After the meeting
We explain the outcome in writing and, if the decision stands, set out whether the Independent Review Panel route has substance in your case.
What happens next
Our support process
Evidence base
What we look at
Everything in the submission is traceable to a document or a first-hand account.
The decision and the DST
The scoring under challenge, domain by domain.
The care records
Daily notes, charts and incident records across the period.
The needs assessment and care plan
The independent account of what the person needs.
Clinical input
GP, community nursing, SALT and specialist evidence.
Correspondence with the ICB
What was asked for, what was provided and what was ignored.
Process history
Dates, notice, attendance and whether the framework was followed.
Deliverable
What you receive
Local resolution support is records based and honest about prospects. You receive:
An honest written view on whether the records support a challenge
A full analysis of the care records against the DST scoring
A structured written submission for local resolution
Representation at the local resolution meeting by a registered professional
A written summary of the outcome and advice on the Independent Review Panel route
A written outcome summary and next steps
Who we work with
For solicitors, deputies, care providers and advisers
Instruction is straightforward and the evidential standard is consistent whichever stage we are brought in at:
Scope confirmed in writing
The stage, the fee and the timescale are confirmed in writing before instruction.
Evidence in the language of the framework
Needs are described against the twelve care domains and the four key characteristics, not in general terms.
Peer review as standard
A second qualified professional reviews the work before it is submitted.
Honest merits advice
Where a case has no realistic prospect, we say so before you spend anything further on it.
Already working with us
£3,950 plus VAT
- The appeal drafted and submitted within the deadline
- Evidence assembled domain by domain from the records
- Representation at the local resolution meeting
- Peer review by a second qualified professional
One fee, agreed in writing before any work starts, and never a percentage of what is recovered. Most CHC support is charged by the hour or as a share of the outcome, so the cost is unknown when you commit and grows the longer the case runs. Ours is stated up front, plus VAT and travel, and does not change if the case turns out to be harder than expected.
New to Nellie Supports
£7,000 plus VAT
- The Independent Social Care Needs Assessment and Care Plan, £1,100 plus VAT
- The Case Review and Merits Assessment, £1,950 plus VAT
- Both charged once and never re-charged
- Everything listed in the returning price
Two things sit behind this price. The needs assessment is an independent professional record of what the person actually needs, in the language the twelve care domains are scored in, and every later stage builds on it. The merits assessment is the honest opinion on whether the appeal is worth bringing at all. We would rather tell you a case is weak before you spend on it than take the instruction and bill you for a submission that was never going to succeed.
Transparent pricing
Two prices, depending on whether we already have your case
The work is identical. What differs is whether the gateway assessment has already been done and paid for. It is charged once per client and never re-charged, so every later stage of your case is at the returning price.
For families
A clear fee, agreed in writing before we start, with no percentage of anything recovered. We explain what is happening in plain English and deal with the process so you do not have to.
For professionals
Scope, fee and timescale confirmed in writing before instruction. Evidence prepared against the twelve care domains and the four key characteristics, peer reviewed by a second qualified professional.
Provider evidence
Why choose Nellie Supports for appeal representation
Registered professionals who prepare the evidence and then stand behind it in the room.
Why families and professionals choose Nellie Supports
Honest viability before commitment
We tell you if the records do not support a challenge. A weak case costs a family money and hope, and we will not take one forward quietly.
Records based, not rhetoric based
Appeals succeed on evidence and procedure. The work is in the records, and that is where we do it.
Social work led, no percentage fees
Fees published before instruction, plus VAT. We take no share of any backdated funding.
A permanent employed team
A full-time, in-house multidisciplinary team with more than 11,000 assessments completed practice-wide.
Peer reviewed as standard
Every submission is reviewed by a second qualified professional before it goes to the ICB.
We know the assessment from the inside
Our assessors write professional assessments for a living, so we read a Decision Support Tool the way its authors do.
A family came to us four months after a not eligible letter, with two months of the six month window left and a strong sense that something had gone wrong. The first thing we did was tell them we did not yet know whether they had a case.
A registered professional obtained the completed Decision Support Tool and the full care records and compared them line by line. Three domains had been scored on the person's stable days, while the records themselves described weekly crises, and the family's own account of the nights had never been recorded at all. That gap, between what the records showed and what the tool said, became the substance of the local resolution submission. We put it in writing, domain by domain, and represented the family at the meeting that followed.
The Integrated Care Board makes the decision. Our job was to make sure it was made on the evidence that existed all along.
Most appeals are built as a critique of the Decision Support Tool, which puts the family in the position of arguing about a document the Integrated Care Board wrote. This one was built on our own assessment of his needs, carried out by a registered professional and mapped to the twelve domains. The scoring was then compared against that, rather than the other way round.
This is an illustrative example. It does not describe any individual client.
How local resolution works in practice
Frequently asked questions
Frequently Asked Questions About Local Resolution
How long do we have to challenge a decision?
There is a six month window to challenge an eligibility decision, running from the date of the decision letter. If you are close to the edge of that window, contact us promptly and say so, because a well-prepared request submitted in time protects your position while the full submission is developed. Out-of-time requests can be refused outright.
What is local resolution?
Local resolution is the first stage of challenge, handled by the Integrated Care Board that made the original decision. It is where a well-evidenced written submission does its work, because the ICB reviews its own decision against the National Framework and the evidence you present. Challenges can be resolved at this stage without going further.
What is the Independent Review Panel?
The Independent Review Panel is the NHS England stage that follows local resolution. It reviews whether the Integrated Care Board followed proper procedure and applied the National Framework correctly. It is not part of this service: we provide the panel application and representation as a separate service, £6,250 plus VAT for returning clients, and the evidence prepared at local resolution carries forward into it.
What are our chances of success?
We do not quote success rates, because every case turns on its own records and no honest provider can promise an outcome. What we will give you is a frank written view of your evidence before you commit to either stage, including where the decision looks sound. That honesty costs us some instructions, and it is the only defensible way to work.
What if local resolution does not change the decision?
The next stage is the NHS England Independent Review Panel, which we provide as a separate service. Beyond the panel sits the Parliamentary and Health Service Ombudsman, which looks at maladministration and procedural failure rather than re-deciding eligibility. We will tell you honestly whether either route has substance in your case.
Challenging a CHC decision
How to challenge a CHC decision through local resolution, the Independent Review Panel and the Ombudsman.
CHC eligibility and primary health need
What a primary health need is and how the four key characteristics are judged.
The Independent Review Panel explained
Who convenes it, what it tests and how to prepare.
The Ombudsman and CHC complaints
The final stage, and when it applies.
Re ACC and CHC appeals: guidance for professional deputies
What the Re ACC ruling means for professional deputies challenging NHS Continuing Healthcare funding decisions.
Supporting guidance
Related NHS Continuing Healthcare guides
CHC Assessment Support: DST and MDT Meeting
Evidence prepared across the twelve care domains of the Decision Support Tool (DST) and representation at the multi-disciplinary team (MDT) meeting.
Retrospective CHC Claims
Claims for periods of care that were never assessed, starting with a £495 records review credited if you proceed. Never a percentage.
Other CHC support stages
Discuss your case
Has funding been refused?
Contact Nellie Supports to discuss the decision letter and the six month window. We will tell you honestly whether the records support a challenge at local resolution before you commit to one.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.