Refused NHS Continuing Healthcare? You Have 6 Months to Appeal.
If you’ve received a CHC decision letter saying your relative is not eligible, you have the right to challenge it. But you do not have unlimited time. In most cases, you have 6 months from the date of the decision letter to request a formal appeal. After that, your right to challenge may be lost.If your relative is already paying care fees privately - often £1,200 to £1,800 per week - every week matters.
A refusal does not automatically mean:
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The Decision Support Tool (DST) was accurate
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The scoring was applied correctly
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The Primary Health Need test was properly considered
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Your relative does not have significant health needs
It means the ICB has decided the threshold was not met. That decision can be wrong.
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Why NHS Continuing Healthcare Refusals Happen
An NHS Continuing Healthcare refusal does not automatically mean your relative’s needs are minor.
It means the Integrated Care Board (ICB) has decided that the evidence presented did not meet the eligibility threshold under the National Framework.
That threshold is based on whether the individual has a Primary Health Need - assessed through the Decision Support Tool (DST).
In practice, refusals often arise because:
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Domain scores do not accurately reflect care records
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Evidence is summarised but not properly analysed
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The four key characteristics - Nature, Intensity, Complexity and Unpredictability - are not fully evidenced
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Multidisciplinary Team (MDT) recommendations are adjusted at panel stage
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Needs are framed as “manageable” rather than evaluated in context
The distinction between health needs and social care needs is frequently misunderstood.
CHC eligibility is not about diagnosis.
It is about the quality, interaction and presentation of needs.
A structured appeal examines whether:
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The DST accurately reflects documented evidence
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The reasoning behind each domain score is consistent
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The Primary Health Need test was properly applied
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The National Framework guidance was followed
The appeal process exists because the original decision can be flawed.
How We Assess Your CHC Refusal
Every CHC appeal begins with structured analysis.
We do not submit appeals based on frustration or disagreement alone. We assess whether the original decision complies with the National Framework and whether the evidence supports a different outcome.
Our review process includes:
Full Decision Review
We examine:
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The Decision Support Tool (DST)
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Domain scoring rationale
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Multidisciplinary Team (MDT) notes
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Panel decision summary
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The formal decision letter
We look for internal inconsistencies, scoring anomalies, and unsupported conclusions.
Evidence Correlation
We compare the DST scoring directly against:
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Care home daily records
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Nursing notes
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GP and hospital records
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Incident logs
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Medication records
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Risk assessments
CHC eligibility depends on how needs are evidenced - not simply how they are described.
Where records demonstrate greater severity than reflected in the DST, this is identified clearly.
Primary Health Need Analysis
Eligibility is ultimately determined by whether the individual has a Primary Health Need, assessed through:
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Nature
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Intensity
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Complexity
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Unpredictability
We evaluate whether these characteristics were properly analysed and whether the reasoning given by the ICB withstands scrutiny.
Appeal Strength Advice
You receive clear advice on:
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Whether the appeal is viable
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Which domains are realistically challengeable
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What additional evidence may be required
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Whether retrospective recovery should be considered
If a case is weak, we say so.
If a case is strong, we explain why.
Our role is to provide clear, evidence-based advice - not false reassurance.
Clear Next Steps
If you proceed, we:
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Draft structured appeal submissions
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Correlate evidence to each contested domain
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Prepare you for Local Resolution meetings
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Represent you where instructed
Every stage is evidence-led.
The CHC Appeal Process Explained
Stage 1: Local Resolution
This is the first formal stage of appeal.
You (or your representative) submit a written challenge to the Integrated Care Board (ICB), setting out:
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Which domain scores are disputed
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Why the evidence supports a higher score
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How the Primary Health Need test should have been applied
A Local Resolution Meeting is often arranged. This is not a tribunal, but it is a structured review meeting.
Many cases are corrected at this stage when:
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Evidence is properly correlated
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Scoring inconsistencies are exposed
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National Framework guidance is applied correctly
This stage is evidence-led - not adversarial.
Stage 2: Independent Review Panel (IRP)
If Local Resolution does not change the outcome, the case can be referred to NHS England for an Independent Review Panel.
The IRP examines:
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Whether the National Framework was properly followed
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Whether the decision-making process was consistent
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Whether the eligibility conclusion was reasonable based on evidence
This stage requires disciplined written submissions and structured argument.
It is not a fresh assessment of needs - it is a review of how the original decision was made.
Stage 3: Parliamentary & Health Service Ombudsman
If procedural errors remain unresolved, a complaint can be made to the Ombudsman.
This stage does not re-assess eligibility directly. It examines fairness and process.
How Long Does a CHC Appeal Take?
Timelines vary, but appeals can take several months depending on:
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ICB capacity
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Evidence complexity
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Whether the case proceeds to IRP
During this time, care fees often continue to be paid privately — which is why early action matters.
Important: Appeals Are Evidence-Based
CHC appeals are not won by volume of documents or emotional argument.
They are won by:
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Accurate interpretation of the National Framework
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Clear domain-by-domain analysis
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Proper application of the Primary Health Need test
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Consistent evidence correlation
Structure changes outcomes.
The Financial Impact of a Successful CHC Appeal
NHS Continuing Healthcare is not means-tested.
If eligibility is granted, the NHS becomes responsible for funding the full cost of assessed care needs.
For many families, that represents:
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£1,200–£1,800 per week in care home fees
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£60,000–£90,000 per year
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Ongoing financial uncertainty
A successful CHC appeal can mean:
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Full NHS-funded care
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No contribution based on savings or property
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No local authority capital threshold
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Removal of continuing private care fees
For families who have been paying privately, this can be financially transformative.
Retrospective Recovery
If your relative should have been found eligible earlier, you may also be entitled to retrospective reimbursement.
This can apply where:
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The DST scoring was incorrect
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The Primary Health Need test was misapplied
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The National Framework was not properly followed
In some cases, families recover significant sums in previously paid care fees.
Each case depends on evidence and time limits, but it is an important consideration during review.
The Cost of Delay
While an appeal is being considered:
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Care fees often continue
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Savings may reduce
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Property decisions may feel pressured
The 6-month appeal window is fixed in most cases.
Acting early protects both your legal position and your financial position.
Financial Protection While You Appeal
We understand that families are already managing substantial care costs.
For that reason, we offer structured fixed-fee stages and, where appropriate, our Care Funding Cap - ensuring your total support costs remain predictable.
Clarity matters when financial pressure is high.
Frequently Asked Questions
The first step is understanding whether the decision is defensible.
Not every refusal is wrong.
But many are poorly reasoned or inconsistently applied.
A structured review provides clarity on whether an appeal is realistic and proportionate.
A CHC Appeal Viability Review is a structured, forensic assessment of the refusal decision.
We examine whether the Integrated Care Board’s decision complies with the National Framework and whether the evidence supports a different eligibility outcome.
This is not a brief opinion.
It is a detailed, evidence-led analysis designed to determine whether a formal appeal is proportionate and realistically viable.
Your review includes:
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Full Decision Support Tool (DST) forensic analysis
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Review of MDT recommendations and panel rationale
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Domain-by-domain scoring scrutiny
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Correlation of care records to assessed levels
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Reassessment of Primary Health Need
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Analysis of Nature, Intensity, Complexity and Unpredictability
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Identification of procedural inconsistencies
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Structured written opinion on appeal strength
Where appropriate, we also advise on retrospective recovery potential.
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You receive a written opinion setting out:
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Whether an appeal is realistically viable
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Which domains are materially challengeable
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The strength of the Primary Health Need argument
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The risks of proceeding
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Recommended next steps
If the case is weak, we will advise against proceeding.
If the case is strong, we will explain why and outline the appropriate appeal pathway.
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CHC appeals are technical.
They are determined by:
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Proper application of the National Framework
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Accurate domain scoring
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Correct interpretation of the four key characteristics
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Consistency between evidence and conclusion
Submitting an appeal without structured analysis risks weakening your position at Local Resolution and Independent Review Panel.
This review ensures any challenge is disciplined and evidence-based.
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In most cases, you have 6 months from the date of the decision letter to request Local Resolution.
Delay can risk losing the right to challenge.
Early structured analysis protects your position.
This is the space to describe the service and explain how customers or clients can benefit from it. It’s an opportunity to add a short description that includes relevant details, like pricing, duration, location and how to book the service.
Next Step
If you have received a CHC refusal letter and want structured, expert analysis of whether an appeal is viable: Book a CHC Appeal Viability Review. You will receive clear advice grounded in the National Framework and supported by evidence analysis.
Do not wait until the 6-month deadline approaches.
Early clarity protects both your legal position and your financial position.