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. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
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 who makes NHS Continuing Healthcare eligibility decisions in England. It sets out the role of the multidisciplinary team in assessing need and making a recommendation, the role of the Integrated Care Board in reaching the decision, the narrow circumstances in which a recommendation may be departed from, what evidence must be considered, and the rights of the person and their representative throughout.
Who decides NHS Continuing Healthcare eligibility
Two different bodies are involved in an NHS Continuing Healthcare decision, and confusing them causes a great deal of frustration. The multidisciplinary team assesses and recommends. The Integrated Care Board decides. This guide explains who does what, on what evidence, and what that means if you disagree.
The multidisciplinary team
The multidisciplinary team carries out the full assessment using the Decision Support Tool. It must include at least two professionals from different healthcare professions, or one healthcare professional and one social care professional, and in practice usually includes a nurse assessor and a social worker, with input from others who know the person well. Its job is to establish the needs across the twelve care domains, analyse them through the four key characteristics, and make a reasoned recommendation on whether the person has a primary health need.
The Integrated Care Board
The Integrated Care Board makes the eligibility decision. It is the responsible commissioner and holds accountability for the outcome, so the recommendation, however carefully reached, is not the decision itself. In the large majority of cases the Board accepts the recommendation. Where it does not, the Framework expects that departure to be exceptional and properly explained, and the reasons should be given in writing to the person and their representative rather than communicated as a bare outcome.
When a recommendation can be departed from
The Framework contemplates a Board rejecting a recommendation only in exceptional circumstances, for example where the Decision Support Tool is incomplete, where the recommendation is not supported by the evidence recorded, or where there is a clear error in the application of the primary health need test. Disagreement with a properly reasoned professional judgement is not, on its own, a sound basis. Where a recommendation of eligibility is overturned, asking for the specific reasoning is a reasonable and often productive step.
What evidence must be considered
The decision must rest on the evidence gathered during the assessment. That includes the Decision Support Tool itself, care records, clinical notes, medication records, risk assessments, care plans, and the contributions of professionals involved in the person's care. It must also include the views of the person and, where appropriate, their family or representative. Evidence should be contemporaneous and specific rather than general, and gaps in the record should be identified rather than filled with assumption.
The role of the person and their representative
The person should be involved throughout and should be supported to participate. Where they may lack capacity to be involved in the process, consideration should be given to whether an advocate is required, and any best interests decision about proceeding should be recorded. Family members and representatives can attend the assessment, provide evidence and comment on the completed Decision Support Tool. Contributions should be recorded even where the team does not agree with them, so that any later review can see the disagreement.
Timescales
The Framework expects the process from Checklist to decision to be completed within 28 days in most cases. Delay is common, particularly around hospital discharge and where records must be gathered from several sources. A missed timescale does not invalidate the decision, but it is a legitimate matter to raise, and where delay has caused a person to pay for care that would otherwise have been NHS funded, the period concerned should be addressed when the decision is made.
How the decision should be communicated
The outcome should be given in writing, with reasons, together with a copy of the completed Decision Support Tool and information about how to ask for the decision to be reviewed. A decision communicated only by telephone, or given without the underlying paperwork, is difficult to test and it is reasonable to request the full documentation before deciding whether to challenge.
If you disagree
The route is local resolution first, then referral to NHS England for an Independent Review Panel if the matter remains unresolved. The most effective challenges identify specific domains where the recorded level does not match the evidence, or specific gaps in the reasoning on the four key characteristics, rather than expressing general disagreement with the outcome.
Key takeaway
The multidisciplinary team assesses and recommends, the Integrated Care Board decides. The decision must rest on the evidence and must be explained in writing. If the Board departs from a recommendation, that departure should be exceptional and reasoned, and you are entitled to see the reasoning.
Frequently asked questions
Can the Integrated Care Board overturn the team's recommendation?
Yes, but the Framework expects this to be exceptional and properly reasoned, for example where the Decision Support Tool is incomplete or the recommendation is not supported by the recorded evidence. You can ask for the reasons in writing.
Who must be in the multidisciplinary team?
At least two professionals from different healthcare professions, or one healthcare and one social care professional. In practice a nurse assessor and a social worker are typical, with input from others who know the person's day to day needs.
Can family attend the assessment?
Yes. The person should be involved wherever possible and family or representatives can attend, contribute evidence and comment on the completed tool. Ask for your comments to be recorded even where the team takes a different view.
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.