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. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Social Work England. Professional standards. Available at: https://www.socialworkengland.org.uk
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
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 catalogues the defects that recur in NHS Continuing Healthcare assessments. It covers misapplication of the well-managed need principle, decisions made on diagnosis or setting, levels inconsistent with the narrative, missing characteristics analysis, incomplete multidisciplinary input, absent night time evidence, and cost or resource considerations entering the eligibility decision.
Common flaws in CHC assessments
The same defects appear again and again in NHS Continuing Healthcare assessments. Recognising them turns a general sense that a decision is wrong into a list of specific points a Board has to answer.
Well-managed need misapplied
The most common defect by a distance. Needs are recorded as they present with care in place, so a person kept stable by a rigorous regime is recorded as having little need. Intact skin under two hourly repositioning, settled behaviour under a support plan, and stable weight under supervised feeding are the classic examples.
Decisions made on diagnosis
Wording such as this is a social care condition, or that dementia does not qualify, indicates a decision made on diagnosis rather than assessed need. The Framework excludes that approach. It is a clean and identifiable defect, and it usually appears in writing, which makes it straightforward to quote back.
Decisions made on setting
Statements that funding is only available in a nursing home, or that a residential placement rules the person out, import setting into a decision from which it is expressly excluded. Watch also for the circular version, where funding is refused because of the setting and the setting cannot change without funding.
Levels inconsistent with the narrative
A narrative describing frequent skilled intervention sitting above a moderate level. This is the most productive thing to look for when reading a completed tool, because it needs no outside evidence to demonstrate. The document contradicts itself, and the inconsistency can be pointed out from the tool alone.
Characteristics named but not reasoned
The decision recites nature, intensity, complexity and unpredictability and then states a conclusion, without analysing how the recorded needs engage any of them. That is a failure to show the reasoning, and it is the point the Grogan decision supports. Complexity and unpredictability are the two most often asserted without support.
Process failures
Incomplete multidisciplinary input, particularly no social care input or nobody who knows the person. Care records not obtained or not considered. Night records absent entirely. Family excluded or their contributions unrecorded. Assessment conducted during acute illness. Cost or resource availability influencing an eligibility decision, which is not a permissible consideration.
Key takeaway
Read for these specifically rather than reading generally. Internal inconsistency between narrative and level needs no outside evidence, and diagnosis or setting reasoning is usually written down. A list of named defects gets a better response than a statement that the decision was wrong.
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Frequently asked questions
What is the most common flaw?
Misapplied well-managed need. Needs are recorded as they present with care in place, so a person kept stable by an intensive regime is recorded as having little need rather than significant managed need.
What is easiest to demonstrate?
Internal inconsistency between the narrative and the level recorded above it. That needs no outside evidence, because the document contradicts itself and the point can be made from the tool alone.
Is cost a permissible consideration?
Not in an eligibility decision. Cost may be relevant to how needs are met once eligibility is established, but not to whether the person has a primary health need.
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.