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NHS Continuing Healthcare
How to Appeal a CHC Decision
Local resolution, the six month window, and what a strong submission contains
How is a CHC decision challenged?
An NHS Continuing Healthcare decision can be challenged within six months. The first stage, local resolution, is handled by the Integrated Care Board that made the decision, and it is where a structured, records-based written submission does its work. If local resolution does not resolve the matter, the case can go to the NHS England Independent Review Panel.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
An appeal is not a complaint about fairness in general. It is a demonstration, from the records, that the needs picture was scored wrongly or the process was not followed. That framing decides everything about how the work is done. This guide describes the system in England. Wales operates its own Continuing NHS Healthcare framework through health boards.
The stages of challenge
The route runs in order:
- Local resolution with the Integrated Care Board, opened within the six month window
- The NHS England Independent Review Panel, if local resolution does not resolve it
- The Parliamentary and Health Service Ombudsman, where procedure has failed beyond that
How to prepare
Building the submission:
- Obtain the full care records, the completed Decision Support Tool and the decision letter
- Map each disputed domain: the score given, the evidence that contradicts it, the score the evidence supports
- Describe needs through nature, intensity, complexity and unpredictability, not through diagnosis labels
- Identify any procedural failures: who was consulted, what was recorded, what was ignored
- Put it in writing, structured domain by domain, and keep copies of everything
Where people often go wrong
- Writing an emotional letter instead of an evidence-led submission
- Letting the six month window close while waiting for someone else to act
- Arguing every domain instead of the domains where the evidence is strong
- Expecting the meeting to fix what the written submission failed to establish
- Believing anyone who promises an outcome: no honest provider can
- Writing an emotional letter instead of an evidence-led submission
- Letting the six month window close while waiting for someone else to act
- Arguing every domain instead of the domains where the evidence is strong
- Expecting the meeting to fix what the written submission failed to establish
- Believing anyone who promises an outcome: no honest provider can
What local resolution involves
Local resolution is the Integrated Care Board reconsidering its own decision. In practice it turns on the written submission: a domain-by-domain analysis showing where the Decision Support Tool departs from the records, and where the process departed from the National Framework. A meeting is often part of the stage, but the meeting follows the paperwork, it does not replace it.
Realistic expectations help. These stages take time, outcomes are never guaranteed, and the strength of the case is set by the records, not by how strongly the family feels. What a family controls is the quality of the evidence work.
A social work led multidisciplinary practice
Nellie Supports is a social work led multidisciplinary specialist practice working across England and Wales, operating through a permanent, full-time employed team that has completed more than 11,000 assessments. Our NHS Continuing Healthcare work prepares and presents the evidence of need at every stage of the process.
Frequently Asked Questions
Do we need a solicitor to appeal?
No. The challenge stages are not court proceedings. Where a legal remedy is genuinely needed, an honest adviser will say so, and we do.
How long does local resolution take?
It varies between Integrated Care Boards and cases, and it is rarely quick. Ask the ICB for its expected timescale in writing when the challenge is opened.
Can new evidence be added?
Yes. Where the records missed important day-to-day needs, statements from family and carers and any professional reports can be put into the submission.
This guide is general information about NHS Continuing Healthcare in England, not legal advice, and does not create a professional relationship. Nellie Supports provides independent social work assessment, evidence and advocacy support. We do not provide regulated legal advice, and where a legal remedy is needed we will say so and support your solicitor's work.