NHS Continuing Healthcare
CHC Case Review and Merits Assessment: An Honest Opinion Before You Appeal
The appeal gateway for new clients: a full case review and a written merits opinion before any appeal is instructed
The Case Review and Merits Assessment is a registered social worker's full review of the care records and the CHC decision, producing a written, honest opinion on whether an appeal has a realistic prospect of success and, if so, on what grounds. It is the gateway for new appeal clients with no previous Nellie Supports involvement, completed alongside the needs assessment, and it protects families from paying for appeals that cannot succeed. The fixed fee is £1,950 plus VAT.
£1,950
Fixed fee, plus VAT, stated before instruction
One working day
Enquiry triage response
England
Wales runs a separate Continuing NHS Healthcare framework
Social work led
Registered social workers, peer reviewed
Nellie Supports is England and Wales' largest identified specialist private social work and mental capacity assessment practice, operating through a permanent, full-time employed team that has completed more than 11,000 assessments. Our NHS Continuing Healthcare support is social work led: we prepare and present the evidence of need. We are not a law firm and not a claims company.
When you need a merits assessment
You have a CHC refusal in your hand and six months to challenge it, and you are new to Nellie Supports. Before any appeal is drafted, the case needs an honest answer to one question: can this challenge actually succeed on the evidence?
The merits assessment is completed alongside the needs assessment for every new appeal client. It means we only take forward appeals with real merit, and where the records do not support a challenge, you find that out for a fixed fee rather than at the end of a long, expensive appeal that was never going to succeed.
How merits are judged
A CHC decision can be challenged within six months, but the right to challenge is not the same as a reason to. An appeal succeeds where the assessment departed from the evidence in the records, judged against the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care.
Merits are judged the way the appeal will be judged: whether the Decision Support Tool scoring and the eligibility decision match the evidence of the person's needs, assessed through their nature, intensity, complexity and unpredictability. Where the records support a challenge, the opinion says where and why. Where they do not, it says that too.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
Framework: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); the primary health need test; the six month challenge window
For more, read our guide: Challenging a CHC decision
Our review process
Initial enquiry and triage
Contact us by phone, email or website form. We confirm where your case stands against the six month window and what records will be needed within one working day.
Scope and fixed fee
We confirm the scope, the fixed fee plus VAT and any travel charge, in writing before you commit to anything.
Full case review
A registered social worker reads the full care records, the completed Decision Support Tool and the decision letter, properly and in full.
The merits assessment
Each domain score and the eligibility judgement are tested against what the records actually say, and against the National Framework.
The written opinion
You receive a written merits opinion: whether an appeal has a realistic prospect, on what grounds, and our honest recommendation on the next step, whichever way the evidence points.
What you receive
The review is practical and evidence led. You receive:
A full review of the records, the DST and the decision
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A domain-by-domain analysis of where the assessment departed from the evidence
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A written merits opinion with an honest recommendation
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A clear next step, whether that is an appeal or not
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Fees
£1,950 plus VAT
Case review and merits assessment £1,950 plus VAT, fixed. Completed alongside the Independent Social Care Needs Assessment and Care Plan (£1,100 plus VAT, charged once) for new clients. Existing Nellie Supports clients skip this step. Travel is confirmed in writing before booking.
Travel for in-person attendance is confirmed in writing before booking.
Fixed fee confirmed in writing
The whole price, plus VAT, is agreed before instruction.
The whole case reviewed
The full records, the DST and the decision letter, read in full.
An honest opinion either way
If the appeal cannot succeed, the opinion says so, and why.
Peer review as standard
A second qualified professional reviews the opinion before it is issued.
How the merits assessment works in practice
A son contacted us certain that his mother's Decision Support Tool had been rigged against her. He wanted to appeal everything: every domain score, every sentence of the decision letter, and he wanted it lodged that week.
A registered social worker reviewed the full care records against the completed DST. The honest picture was mixed. Most of the domain scores matched what the records actually said. But two did not: cognition had been scored from a single good-day conversation that the daily notes contradicted, and the altered states of consciousness domain had ignored a documented pattern of unresponsive episodes. The written merits opinion said exactly that: a scattergun appeal would fail, a narrow appeal on those two domains had a realistic prospect, and here was the evidence for each point.
The family instructed the appeal application on that basis, focused where the records were strongest. The eligibility decision stayed where it always sits, with the Integrated Care Board. What the merits assessment bought was an appeal built on the two arguments worth making, and the confidence of knowing the difference.
This is an illustrative example. It does not describe any individual client.
Why families and professionals choose Nellie Supports
Social work led, not a claims company
Registered social workers prepare and present the evidence of need. We are not a call centre and not a no-win-no-fee operation.
We say no when no is the answer
We only take forward appeals with real merit. If the records do not support a challenge, we tell you before you spend money on one.
Fixed fees, plus VAT
The whole price is published and confirmed in writing before instruction. No percentages, no surprises.
A permanent employed team
A full-time, in-house multidisciplinary team, not an ad hoc panel of associates, with more than 11,000 assessments completed practice-wide.
Frequently Asked Questions About the Case Review and Merits Assessment
Why is this mandatory for new appeal clients?
Because it protects you. An appeal drafted without a merits review is a bet placed before anyone has read the cards. For new clients we review the case first, alongside the needs assessment, so any appeal we draft is built on grounds the records actually support. Existing clients skip this step because we already know the case.
What if you conclude the appeal cannot succeed?
Then the written opinion says so plainly, and explains why. That is not wasted money: it is the difference between a fixed fee now and a long, expensive appeal that was never going to succeed. Where a different route exists, such as a complaint about how the process was handled or a future reassessment when needs change, the opinion points to it.
Do existing Nellie Supports clients need this?
No. The merits assessment is the gateway for new clients with no previous Nellie Supports involvement. Where we have already supported the case, at the assessment or an earlier stage, we know the records and the history, so appeal work can be instructed directly.
What does the fixed fee include?
The fixed fee of £1,950 plus VAT covers the full review of the care records, the Decision Support Tool and the decision letter, the domain-by-domain merits analysis, the written opinion and the recommendation on next steps, with peer review before it is issued. For new clients it is completed alongside the Independent Social Care Needs Assessment and Care Plan, £1,100 plus VAT, charged once.
Is this legal advice?
No. 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.
Related NHS Continuing Healthcare guides
Challenging a CHC decision
The NHS Continuing Healthcare process explained
CHC eligibility and primary health need
Retrospective CHC claims explained
Where your case can go next
If the merits support a challenge, our team supports every stage of the appeal pathway.
Independent Social Care Needs Assessment & Care Plan
CHC Appeal Application
CHC Appeal Support
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.
Thinking about an appeal?
Contact Nellie Supports to arrange a case review and merits assessment. We will confirm the scope, the fixed fee and the next steps in writing.
We aim to respond to all enquiries the same working day.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.