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 the two categories of ground on which an NHS Continuing Healthcare decision can be challenged. It distinguishes substantive grounds, which concern whether the eligibility conclusion was right, from procedural grounds, which concern whether the decision was properly made, gives examples of each, and explains why separating them produces better responses at local resolution and panel stage.
Procedural and substantive grounds of CHC appeal
Appeals are stronger when the grounds are sorted into the right categories. A point about whether the conclusion was correct calls for a different response from a point about whether the process was followed. Mixing them tends to produce a reply that addresses neither properly.
The two categories
Substantive grounds concern the outcome: the domain levels were wrong, the characteristics analysis was flawed, the primary health need test was misapplied. Procedural grounds concern how the decision was reached: the team was not properly constituted, the family's evidence was not recorded, the recommendation was departed from without reasons, no written decision was provided. Both are legitimate and they are best raised separately.
Substantive grounds in practice
The most common are that domain levels do not reflect the evidence, that needs were recorded as managed rather than as they would be without intervention, that a diagnosis or setting drove the outcome, or that the four key characteristics were named but not applied. Each should be tied to specific domains and dated evidence rather than expressed as a general disagreement.
Procedural grounds in practice
The most common are an improperly constituted multidisciplinary team, no contribution from anyone who knows the person day to day, the family's account not recorded, the completed Decision Support Tool not provided, a decision issued without reasons, and the Integrated Care Board departing from the recommendation without identifying a defect in the assessment.
Why separating them matters
The remedies differ. A successful substantive ground points towards the decision being overturned. A successful procedural ground more often points towards the assessment being redone properly. Setting them out separately lets the reviewer address each on its own terms, and it avoids a response that answers the process point and treats the eligibility point as covered.
Structuring the submission
Two headed sections work well. Under substantive grounds, list each domain with the level recorded, the level contended for, the descriptor and the evidence. Under procedural grounds, list each failure with the date and what should have happened. Keep both short, and lead with the strongest point in each category rather than the chronological first.
Grounds that rarely succeed alone
Delay, poor communication and the manner in which staff behaved are real complaints but they are not eligibility grounds. They belong in the complaints process and ultimately with the Ombudsman. Raising them within an eligibility appeal tends to dilute the stronger points, so it is usually better to run them separately.
Keeping the record
Whichever grounds you rely on, keep a dated written record of what was submitted and how the Board responded. If the matter progresses to an Independent Review Panel, the panel will want to see what was argued at local resolution and whether it was engaged with. An unanswered ground is itself a point worth making.
Key takeaway
Sort your grounds into substantive and procedural, set them out under separate headings, tie each substantive point to a domain and dated evidence, and keep complaints about delay or conduct in the complaints process where they belong.
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Frequently asked questions
Which type of ground is stronger?
Neither is inherently stronger. Substantive grounds point towards the decision being overturned, procedural grounds more often towards the assessment being redone. Running both gives the reviewer two routes to a remedy.
Is delay a ground of appeal?
Not on eligibility. Delay is a complaint, pursued through the Board's complaints process and ultimately the Ombudsman, particularly where it caused financial loss. Keep it separate from the eligibility grounds.
Can I add grounds later?
Usually yes, particularly once records arrive. Send them in writing as an addition to the existing submission, referencing the original date so the sequence is clear on the file.
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.