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NHS Continuing Healthcare
Not Eligible After a CHC Assessment
What the decision letter means, and the choices in front of you
What does a not eligible decision mean?
A not eligible decision means the Integrated Care Board has decided the person's overall needs do not amount to a primary health need. It is not necessarily the end. The decision can be challenged within six months, starting with local resolution, and for people in nursing homes NHS-funded Nursing Care may still apply.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
The decision letter usually arrives with little explanation of what can happen next. The sensible first step is not an argument but a comparison: does the completed Decision Support Tool match what the care records actually show? This guide describes the system in England. Wales operates its own Continuing NHS Healthcare framework through health boards.
Your options after the decision
After a not eligible decision, the realistic routes are:
- Request the completed Decision Support Tool and the decision letter with reasons
- Compare the domain scores against the care records, looking for needs that were under-described
- Challenge the decision within six months, starting with local resolution
- For a person in a nursing home, check whether NHS-funded Nursing Care applies
- If needs increase later, ask for a new Checklist rather than waiting for a review
How to prepare
Before deciding whether to challenge:
- Get the completed DST, the decision letter and the care records in one place
- Note each domain where the score does not match the recorded evidence
- Note anything important about daily needs that never made it into the records
- Check the date on the decision letter: the six month window runs from the decision
- Get an honest professional view of the evidence before committing money to a challenge
Where people often go wrong
- Challenging on strength of feeling rather than on the records
- Missing the six month window while gathering courage
- Assuming the decision also rules out NHS-funded Nursing Care: it does not
- Paying for an appeal no honest reading of the evidence supports
- Signing up to percentage-based fee arrangements without understanding what they cost
- Challenging on strength of feeling rather than on the records
- Missing the six month window while gathering courage
- Assuming the decision also rules out NHS-funded Nursing Care: it does not
- Paying for an appeal no honest reading of the evidence supports
- Signing up to percentage-based fee arrangements without understanding what they cost
Reading the DST against the records
A challenge stands or falls on whether the Decision Support Tool reflects the evidence. Go domain by domain: what score was given, and what do the care records, professional reports and the family's day-to-day knowledge actually show? Under-scored fluctuation, well-managed needs treated as absent, and good-day evidence are the recurring patterns.
Where the gap between the scores and the records is real, local resolution with the Integrated Care Board is the first stage of challenge, and a structured written submission built on that gap is what gives it substance.
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
How long do we have to challenge?
There is a six month window to challenge an eligibility decision, running from the decision. If you are near the edge of it, act promptly and say so when you seek help.
Is NHS-funded Nursing Care automatic instead?
No, but for a person in a nursing home who is not eligible for CHC, NHS-funded Nursing Care should be considered. It is a contribution towards nursing care costs rather than a full package.
Should we always appeal?
No. An appeal is only worth a family's money and energy where the records support it. An honest review of the evidence first is the single most protective step you can take.
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.