Appeal Viability Review
NHS Continuing Healthcare Appeal Viability Review
If NHS Continuing Healthcare (CHC) funding is refused following a Decision Support Tool (DST) assessment, families may have the right to challenge the decision. However, not every case will meet the threshold for a successful appeal.
Our Appeal Viability Review provides an independent professional assessment of whether the available evidence suggests that a CHC appeal may be realistic.
This review examines the completed Decision Support Tool, the evidence used during the assessment, and the wider care records in order to determine whether the outcome may be open to challenge.
When an Appeal May Be Considered
Following a DST meeting, the Integrated Care Board (ICB) will normally issue a formal eligibility decision.
If the decision is that the person does not meet the threshold for NHS Continuing Healthcare, families may request a review of the outcome.
Appeals are usually based on issues such as:
• incorrect scoring of DST domains
• relevant care evidence not being considered
• misinterpretation of health needs
• failure to apply the Primary Health Need test correctly
Understanding whether these issues are present is essential before pursuing a formal appeal.
Our Appeal Viability Review
Fixed Fee: £3,000
Free if Nellie Supports represented you at your most recent DST
Our Appeal Viability Review involves a structured professional review of the documentation relating to the CHC decision.
This includes:
• the completed Decision Support Tool (DST)
• care records and care plans
• nursing and medical documentation
• risk assessments and incident reports
• any supporting evidence submitted during the assessment
We analyse this material against the NHS Continuing Healthcare National Framework and the Primary Health Need criteria to determine whether the decision may be open to challenge.
When Families Request an Appeal Review
Families often request this service when:
• CHC funding has been refused after a DST meeting
• they believe the decision does not reflect the person’s health needs
• the scoring of DST domains appears inconsistent with the evidence
• they want an independent professional opinion before pursuing an appeal
Understanding the strength of a potential appeal can help families decide whether to proceed with the Local Resolution stage of the CHC appeals process.
Understanding the CHC Appeals Process
Where a CHC decision is challenged, the first stage is usually Local Resolution with the Integrated Care Board.
If the outcome remains disputed, the case may progress to an Independent Review Panel (IRP).
You can learn more about retrospective and appeal cases here:
Was the CHC Decision Correct?
Many families request an Appeal Viability Review because the outcome of the Decision Support Tool meeting does not appear to reflect the person’s health needs.
In practice, CHC decisions are sometimes challenged where:
• the scoring of DST domains appears inconsistent with the care records
• relevant medical evidence was not considered during the assessment
• needs were described in a way that understated their severity
• the Primary Health Need test was not properly applied
These situations do not automatically mean an appeal will succeed. However, they may indicate that the decision should be professionally reviewed before the case is closed.
An Appeal Viability Review examines the completed Decision Support Tool and supporting care records to determine whether the outcome may realistically be open to challenge.
Speak to a CHC Specialist
If NHS Continuing Healthcare funding has been refused following a Decision Support Tool assessment, our Appeal Viability Review can provide an independent professional view of whether the decision may be open to challenge.
Contact us to discuss your situation and understand the next steps.
Received a CHC Refusal Letter?
Many families contact us shortly after receiving a letter confirming that NHS Continuing Healthcare funding has been refused. At this stage it is common to feel uncertain about what the decision actually means.
At this stage it is common to feel uncertain about what the decision actually means.
A refusal does not necessarily mean that the person’s needs were fully understood or correctly assessed. It simply means that the Integrated Care Board has decided the CHC eligibility threshold was not met.
In some cases families later discover that:
• important care records were not considered
• DST domains were scored conservatively
• the overall complexity of needs was understated
• the Primary Health Need test was not applied correctly
These situations do not automatically mean an appeal will succeed.
However, they can indicate that the decision may benefit from independent professional review before the case is closed.
Before Starting a CHC Appeal
A CHC appeal can involve a significant amount of documentation and preparation.
For this reason, many families request an Appeal Viability Review first.
This allows the completed Decision Support Tool and supporting care records to be examined to determine whether a realistic basis for challenge appears to exist.
This review provides clarity on whether:
• the decision appears consistent with the evidence
• the case may be open to challenge
• pursuing the appeal process is likely to be worthwhile