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 v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. Mental Capacity Act 2005, c. 9. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
Copywright
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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 sets out what an instructing professional should expect when commissioning an independent NHS Continuing Healthcare report. It covers the expected structure and content, quality assurance before issue, communication during the work, handling of adverse findings, the position on attendance at meetings and panels, and what should happen where the assessor's view does not support the instructing party.
What to expect from an independent CHC report
Commissioning an independent report should be a predictable process. This sets out what an instructing professional is entitled to expect, both in the document and in how the work is conducted.
Structure you should expect
Instruction and scope, methodology including what was reviewed and what was not, findings organised by the twelve care domains with sources and dates, analysis of nature, intensity, complexity and unpredictability, conclusions answering the questions asked, declared limitations, and the author's qualifications and registration.
Sourcing throughout
Every material finding traceable to a record with a date, to direct observation, or to an attributed account from a named source. A report making assertions without sourcing cannot be tested, and a report that cannot be tested is of limited use at panel, where the material will be probed.
Quality assurance before issue
Ask whether reports are reviewed before they are issued. Internal peer review by a second qualified professional catches unsupported conclusions, gaps in sourcing and reasoning that does not follow. It is the difference between a report checked by its author and one checked by someone with no investment in it.
Communication during the work
Notification if the records prove materially more extensive than anticipated. Notification if access cannot be arranged. Notification, promptly, if the emerging view is unlikely to assist. Being told late that a report will not help is worse than being told early, particularly where a deadline is approaching.
Adverse findings
An independent assessor must report what they find, including where it does not support the instructing party. This is the point of independence rather than a failure of it, and a professional should expect it as a possibility at instruction. A provider whose reports always support the instructing party is not producing independent evidence.
What happens with an unhelpful report
It should be discussed rather than quietly shelved. Sometimes the finding is narrower than it first appears, or supports a different argument such as an increase in the package rather than eligibility. Sometimes it indicates the case should not proceed, which is itself valuable information delivered before further costs are incurred.
Attendance and follow-up
Clarify whether attendance at a multidisciplinary assessment, local resolution meeting or panel is within scope. Clarify whether responding to the Board's counter-arguments is included. These frequently arise later and are much easier to settle at instruction than mid-process.
Key takeaway
Expect domain-structured findings with dated sourcing, declared limitations, and peer review before issue. Expect prompt notification if the view is unlikely to assist, and expect adverse findings to be reported. Settle attendance and follow-up scope at instruction.
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Frequently asked questions
What structure should the report follow?
Instruction and scope, methodology, findings by care domain with dated sources, analysis of the four key characteristics, conclusions answering the questions asked, declared limitations, and the author's qualifications and registration.
What if the report does not support us?
It should still be reported and discussed. Independence means reporting what is found. Sometimes the finding supports a different argument, and sometimes it indicates the case should not proceed, which saves further cost.
Should we be told early if it is not going well?
Yes, promptly. Being told late that a report will not assist is considerably worse than being told early, particularly where a submission deadline is approaching.
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.