How to Appeal a CHC Decision in England

Your parent was assessed for NHS Continuing Healthcare and the Integrated Care Board said no. The decision letter arrived, and you are now watching care home fees drain their savings at over £1,000 per week. You have six months from the date of that letter to challenge it — and the process is more winnable than most families realise.

Around 40% of CHC appeals result in a revised decision or a referral for reassessment. The system is designed to be challenged, and the ICB knows it. Here is how to structure an effective appeal.

Understand Why the Decision Was Negative

Before you appeal, request the completed Decision Support Tool (DST) document. You are legally entitled to a copy. Read each of the 12 domain scores carefully, paying particular attention to:

• Domains scored as "Moderate" that you believe should be "Severe" or "High"
• Evidence gaps — sections where the assessor wrote a brief summary rather than citing specific clinical incidents
• Inconsistencies between the DST and your parent's hospital discharge notes, GP records, or daily care logs

The most common reason families win appeals is that the original assessment underscored domains by relying on a snapshot rather than a pattern of need over time.

Stage 1: Local Resolution

Write to the ICB requesting a local resolution meeting. Your letter should:

1. Identify the specific domains you are disputing, with evidence
2. Attach daily care home notes, MAR charts, GP referral letters, and specialist consultant reports
3. Reference the National Framework criteria for each disputed domain — especially the four characteristics (nature, intensity, complexity, unpredictability)

At the local resolution meeting, the ICB will review your evidence against the original scoring. Bring a family member or advocate who can speak to day-to-day care needs. Take notes on every point discussed.

If the ICB upholds the decision after local resolution, they must issue a written outcome explaining why, and confirm your right to escalate to the next stage.

Stage 2: Independent Review Panel

If local resolution fails, you can escalate to NHS England for an Independent Review Panel (IRP). The IRP does not reassess your parent clinically — instead, it reviews whether the ICB followed proper procedures and interpreted the National Framework fairly.

The IRP examines:

• Whether the MDT assessment was conducted by appropriately qualified professionals
• Whether all relevant evidence was considered, including evidence you submitted during local resolution
• Whether the ICB applied the "primary health need" test correctly across all four characteristics

The panel makes a recommendation to the ICB, which must then explain how it will respond. An IRP recommendation in your favour does not guarantee a reversal, but it creates significant pressure for the ICB to reassess.

Building Your Evidence File

The strongest appeals are built on daily documentation, not retrospective arguments. If your parent is currently in a care home and you suspect they should qualify for CHC:

• Ask the care home manager for weekly care notes and incident reports
• Keep your own diary noting episodes that demonstrate intensity, complexity, or unpredictability
• Request a GP summary letter confirming the clinical nature of your parent's conditions
• Get specialist letters (neurologist, respiratory consultant, tissue viability nurse) confirming that needs are primarily health-driven

The England Care Funding Guide includes appeal letter templates, a CHC Evidence Diary, and domain-by-domain scoring prompts that walk you through exactly what the assessors are looking for in each of the 12 domains.

Time Limits and Retrospective Claims

You have six months from the date of the ICB's decision letter to submit an appeal. If your parent was never screened for CHC but should have been — for example, they were discharged straight to a self-funded care home placement without a checklist being completed — you may be able to claim a retrospective CHC assessment. Successful retrospective claims can result in refunds of care fees paid going back years.

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