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 describes what a well-evidenced NHS Continuing Healthcare case looks like. It covers the foundation of contemporaneous records, structuring evidence by care domain, describing need without the care in place, reasoning on the four key characteristics, addressing procedural matters separately, presentation and pagination, and knowing which points to lead with.
What a well-evidenced CHC case looks like
A strong NHS Continuing Healthcare case is not a strongly worded one. It is one where every assertion has a dated source, the material is organised the way the decision will be made, and the strongest points come first.
It rests on contemporaneous records
The foundation is always what was written at the time. Daily notes, incident logs, charts, night records and medication records, obtained for a defined period and read by domain. Everything else builds on that. A case resting on assertion, however accurate, is weaker than one resting on dated entries nobody wrote for the purpose of the dispute.
It is organised by domain
The decision will be made across twelve care domains, so the evidence should arrive in that shape. For each domain in issue: the level recorded, the level said to apply, the descriptor relied on, and the evidence with dates. A reviewer who can find your point for each domain in seconds is a reviewer who will address it.
It describes need without the care in place
Every domain narrative should answer what would happen without the intervention. This single discipline addresses the most common defect in the system, and it is what separates a description of need from a description of a well-run care package.
It reasons on the four characteristics separately
After the domains, a separate section on nature, intensity, complexity and unpredictability, each reasoned against the recorded needs rather than named. Complexity should identify which needs interact and what judgement that requires. Unpredictability should give dated events, the warning available and the consequence.
It separates procedural points
Process failures belong in their own section rather than mixed with substantive argument. Incomplete multidisciplinary input, records not obtained, family excluded, reasoning absent from the decision. Separating them means each receives a distinct answer instead of a single general response covering everything.
It is presented so it can be used
Paginated, with an index, with sources cited by date and page, and short enough to be read. Two to four pages of submission over a properly ordered bundle beats forty pages of narrative. Lead with the two or three strongest domains, because reviewers work through a great deal of material and attention is finite.
Key takeaway
Records first, organised by domain, need described without the care in place, characteristics reasoned separately, procedure in its own section, and presented so it can actually be used. Strength comes from structure and sourcing, not from emphasis.
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Frequently asked questions
How long should a submission be?
Two to four pages over a properly ordered and paginated bundle. Length is not strength, and a focused submission is more likely to have each point addressed than a long narrative.
What is the single most important discipline?
Describing each need as it would be without the care in place. That addresses the most common defect in the system and separates need from a well-run care package.
Should procedural points go with the domain points?
No. Keep them in a separate section so each receives a distinct answer rather than a single general response covering everything at once.
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.