NHS Continuing Healthcare
Challenging a CHC Decision
Local resolution, the Independent Review Panel and the Ombudsman, and what actually makes a challenge succeed.
How do I appeal a CHC decision?
A CHC decision is challenged in stages. You first ask the Integrated Care Board for local resolution, normally within six months of the written decision. If that does not resolve it, you can request an Independent Review Panel through NHS England. If the panel process is exhausted, the Parliamentary and Health Service Ombudsman can consider the complaint.
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Most refusals are not overturned because someone disagreed more forcefully. They are overturned because the reasoning in the Decision Support Tool does not stand up against the evidence, or because the process departed from the national framework. A challenge works when it identifies precisely where that happened.
The stages of challenge
Each stage has to be attempted before the next becomes available.
- Local resolution: a request to the Integrated Care Board to review its own decision
- Independent Review Panel: convened by NHS England where local resolution fails
- Parliamentary and Health Service Ombudsman: considers maladministration once the process is exhausted
- Judicial review: rare, and a matter for solicitors rather than assessors
- Fresh assessment: appropriate where needs have changed since the original decision
How to prepare
A challenge is only as good as the paperwork behind it, so gather it before you write anything.
- Request the full assessment file, including the completed Decision Support Tool
- Note the date of the written decision, which starts the time limit running
- Identify the specific domains you say are wrong, and why
- Assemble the evidence that contradicts each disputed level
- Record any procedural failure separately from the disagreement on need
Where people often go wrong
- Appealing in general terms rather than domain by domain
- Missing the six month window for requesting local resolution
- Arguing about the diagnosis instead of the level of need
- Not requesting the assessment file before writing the challenge
- Going straight to the Ombudsman before the earlier stages are exhausted
- Appealing in general terms rather than domain by domain
- Missing the six month window for requesting local resolution
- Arguing about the diagnosis instead of the level of need
- Not requesting the assessment file before writing the challenge
- Going straight to the Ombudsman before the earlier stages are exhausted
What makes a challenge succeed
Strong challenges are specific. They identify the domain levels that are wrong, set out the evidence that contradicts them, and show why the recorded reasoning on primary health need does not follow from the scores. They also identify process failures: evidence not gathered, the family excluded, disagreement not minuted, or reasoning simply absent from the written decision.
A social work led multidisciplinary practice
We review the Decision Support Tool against the evidence, identify where the reasoning fails, and put the challenge in writing in the framework's own terms. We attend local resolution meetings and Independent Review Panels, and we will tell you honestly when a case is not worth pursuing.
Frequently Asked Questions
How long do I have to appeal a CHC decision?
You normally have six months from the date of the written eligibility decision to ask the Integrated Care Board for local resolution. The time limit runs from the decision letter rather than from the assessment meeting, so keep the letter and note the date it is received.
What is an Independent Review Panel?
It is a panel convened by NHS England where local resolution has not resolved a disputed decision. It is chaired independently and includes representatives from the Integrated Care Board and the local authority. The panel reviews whether the framework was applied correctly and makes a recommendation to NHS England.
Can I challenge a decision to withdraw CHC funding?
Yes. A decision to withdraw funding at review is challenged through the same route as an initial refusal. Funding should not usually be withdrawn until any dispute is resolved, and a withdrawal has to be justified by a genuine change in need rather than by a reassessment reaching a different view of the same needs.
Do I need a solicitor to appeal?
Not usually. Local resolution and the Independent Review Panel are not court proceedings, and most challenges turn on care evidence and how the framework was applied rather than on points of law. Independent social work input is generally more directly useful at these stages than legal representation.
This page explains how NHS Continuing Healthcare decisions are challenged in England. It is general information rather than legal advice. Nellie Supports is an independent social work practice and does not provide regulated legal services.