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.
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 explains what evidence supports an NHS Continuing Healthcare appeal. It covers the records that carry most weight, how to obtain them including through a subject access request, why contemporaneous records outperform recollection, how to organise material domain by domain, the value of evidence covering periods when care lapsed, and how to present it concisely.
What evidence supports an NHS Continuing Healthcare appeal
Appeals are won on evidence rather than on argument. The most effective submissions are short, organised by care domain, and anchored to dated entries in records the Integrated Care Board can verify. This guide explains what to gather and how to use it.
Start with the Board's own documents
The completed Decision Support Tool, the multidisciplinary team recommendation and the written decision are the foundation. Much of the strongest material comes from inconsistencies within them, most often a narrative describing significant skilled intervention sitting above a moderate or low level. Using the Board's own document against its conclusion is more persuasive than any external report.
Care records carry the most weight
Daily notes, care plans, risk assessments, behaviour support plans, repositioning and skin charts, food and fluid charts, medication administration records, incident and accident logs, body maps and falls records. These are contemporaneous, they were written for a purpose other than the appeal, and they describe what actually happened on specific dates. That combination makes them difficult to dismiss.
How to obtain records
Ask the provider directly first, which is usually quickest. Where that does not work, a subject access request can be made to the care provider, the GP practice or the hospital trust, and should normally be answered within one month. Where the person lacks capacity, an attorney or deputy with the relevant authority can make the request, and the authority document should be supplied with it.
Evidence of what happens without the care
This is the material that addresses the well-managed need principle, and it is the most valuable of all. Records covering periods when an intervention lapsed, when staffing was short, when the person was admitted to hospital, or when a new team took over, show the underlying need directly. Any such period is worth locating and quoting precisely.
Professional input
Letters from a GP, specialist nurse, consultant, occupational therapist, speech and language therapist or dietitian can be valuable, particularly where they describe the skill and frequency of intervention rather than simply confirming a diagnosis. Ask for a description of what the person needs and what would happen without it, rather than a general letter of support.
Organise it by domain
Structure the submission the way the Decision Support Tool is structured. For each domain you are challenging, state the level recorded, the level you say applies, quote the descriptor, then list the evidence with dates and page references. This lets a reviewer check each point quickly, and it maps directly onto how the decision was made.
Keep it short
A focused submission of two to four pages with an evidence bundle behind it outperforms a long narrative every time. Reviewers work through many cases and a submission that makes its points findable is more likely to have each of them addressed. Lead with the two or three strongest domains rather than everything you disagree with.
What carries less weight
General statements that needs are greater than recorded, comparisons with other people's outcomes, emotional appeals, and undated recollections. None of these are illegitimate, but none of them give a reviewer something to verify. Where a point can only be made from memory, say so and give as much specificity about timing as possible.
Key takeaway
Build from the Board's own documents outwards, gather contemporaneous care records, prioritise anything showing what happens when the care lapses, and organise everything domain by domain against the descriptors. Short and verifiable beats long and general.
Frequently asked questions
What is the single most useful record?
Care home or domiciliary daily notes, because they are contemporaneous, detailed and were written for another purpose. Records covering any period when the usual care lapsed are the most valuable of all.
How do I get records if the provider will not share them?
Make a subject access request to the provider, GP practice or hospital trust, which should normally be answered within one month. Where the person lacks capacity, an attorney or deputy can make the request with their authority document.
Do I need a medical report?
Not necessarily. Professional input helps most when it describes the skill and frequency of intervention required rather than confirming a diagnosis. Day to day care records often carry more weight than a clinical letter.
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.