NHS Continuing Healthcare
CHC Case Review and Merits Assessment: An Honest Opinion Before You Appeal
The Case Review and Merits Assessment is a registered professional'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 fee is £1,950 plus VAT, with travel charged separately.
For new clients, a full case review and a written merits opinion before any appeal is instructed
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. Wales runs its own Continuing NHS Healthcare framework
£1,950
Fixed fee, plus VAT
One working day
Response to your enquiry
England
Cover throughout the country
Social work led
Registered professionals
Plain-English explanation
What a case review and merits assessment is
An honest written opinion on whether an appeal is worth bringing, based on the decision, the Decision Support Tool and the records behind them.
A structured review of the decision, the Decision Support Tool and the records behind them, ending in an honest written opinion on whether an appeal is worth bringing.
For new clients it is the first step before any appeal is instructed. If the case has no realistic prospect, we say so before you spend anything further on it.
Not every refusal is worth appealing
Some decisions are wrong and some are simply unwelcome. We say which this is before you spend anything further, because an appeal without merit costs money and months and ends in the same place.
Common situations
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 clear, stated fee rather than at the end of a long, expensive appeal that was never going to succeed.
A refusal has arrived
You want to know whether the decision is actually wrong before appealing.
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
A deputy or attorney must show the spend is in the person’s interests.
1
The eligibility test behind the decision
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.
Nature of the person's needs
Intensity of the person's needs
Complexity of the person's needs
Unpredictability of the person's needs
2
Whether the records support a challenge
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.
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
Paid for care during a period that was never assessed? Read: Retrospective CHC claims explained
The framework
How we assess the merits of a CHC challenge
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 fee
We confirm the scope, the fee plus VAT and any travel charge, in writing before you commit to anything.
Full case review
A registered professional 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 happens next
Our review process
Evidence base
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
The evidence the scoring should have been drawn from.
The Checklist
How the person came into the process, and what it recorded.
Process compliance
Whether the framework’s own requirements were followed.
Deliverable
What you receive
The review is practical and evidence led. You receive:
A full review of the records, the DST and the 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
Who we work with
For solicitors, deputies, care providers and advisers
Instruction is straightforward and the evidential standard is consistent whichever stage we are brought in at:
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.
Peer review as standard
A second qualified professional reviews the work before it is submitted.
Honest merits advice
Where a case has no realistic prospect, we say so before you spend anything further on it.
Already working with us
£1,950 plus VAT
- The care records, the Decision Support Tool and the decision letter read in full
- An honest written opinion on whether an appeal has a realistic prospect
- The grounds identified where it does
- Peer review by a second qualified professional
One fee, agreed in writing before any work starts, and never a percentage of what is recovered. Most CHC support is charged by the hour or as a share of the outcome, so the cost is unknown when you commit and grows the longer the case runs. Ours is stated up front, plus VAT and travel, and does not change if the case turns out to be harder than expected.
New to Nellie Supports
£3,050 plus VAT
- The Independent Social Care Needs Assessment and Care Plan, £1,100 plus VAT
- Charged once per client and never re-charged as your case progresses
- Everything listed in the returning price
The needs assessment is not an administrative step, and it is the reason our later stages cost less than they otherwise would. It is an independent professional record of what the person actually needs, written in the language the twelve care domains are scored in, before the NHS process forms its own view. Every stage after it builds on that record rather than starting again, which is why it is charged once and never re-charged.
Transparent pricing
Two prices, depending on whether we already have your case
The work is identical. What differs is whether the gateway assessment has already been done and paid for. It is charged once per client and never re-charged, so every later stage of your case is at the returning price.
For families
A clear fee, agreed in writing before we start, with no percentage of anything recovered. We explain what is happening in plain English and deal with the process so you do not have to.
For professionals
Scope, fee and timescale confirmed in writing before instruction. Evidence prepared against the twelve care domains and the four key characteristics, peer reviewed by a second qualified professional.
Provider evidence
Why choose Nellie Supports for a merits assessment
An honest opinion before you commit to an appeal, from people who run appeals for a living.
Why families and professionals choose Nellie Supports
Social work led, not a claims company
Registered professionals 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.
Published 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.
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 professional 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.
We did not take the Decision Support Tool at face value, and we did not take the family’s account at face value either. A registered professional read the whole record and formed an independent view of what her needs actually were. That is what makes a merits opinion worth having: it is an assessment, not a second opinion on somebody else’s assessment.
This is an illustrative example. It does not describe any individual client.
How the merits assessment works in practice
Frequently asked questions
Frequently Asked Questions About the Case Review and Merits Assessment
Why do new appeal clients start with a case review?
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 known 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 fee include?
The 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.
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.
Supporting guidance
Related NHS Continuing Healthcare guides
Independent Social Care Needs Assessment & Care Plan
Included in the new client price of every CHC service and charged once. Independent needs assessment and written care plan, also available on its own.
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.
Where your case can go next
Discuss your case
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.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.