Nellie Supports · NHS Continuing Healthcare
CHC Case Review and Merits Assessment
Understand the strengths and gaps in a CHC challenge before commissioning an appeal. We review the decision, DST and relevant assessment-period records, then provide a written merits opinion and recommended next step. The review is £2,340 including VAT. New appeal clients also require the independent needs assessment, with the combined scope and fee confirmed before instruction. Travel is charged separately.
Service overview
Understand the strengths and gaps in a CHC challenge before commissioning an appeal. We review the decision, DST and relevant assessment-period records, then provide a written merits opinion and recommended next step. The review is £2,340 including VAT. New appeal clients also require the independent needs assessment, with the combined scope and fee confirmed before instruction. Travel is charged separately.
All travel is charged separately at £48 per hour including VAT (£40 excluding VAT). The travel cost and any additional work are confirmed in your written quotation before booking.
A written, evidence-based view of a CHC challenge before further appeal work is agreed.
Merits review: £2,340 including VAT
Decision received: Tell us the date
Cover throughout the country: England
Registered professionals: Social work led
At a glance
Role
An independent opinion on whether an appeal has real merit
Framework
National Framework for NHS CHC and NHS-funded Nursing Care, 2022 revision
Format
Records review and written opinion
Deliverable
A written merits opinion with a clear recommendation
Coverage
England only. Wales has a separate Continuing NHS Healthcare framework.
Who are you arranging this for?
We agree how the person will be involved, who can instruct us and who should receive updates.
I am supporting a family member
You have someone to explain the process, organise the relevant evidence and help you put the person's needs into words. The work and fee are agreed before we start.
I am instructing as a professional
We agree the instruction, authority to act, evidence required, reporting arrangements and timetable with you. Written work links each point to its source.
What a case review and merits assessment is
Nellie Supports is an independent social work practice. Our NHS Continuing Healthcare support helps families and professionals in England explain care needs and present relevant evidence.
What a case review and merits assessment is
A reasoned written view on whether the available evidence supports a challenge, and what to do next.
We examine the decision, DST and records relevant to the assessment period, then explain the supported points, weaknesses and any missing evidence.
New appeal clients start with this review alongside the independent assessment. Clients whose continuing case we already know do not routinely repeat the same merits work.
When you need a merits assessment
A refusal can leave you unsure whether the assessment missed something or whether another route would help. The review gives you an independent account before you decide on further paid work.
We distinguish a supported challenge from an unwelcome outcome, and historical evidence from later changes that may require a fresh assessment.
A refusal has arrived
You want to understand whether the records support a challenge.
The DST scoring looks low
The domain levels do not match the records you have read.
A deadline is approaching
Your decision letter sets a time limit, commonly six months.
You are advising a client
A professional needs an independent view before recommending an appeal.
A previous appeal failed
You want to know whether anything remains open.
The costs need justifying
You need a documented reason for commissioning further work and to check authority to act.
Not every refusal is worth appealing
The opinion explains what supports a challenge, what weighs against it and what remains uncertain. We recommend further work only where we can explain its purpose.
How we assess the merits of a CHC challenge
The review considers whether the ICB followed the National Framework and properly evaluated needs at the time of the disputed assessment. Check the deadline in the decision letter promptly.
We compare relevant records with the domain levels and the overall primary health need reasoning. Post-assessment deterioration is considered separately as a possible reason for fresh assessment.
National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care; the primary health need test; the relevant ICB review procedure and deadline.
Read the supporting guidance
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
Our review process
Initial enquiry and triage
Send the decision date, DST date and details of any approaching deadline. We confirm the relevant period and the records needed for the review.
Scope and fee
We confirm the scope, total fee including VAT, payment stages and any additional costs in writing before you instruct us. Further work is agreed before it starts.
Full case review
We review the agreed set of care records, completed DST and decision letter, identifying missing material that may limit our view.
The merits assessment
The analysis considers domain descriptors, the total needs and any material procedural issue, using evidence relevant to the disputed assessment.
The written opinion
You receive the supported grounds, weaknesses, gaps and our recommendation. The opinion is not a promise of a successful appeal.
What we look at
A merits opinion is only as good as the papers it is based on.
The eligibility decision letter
What was decided, on what basis, and by when it can be challenged.
The completed Decision Support Tool
Every domain level and the reasoning recorded for it.
The MDT recommendation
Whether the recommendation and the decision actually match.
The care records
Contemporaneous evidence of needs, care, monitoring and interventions during the disputed period.
The Checklist
How the person came into the process, and what it recorded.
Process compliance
Whether the framework’s own requirements were followed.
What you receive
The review is practical and evidence led. You receive:
Review of the agreed records, DST and decision
A domain-by-domain analysis of where the assessment departed from the evidence
A written merits opinion with an honest recommendation
A clear next step, whether that is an appeal or not
Two prices, depending on whether we already have your case
The merits review is £2,340 including VAT. New appeal clients also need the independent needs assessment. We confirm the whole instruction, assessment period and fee before work begins.
Already working with us
- The relevant records, DST and decision reviewed within the agreed scope
- A reasoned written opinion on the grounds, weaknesses and uncertainties
- The grounds identified where it does
- Evidence sources and limitations explained
£2,340 including VAT
New to Nellie Supports
- Independent needs assessment and care plan, scoped for the relevant decision period
- Updates included for the same person and continuing case
- The merits review and written recommendation
Combined instruction confirmed in writing
Fees
£2,340 including VAT
The merits review is £2,340 including VAT. Any independent assessment or historical reconstruction required for a new appeal case is identified in the combined written quote. Appeal drafting and meeting representation are separate work.
Fee confirmed in writing
VAT is included; travel is charged separately. The total fee and scope are agreed before instruction.
The whole case reviewed
The agreed records compared with the DST and decision, with any gaps identified.
An honest opinion either way
If the evidence does not support further appeal work, the opinion explains why and what other route may be relevant.
Evidence and reasons explained
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
How the merits assessment works in practice
A family disagrees with several DST levels and wants to know which concerns are supported by the care records.
In this example, the review would separate the points supported by contemporaneous records from those that are uncertain or concern later changes.
The written opinion would recommend a focused challenge, further evidence gathering or a different next step, depending on what the records show.
The family would have reasons for the recommendation and a clearer basis for deciding whether to commission more work.
Illustrative example only. This does not describe a client or predict an NHS or Ombudsman decision.
For solicitors, deputies, care providers and advisers
We agree a clear instruction and reporting arrangements before starting work.
Scope confirmed in writing
The stage, the fee and the timescale are confirmed in writing before instruction.
Evidence in the language of the framework
Needs are described against the twelve care domains and the four key characteristics, not in general terms.
Evidence and reasons explained
The written work identifies the records used, the reasons for our view and any gaps that could affect it.
A reasoned next step
We explain where the evidence does not support further work and what other route may be relevant.
Why choose Nellie Supports for a merits assessment
Independent analysis to help you decide what further work, if any, is justified.
For families
You have someone to explain the process, organise the relevant evidence and help you put the person's needs into words. The work and fee are agreed before we start.
For professionals
We agree the instruction, authority to act, evidence required, reporting arrangements and timetable with you. Written work links each point to its source.
Why families and professionals choose Nellie Supports
Independent social work support
Our social work approach connects the person's everyday needs with the evidence and questions relevant to the CHC stage.
A clear recommendation either way
We explain where the records support a challenge and where they do not, before further work is agreed.
Fees including VAT
Your scope and total fee including VAT are confirmed before instruction. Additional work is agreed before it starts.
A clear point of contact
A named contact helps you understand the agreed work, the information needed and the next step.
Frequently Asked Questions About the Case Review and Merits Assessment
Why do new appeal clients start with a case review?
We need to understand the evidence before recommending or drafting a challenge. New appeal clients therefore start with a merits review and independent assessment. Existing continuing cases do not routinely repeat work already completed.
What if you conclude the appeal cannot succeed?
The opinion explains why further appeal work is not recommended on the available evidence. It may identify missing records, a complaints issue or changed needs that warrant a fresh NHS assessment.
Do existing Nellie Supports clients need this?
Not routinely where we already know the same continuing CHC case. We confirm what earlier work remains suitable and whether any additional analysis is needed.
What does the fee include?
£2,340 including VAT covers the agreed merits review and written opinion. New appeal clients also need the independent assessment, specified in the combined quote. Drafting and representation are separate services.
Is this legal advice?
No. Nellie Supports provides independent social work assessment, evidence and advocacy support in England. We do not provide regulated legal advice. We explain when a solicitor's advice is needed.
Related NHS Continuing Healthcare guides
Challenging a CHC decision
The stages of challenge and what makes an appeal persuasive.
The NHS Continuing Healthcare process explained
A plain English guide to the Checklist, the Decision Support Tool, the MDT and the ICB decision.
CHC eligibility and primary health need
What a primary health need is and how the four key characteristics are judged.
Retrospective CHC claims explained
What a retrospective NHS Continuing Healthcare claim (PUPoC) is, who can claim and how the records decide it.
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
Our independent needs assessment and care plan underpin Nellie's casework and are included where specified in the new client package. They are not a requirement for accessing NHS assessment.
CHC Appeal Support: Local Resolution
Written submission and representation at local resolution with the Integrated Care Board, the first stage of a CHC appeal. The Independent Review Panel is a separate service.
Nellie Supports provides independent social work assessment, evidence and advocacy support in England. We do not provide regulated legal advice. We explain when a solicitor's advice is needed.
Thinking about an appeal?
Contact Nellie Supports to arrange a case review and merits assessment. We will confirm the scope, the fee and the next steps in writing.
Tell us about any urgent date at first contact so we can confirm whether the required timetable can be met.
When you need a merits assessment
The eligibility test behind the decision
Whether the records support a challenge
For more, read our guide: Challenging a CHC decision
Paid for care during a period that was never assessed? Read: Retrospective CHC claims explained
£2,340 including VAT
The agreed scope and total fee including VAT are confirmed before work begins. We take no percentage of any funding or repayment. Additional work is agreed separately.
Combined instruction confirmed in writing
The independent assessment explains needs at the relevant time. The merits review tests the disputed decision against that evidence, so each part has a clear purpose and the same work is not charged twice.
Our independent needs assessment and care plan underpin Nellie's casework and are included where specified in the new client package. They are not a requirement for accessing NHS assessment.
Thinking about an appeal?
Practice leadership: Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.