How to appeal an NHS Continuing Healthcare decision

By CareFinder Team · Published 2026-09-18 · Last reviewed 2026-09-18

In England you appeal an NHS Continuing Healthcare decision by writing to the integrated care board (ICB), normally within six months of the decision letter, and asking for a review under its local resolution process. If the ICB does not change its mind, you can ask NHS England for an independent review, and after that complain to the Parliamentary and Health Service Ombudsman. Wales has similar stages with a shorter first deadline.

If the NHS has decided that your relative does not qualify for NHS Continuing Healthcare (CHC), you can challenge that decision. In England you ask the integrated care board (ICB) to review it, normally within six months of the decision letter, then go to NHS England for an independent review and finally to the Ombudsman. The process is slow and heavy on paperwork, but it is free and you do not need a solicitor to use it.

This article deals with England first, because the appeal system described here is an English one, and then explains how Wales, Scotland and Northern Ireland differ. It is general information, not advice on your relative's own case.

Which decision are you challenging?

The route depends on the stage at which the answer was no.

A negative Checklist

The Checklist is only a screening tool. A negative result means no full assessment is carried out. The ICB should write to explain the outcome and your right to ask it to reconsider, and when it reconsiders it must take account of any extra information you send.

If the ICB still refuses, the next step is the NHS complaints procedure, not an independent review. NHS England's own guide says its review process cannot look at an ICB's refusal to carry out a full assessment after a negative Checklist.

Not eligible after a full assessment

This is the decision the formal appeal system is built for. A multidisciplinary team has completed the Decision Support Tool (DST), made a recommendation, and the ICB has decided there is no primary health need. The ICB must give clear written reasons and explain how to ask for a review.

Funding withdrawn after a review

If your relative had CHC and the ICB decides after a reassessment that they are no longer eligible, you have the same right to a review. Under the National Framework the ICB should put the change in writing with reasons, and alternative funding should be arranged before CHC funding stops, so that care is not interrupted.

What are the time limits?

The GOV.UK public information leaflet on NHS Continuing Healthcare sets out the stages. The deadlines below come from Age UK's factsheet on NHS Continuing Healthcare and NHS England's guide:

• Asking the ICB for a review: within six months of the date you received the written decision. The ICB should acknowledge your request in writing within five working days.
• Asking NHS England for an independent review: within six months of hearing the final outcome of local resolution. NHS England then sends an application form, which needs to be returned within six weeks.
• Going to the Ombudsman: within 12 months of receiving the written outcome of the independent review.

Each ICB publishes its own local resolution process, and some build in shorter deadlines for later steps, so ask for a copy at the start. If a deadline is close, send a short written request now, say that your detailed reasons will follow, and ask the ICB to confirm in writing that it has been received.

What can you actually appeal about?

There are only two grounds:

• the decision itself, meaning whether your relative has a primary health need; or
• the procedure the ICB followed in reaching that decision.

The independent review process cannot look at the eligibility criteria themselves, the type or location of a care package, the content of any alternative package, the treatment your relative has received, or how a refund has been calculated. Those belong in the NHS complaints procedure.

One point saves families a lot of wasted effort. NHS England's guide is clear that procedural mistakes alone will not lead a panel to recommend eligibility. The only basis for that is a primary health need, judged by the nature, intensity, complexity and unpredictability of the person's needs. Procedural faults matter mainly where they stopped the ICB making a fair and robust decision, in which case the case may be sent back for a fresh assessment.

How do you build a strong case?

1. Get the papers. Ask the ICB for the completed DST, the Checklist and the team's recommendation if you do not already have them. Ask the care home or care agency for the care plan, daily notes, medication records and any behaviour or incident charts for the period that was assessed.
2. Work through the DST domain by domain. Where you think a level was set too low, say which level you believe is right and point to a record or a report that shows it.
3. Be specific. NHS England's example is that usually two or three times a day helps far more than a lot. Give frequencies, times of day, how many staff are needed and what happens when care is late.
4. Remember that well-managed needs are still needs. A calm week in a good care home does not mean the underlying need has gone. Describe what the care is preventing.
5. Cover the things assessors miss. Needs that fluctuate or are hard to anticipate, anything that makes giving care more complicated, mental and emotional needs, and care given by relatives as well as by professionals.
6. List any procedural failures. Examples are not being invited to contribute, important records not being obtained, or the ICB departing from the team's recommendation, which it should only do in exceptional circumstances.

What happens at local resolution?

The National Framework says every ICB must have a published local resolution process that is fair, transparent and includes timescales. It should work like this:

• An informal two-way discussion with an ICB representative, with a written summary for both sides. The ICB should explain how it reached its decision by reference to the DST, and you can supply information that was not considered.
• If needed, a formal meeting with someone who has the authority to decide next steps, such as asking for further reports or asking the team to reconsider. Both sides get a full written record.
• A written outcome that either upholds or changes the decision, with a clear explanation and details of how to apply for an independent review.

You can ask to go straight to the formal meeting, and the ICB should consider that request.

What happens at an independent review?

NHS England's guide to the independent review process explains the stage in plain terms.

• NHS England first previews your application and the ICB's case file. It may send the case back for more local resolution, or ask an independent chair and clinical adviser whether a panel should be held at all. If it decides not to hold one, you get the written reasons and can use the NHS complaints procedure.
• The panel has an independent chair, plus an ICB representative and a council social services representative from organisations that were not involved in the case. A clinical adviser may also be present.
• Panels are normally held online. You can ask for a telephone, face-to-face or hybrid hearing. You can attend or put your views in writing, and the ICB should send you the case file beforehand.
• New evidence is only accepted if the ICB could reasonably have been expected to obtain or consider it at the time. The application form is your last chance to add information, so make it complete.
• The panel's recommendation is advisory, but NHS England and the ICB should accept it in all but exceptional circumstances.

NHS England says the process typically takes three to six months. You may bring a relative, an advocate or an adviser. If you appoint a solicitor, bear in mind that the hearing is not a legal process and the NHS does not reimburse legal costs.

Who pays for care while you wait?

The ICB's original decision stays in force until a review changes it. The Framework says nobody should be left without appropriate support in the meantime, but that support may be means-tested by the council, or your relative may be paying in full. If they live in a nursing home, check that NHS-funded nursing care has been considered, as it is a separate and smaller contribution.

Keep every invoice and receipt. If the decision is overturned, the ICB should refund care costs from the date of its original decision. Where the council was paying, the ICB repays the council and the council returns your relative's contributions. Where your relative was self-funding, the ICB should make a payment intended to put their finances back where they would have been.

An appeal looks back at the needs at the time of the assessment. If your relative's condition has worsened since, ask for a new assessment as well. You do not have to choose between the two.

How is it different in Wales, Scotland and Northern Ireland?

• Wales: the scheme is called Continuing NHS Healthcare and is run by local health boards. The Welsh Government says you must tell the health board within 28 days that you intend to appeal and send the written appeal within six months. There is a local review, then an Independent Review Panel, then the Public Services Ombudsman for Wales.
• Scotland: NHS Continuing Healthcare was replaced in June 2015 by Hospital Based Complex Clinical Care, which asks whether the person's needs can only be met in hospital. There is no CHC appeal panel. Disagreements go through the NHS Scotland complaints procedure and then to the Scottish Public Services Ombudsman.
• Northern Ireland: there is no equivalent of the English framework, and decisions sit with the Health and Social Care Trusts. Challenges go through the health and social care complaints procedure, usually within six months, with free support from the Patient and Client Council, and then to the Northern Ireland Public Services Ombudsman.

Where can you get help?

Age UK's advice line, Citizens Advice and local advocacy services can all help, and your ICB should be able to give you details of advocacy in your area. Age UK's factsheet also points families to Beacon, a specialist CHC advice service. The NHS overview of Continuing Healthcare is a useful reminder of how eligibility is meant to be decided.

Get personal advice where large sums are at stake, where a property may have to be sold to pay fees, or where nobody holds a lasting power of attorney for your relative.

Frequently asked questions

Do I need a solicitor to appeal a CHC decision?

No. The National Framework says legal representation is not necessary because panels have a scrutiny and reviewing role. You can be represented by family, an advocate or an advice service. If you do pay a solicitor, the NHS will not refund the cost.

Can I appeal on behalf of a parent who lacks mental capacity?

Yes, if you hold a lasting power of attorney or are a court-appointed deputy. If you hold neither, the Framework says a best interests process should be used to decide whether the challenge should go ahead, so a close relative is not automatically shut out.

How long does a CHC appeal take?

There is no single national timescale for local resolution; each ICB publishes its own. NHS England says an independent review typically takes three to six months on top of that. Ask the ICB for its published timescales at the start, and plan for the whole process to take many months.

Will appealing affect my relative's care?

It should not. The existing decision stays in place and appropriate care should continue while the review is pending. What may change is who pays, which is why keeping receipts matters.

Can I claim for a past period when nobody assessed my relative?

Possibly. In England you can ask the ICB to review a previously unassessed period of care. The guidance applies to care since 1 April 2012, and earlier periods are only considered in exceptional circumstances. This is a separate request from an appeal.

Key takeaways

• In England, ask the ICB for a review within six months of the written decision, in writing.
• There are two stages, local resolution with the ICB and then an independent review by NHS England, followed by the Ombudsman.
• A negative Checklist is challenged by asking the ICB to reconsider and then through NHS complaints, not through an independent review.
• Panels decide on primary health need, so build your case on detailed evidence of day-to-day needs rather than on procedure alone.
• The original decision stands while you appeal. Keep receipts, because a successful appeal should lead to a refund.
• Wales has a 28-day notice deadline. Scotland and Northern Ireland have no CHC appeal panel and use complaints procedures instead.