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NHS Continuing Healthcare
CHC Ombudsman Referral: When the Process Itself Failed
The Parliamentary and Health Service Ombudsman is the final port of call when the NHS Continuing Healthcare process itself has failed: unreasonable delay, procedural failure or maladministration that the appeal stages have not put right. We prepare and submit the referral: a structured complaint about how the process was handled, with the evidence organised so the Ombudsman can act on it. The fee is £2,500 plus VAT, with travel charged separately.
Structured, evidenced referrals to the Parliamentary and Health Service Ombudsman for CHC process failures
At a glance
Role
Support with a referral to the Parliamentary and Health Service Ombudsman
Framework
National Framework for NHS CHC (2022 revision); PHSO referral process
Format
Records review and written referral
Deliverable
A prepared referral setting out the maladministration complained of
Coverage
England. Wales runs its own Continuing NHS Healthcare framework
£2,500
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 an Ombudsman referral is
A referral prepared for the Parliamentary and Health Service Ombudsman, setting out what went wrong in the process, when, and what injustice followed.
Once the Independent Review Panel is exhausted, the remaining route is the Parliamentary and Health Service Ombudsman. The Ombudsman looks at whether the process was maladministered, not at whether it would re-score the domains.
We prepare the referral: what went wrong, when, what the framework required instead, and what injustice followed.
The Ombudsman does not re-score the assessment
A referral is about maladministration: delay, evidence ignored, a decision taken outside the framework. It asks whether the process failed the person, not whether a different panel would have decided differently.
Common situations
When a referral is the right route
The Ombudsman comes into play when the appeal stages are exhausted or the failure is about process rather than eligibility: months of unreasonable delay, assessments that ignored the National Framework, or complaints that went unanswered. The referral asks the Ombudsman to investigate how the case was handled.
The Ombudsman does not award CHC funding, but its findings can require the NHS body to put things right, apologise, and remedy the injustice the failure caused, which can include recommending the case is reconsidered properly.
The IRP has been exhausted
The NHS process is complete and the outcome is still wrong.
The process was mishandled
Delay, lost evidence, missed meetings or decisions taken without the framework.
Evidence was ignored
Material provided to the ICB never reached the decision maker.
Timescales were breached
The appeal took far longer than the framework allows.
The person was excluded
Family or representatives were not given a proper part in the process.
A professional is advising
A solicitor or deputy needs the referral prepared to the right standard.
1
Maladministration and the resulting injustice
The Parliamentary and Health Service Ombudsman investigates complaints about maladministration in NHS processes, including how an NHS Continuing Healthcare case was handled. It is not another appeal about eligibility; it examines whether the process was conducted properly and fairly.
What should have happened
What actually happened
The injustice that followed
What the Ombudsman can do about it
2
Evidence for the complaint
The Ombudsman looks for maladministration: what should have happened under the National Framework, what actually happened, and the injustice that followed. A referral succeeds on an organised, evidenced account of that gap, not on repeating the eligibility argument.
Framework: Parliamentary and Health Service Ombudsman remit; National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision); NHS complaints procedures
For more, read our guide: The Ombudsman and CHC complaints
Also see: Challenging a CHC decision
The framework
What the Ombudsman can investigate
Initial enquiry and triage
Contact us by phone, email or website form. We review what has happened and confirm within one working day whether an Ombudsman referral is the right route.
Scope and fee
We confirm the scope, the fee plus VAT and any travel charge, in writing before you commit to anything.
The chronology of failure
A registered professional builds the chronology of what should have happened under the National Framework, what actually happened, and the injustice the failure caused.
Drafting and submission
The referral is drafted in the structure the Ombudsman works to, with the evidence organised and cross-referenced, and agreed with you before it is sent.
After the referral
We explain the Ombudsman's response and findings, and what they mean for the case, in plain English.
What happens next
Our support process
Evidence base
What we look at
The referral is built from the paper trail, in date order.
The full decision history
Checklist, DST, decision, local resolution and IRP outcome.
Correspondence and timelines
What was asked, what was answered and when.
Framework requirements
What the process should have done at each point.
Evidence submitted
What was provided to the ICB, and whether it was considered.
The injustice caused
The practical consequence for the person and the family.
Remedy sought
What outcome the referral is actually asking for.
Deliverable
What you receive
Support is practical and evidence led. You receive:
A clear chronology of what went wrong, mapped to the National Framework
A structured referral drafted for the Ombudsman's process
An organised, cross-referenced evidence bundle
A written summary of the submission and what follows
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
£2,500 plus VAT
- The full decision history reviewed
- The chronology of what should have happened against what did
- The referral prepared and submitted to the Ombudsman
- 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
£5,550 plus VAT
- The Independent Social Care Needs Assessment and Care Plan, £1,100 plus VAT
- The Case Review and Merits Assessment, £1,950 plus VAT
- Both charged once and never re-charged
- Everything listed in the returning price
Two things sit behind this price. The needs assessment is an independent professional record of what the person actually needs, in the language the twelve care domains are scored in, and every later stage builds on it. The merits assessment is the honest opinion on whether the appeal is worth bringing at all. We would rather tell you a case is weak before you spend on it than take the instruction and bill you for a submission that was never going to succeed.
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 an Ombudsman referral
An Ombudsman referral is about process failure. It has to be documented, dated and specific.
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.
The right argument for the right forum
An Ombudsman referral is about process, not eligibility. We frame it that way, which is what gives it a chance of succeeding.
Published fees, plus VAT
The whole price is published and confirmed in writing before instruction. No percentages, no surprises.
Peer reviewed as standard
Everything we prepare is reviewed by a second qualified professional before it is used.
A husband had spent nearly two years trying to get his wife's Continuing Healthcare case handled properly: a review promised and never carried out, letters that went unanswered, and a complaint that was closed without addressing what he had actually raised. The eligibility arguments had run their course; the problem now was how the case had been handled.
A registered professional built the chronology the Ombudsman needs: what the National Framework required at each stage, what actually happened, and the injustice the gap caused, from unfunded care fees to months of avoidable distress. The referral was drafted in the structure the Ombudsman works to, with every event cross-referenced to a document, and submitted with an organised evidence bundle.
The Ombudsman's findings were its own to make, and no referral can promise a particular outcome. What the referral did was turn two years of scattered correspondence into an account of maladministration that could actually be investigated.
What made the referral possible was having our own assessment of her needs from the period in question. Without it the complaint would have been that the family disagreed with the outcome, which the Ombudsman does not investigate. With it, the gap between what the records showed and what the process recorded could be demonstrated rather than asserted.
This is an illustrative example. It does not describe any individual client.
How an Ombudsman referral works in practice
Frequently asked questions
Frequently Asked Questions About the Ombudsman Referral
What can the Ombudsman actually do?
The Ombudsman investigates maladministration: unreasonable delay, procedural failure, ignored complaints and processes that departed from the National Framework. It can require the NHS body to apologise, put things right and remedy the injustice caused, which can include recommending a case is properly reconsidered. It does not decide CHC eligibility and does not award funding.
When is the right time to refer?
Generally after the NHS routes are exhausted: the Ombudsman usually expects the complaint to have been through the NHS body's own process, and for eligibility disputes through local resolution and the Independent Review Panel, before it will investigate. If you are unsure where your case sits, we will tell you honestly at triage.
Is this an appeal about funding?
No. The referral is about how the process was handled rather than a claim for funding. If your aim is to overturn an eligibility decision, the appeal stages are the route for that, and we will point you to them instead. The Ombudsman route is for the failures the appeal stages cannot fix.
What does the fee include?
The fee of £2,500 plus VAT covers the review of what happened, the chronology, the drafting of the referral, the organised evidence bundle and submission, with peer review throughout. Travel is the only possible addition and is confirmed in writing before booking.
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.
The stages of challenge and what makes an appeal persuasive.
A plain English guide to the Checklist, the Decision Support Tool, the MDT and the ICB decision.
What a primary health need is and how the four key characteristics are judged.
Supporting guidance
Related NHS Continuing Healthcare guides
Application and representation at the Independent Review Panel, handled as one merged stage.
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.
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.
Other CHC support stages
Discuss your case
The process itself went wrong?
Contact Nellie Supports to discuss a referral to the Parliamentary and Health Service Ombudsman. We will review whether a referral is the right route, confirm the fee and set out the next steps in writing.
Written by Ben Slater, Founder and Managing Director, Nellie Supports. Read our editorial policy.