Challenging a Refusal
How to Appeal a CHC Decision
A refusal is not the end. NHS Continuing Healthcare decisions are frequently wrong \u2014 and you have a legal right to challenge them. The appeals process has three formal stages, and families who prepare carefully have a meaningful chance of overturning a refusal.
Why CHC decisions are so often wrong
The CHC assessment process depends heavily on the skill and objectivity of the multidisciplinary team (MDT) completing the Decision Support Tool. In practice, errors are common.
The most frequent assessment failures are:
- Domain scores set too low because the assessor observed the person on a good day, or relied on care home records that understate night-time needs
- Failure to consider unpredictability as a standalone reason for eligibility \u2014 many assessors focus on continuous need and discount fluctuating conditions
- The primary health need test applied too narrowly, treating needs as social rather than health when the evidence supports health
- Co-morbidities assessed in isolation rather than cumulatively \u2014 two moderate needs that interact may together justify a High score
A refusal based on any of these errors is challengeable. The key is knowing what to challenge and how to frame the argument.
Stage 1 \u2014 Local resolution
The first stage is a local resolution meeting with the Integrated Care Board (ICB) that made the decision. You must request this within three months of receiving the decision letter.
At local resolution you can:
- Submit new evidence \u2014 care logs, GP letters, specialist reports, your own witness statements
- Challenge specific domain scores with reference to the National Framework
- Argue that the primary health need test was applied incorrectly
- Request that a new DST be completed with full family involvement
Bring everything in writing. Set out each domain where you believe the score is wrong, the evidence that supports a higher score, and the paragraph of the National Framework that applies. The ICB must respond to your arguments.
Local resolution is often underused because families treat it as an informal chat. It is not \u2014 it is a formal process that creates a written record used in all subsequent stages.
Stage 2 \u2014 Independent Review Panel
If local resolution fails, or if the ICB does not follow the correct process, you can request an Independent Review Panel (IRP).
The IRP is convened by NHS England (currently \u2014 functions transferring to DHSC by October 2026). The panel includes:
- An independent clinical chair
- An independent clinical advisor
- An ICB representative
The IRP reviews the process and the decision. It can uphold the refusal, recommend a new assessment, or recommend a finding of eligibility. Its recommendation is not formally binding on the ICB, but ICBs that ignore IRP recommendations face significant legal exposure.
Request an IRP within six months of the local resolution outcome. Submit the same written evidence pack, updated with any new developments.
Stage 3 \u2014 Ombudsman and judicial review
If the IRP process was not conducted properly \u2014 for example, if the panel applied the wrong legal test, or if the ICB failed to implement a recommendation \u2014 you can complain to the Parliamentary and Health Service Ombudsman (PHSO).
The PHSO investigates maladministration. It can require the ICB to reconsider, pay compensation, or issue a public report. PHSO investigations take time \u2014 typically 12\u201324 months \u2014 but they carry significant weight.
Judicial review is available as a last resort where an ICB has acted unlawfully \u2014 for example, by applying a blanket policy rather than assessing the individual, or by refusing to carry out an assessment at all. This requires specialist legal advice and is not the starting point, but it is available.
Evidence that makes appeals succeed
The families who succeed in appeals are those who can demonstrate, on paper, that the person's needs were scored incorrectly. The most powerful evidence:
A care diary\u2014 a day-by-day record of the person's needs, interventions, incidents, and responses. If you kept one before the original assessment, use it. If not, start one now and submit it as evidence of ongoing needs.
Night-time records \u2014 care needs that manifest at night are systematically underweighted. Request overnight care logs from the care home and submit them.
GP and specialist letters \u2014 ask the person's GP, consultant neurologist, psychiatrist, or other specialist to write a letter specifically addressing the domain scores they have expertise in. A specialist who says “this person's needs in the behaviour domain are High, not Moderate, because…” is powerful.
Your own witness statement \u2014 family members who know the person's needs intimately should submit formal written statements. Describe specific incidents, not general impressions.
Frequently asked questions
How long does the appeals process take?
Local resolution typically takes 4–8 weeks from request to meeting. An IRP hearing is usually scheduled within 3–6 months of the request. If the process is running slowly, write formally to the ICB setting a deadline and referencing NHS England’s guidance on timelines.
Do I need a solicitor to appeal?
You do not need a solicitor for local resolution or an IRP. Many families succeed without legal representation. However, if you are challenging a significant decision — particularly a retrospective claim — specialist CHC solicitors add real value. They know how panels work and how to frame arguments effectively.
What if the person’s needs have changed since the original assessment?
A material change in needs is grounds for requesting a new assessment, regardless of where you are in the appeals process. Submit evidence of the change and request reassessment in writing. If the person’s needs have increased significantly, a fresh assessment may be faster than completing the appeal.