Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
3. Parliamentary and Health Service Ombudsman. Making a complaint about the NHS in England. Available at: https://www.ombudsman.org.uk
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
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This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains how to challenge an NHS Continuing Healthcare Checklist that has recorded needs at too low a level. It covers obtaining the completed document, reading it against the descriptors, identifying the domains where the evidence supports a higher score, the low threshold that makes small corrections decisive, how to put the request, and when requesting a fresh Checklist is more effective than disputing the old one.
How to challenge a CHC Checklist that scored too low
Because the Checklist threshold is deliberately low, correcting one or two domains is frequently enough to trigger a full assessment. That makes a focused, domain by domain challenge one of the most efficient interventions available in the whole process.
Get the document first
You cannot challenge what you have not seen. Request the completed Checklist from whoever carried it out or from the Integrated Care Board's continuing healthcare team. You are entitled to the completed document, the outcome and the reasons. If only a verbal outcome was given, ask for everything in writing before doing anything else.
Understand the threshold
The Checklist scores eleven domains at A, B or C. The threshold to proceed is two or more A scores, five or more B scores, or one A with four or more B scores. A single A in certain domains may also trigger a full assessment. This is a low bar by design, which is why moving one domain from B to A, or two from C to B, can change the outcome entirely.
Read each domain against the descriptor
Work through domain by domain with the descriptors alongside. Ask three questions of each. Does the recorded level match what the descriptor describes? Has the need been recorded as it would be without the current care? Has anything that happens overnight, intermittently or unpredictably been captured? Most under-scoring is caught by one of those three.
Target the domains that will move the outcome
Do not challenge everything. Identify the two or three domains where the gap between the recorded level and the evidence is widest, and where a change would cross the threshold. A focused request naming three domains with dated evidence is considerably more effective than a long letter disputing all eleven.
Evidence that carries weight
Care plans, risk assessments, behaviour support plans, repositioning and food charts, medication records, incident logs, body maps and falls records. Quote specific dated entries rather than describing the position generally. Where a need is intermittent, give the frequency and the consequences, since that goes to unpredictability and is routinely under-recorded at screening.
How to put the request
Write to the Integrated Care Board's continuing healthcare team. State the date of the Checklist, name each domain you say is wrong, quote the descriptor you say applies, summarise the evidence with dates, and ask for the outcome to be reconsidered or a fresh Checklist to be completed. Keep it to two pages with evidence attached.
When to ask for a fresh Checklist instead
If the person's condition has changed since the original, or if the Checklist was completed during a hospital admission when they were presenting atypically, requesting a new Checklist is usually faster and more productive than disputing the old one. There is no limit on how often one can be completed where circumstances have changed.
Key takeaway
Get the completed Checklist, read it against the descriptors, and target the two or three domains where a change would cross the threshold. Support each with dated records. Where circumstances have changed, ask for a fresh Checklist rather than a review.
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Frequently asked questions
Is there a formal appeal against a Checklist?
Not in the same way as an eligibility decision. You ask the Integrated Care Board to reconsider the outcome or to arrange a fresh Checklist. The process is less formal, which usually makes it quicker.
How many domains should I challenge?
Two or three, chosen because a change would cross the threshold. A focused request with dated evidence achieves more than a long letter disputing every domain.
What if the Checklist was done in hospital?
That is a common source of inaccuracy, in both directions. If the person was presenting atypically, request a fresh Checklist once they have settled rather than arguing about the original.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.