Your relative has been refused NHS Continuing Healthcare. The decision letter is thin, the domain scores look low, and you have six months to challenge it. So what actually goes into the appeal? Not a plea. Not a longer letter. A pack of specific documents, indexed against the assessment, that shows the scoring was wrong.
Most families assemble that pack badly, or not at all. They send records in date order, or they lean on the covering letter and enclose whatever the ICB already had. Both approaches lose.
In 2026, only 16.65% of people who reach a standard CHC assessment are found eligible, down from 31.25% in 2017 (The King's Fund, No man's land, June 2026). At the next stage, local resolution, roughly 13% of refusals are overturned (Nuffield Trust, June 2024). The evidence pack is the part of that second number families can move. Here are the nine documents that decide it, and how to obtain each.
Key Takeaways
- Nine documents carry most CHC appeals: the DST and decision letter, four record sets obtained by Subject Access Request, medication and specialist evidence, a dated family diary, and a domain-mapping index.
- Local resolution overturns about 13% of refusals (Nuffield Trust, 2024); a domain-mapped pack is the lever families control.
- Send Subject Access Requests on day one: UK GDPR gives a one-month free response window.
Key Facts
- 9 documents carry the weight of a typical CHC appeal, from the DST to a domain-mapping index
- 6 of the 9 are obtained by Subject Access Request; 2 you write yourself; 1 comes from the ICB
- 13% of local resolution requests overturn a refusal on average (Nuffield Trust, 2024) — a structured pack is the biggest lever families hold
- One month is the statutory UK GDPR window for a Subject Access Request response (ICO guidance, 2024)
- Six months is the usual deadline to file the appeal, not to finish the pack (National Framework, July 2022)
- The DST is read domain by domain — the pack must be indexed the same way, not by record source
What Is a CHC Appeal Evidence Pack, and Why Isn't the DST Enough?
A CHC appeal evidence pack is the bundle of records you submit to prove the Decision Support Tool scored a domain too low. In 2026, roughly 13% of local resolution requests overturn a refusal (Nuffield Trust, June 2024). That figure rises meaningfully when the pack is structured domain by domain rather than dumped in date order.
The completed DST is where you start, but it's not the case. It's the ICB's account of the case, written by the people who refused funding. It records the domain levels they agreed and, in the rationale boxes, why. Your job on appeal is to show those rationales don't match the records. You can't do that with the DST alone. You need the underlying evidence the DST was supposed to reflect.
That's the whole point of the pack. A refusal at standard assessment is now the statistically normal outcome, not a signal your relative obviously doesn't qualify. The appeal is where the evidence gets a second, closer read. For the full route through local resolution and beyond, see our complete guide to appealing a CHC decision.
Check how your relative's needs map to the 12 domains with our free CHC eligibility screener
The 9 Documents That Decide a CHC Appeal
Nine documents do most of the work in a CHC appeal. In our casework, the packs that succeed almost always contain all nine, indexed to the domains; the packs that fail are usually missing the specialist evidence, the medication records, or the index itself. Here's the full set, what each one proves, and where it comes from.
| # | Document | What it proves | How to obtain |
|---|---|---|---|
| 1 | Decision Support Tool + decision letter | The exact levels and rationales you're challenging | Request from the ICB in writing |
| 2 | GP records (full) | Diagnoses, medication history, deterioration over time | Subject Access Request to the surgery |
| 3 | Hospital records + discharge summaries | Acute episodes, clinical severity, consultant findings | Subject Access Request to the trust |
| 4 | Care-home or home-care daily notes + care plan | Day-to-day need, staffing, interventions in place | Subject Access Request to the provider |
| 5 | Medication Administration Records (MAR charts) | Ongoing active management, PRN and controlled drugs | Subject Access Request to the provider |
| 6 | Specialist + allied-health reports | Domain-specific severity (SALT, tissue viability, psychiatry) | Subject Access Request; ask GP to release |
| 7 | Incident, falls and behaviour logs + body maps | Risk, unpredictability, frequency of events | Subject Access Request to the provider |
| 8 | Family observation diary (dated) | Fluctuation and night-time need the records miss | You write it |
| 9 | Domain-mapping index | Ties every item above to a DST domain + descriptor | You build it |
Three of these are worth singling out. Medication Administration Records (document 5) are the most under-used: a MAR chart showing regular antipsychotics, anticoagulants, or breakthrough analgesia is direct proof of an actively managed need, which is exactly what the well-managed needs principle says cannot be scored down. Specialist reports (document 6) win specific domains outright, because a tissue-viability nurse's note carries more weight on the Skin domain than any general record. And the domain-mapping index (document 9) is the one families skip and the one reviewers read first.
Which Documents Do You Request, and Which Do You Build?
Six of the nine documents are obtained by Subject Access Request, one comes from the ICB, and two you create yourself. Under UK GDPR, a SAR is free and the response is due within one month (ICO guidance, 2024). Send them the day you lodge the appeal, because the records are the slowest part to arrive.
Send a separate SAR to each holder: the GP surgery, the hospital trust, and the care provider. Ask for the full record, not a summary, and name the date range. Providers sometimes offer a "care summary" instead. Decline it. The daily notes and MAR charts are where the real evidence sits, and a summary strips exactly that out. For the wording and the step-by-step process, see our Subject Access Request family guide.
The two documents you write are the diary and the index. Neither needs a clinician. A dated observation diary captures what the records miss, especially the 3am agitation, the refused meals, the falls that were never formally logged. The index is the cover document that turns a pile of paper into an argument.
How Do You Index the Pack Against the 12 DST Domains?
The index is the highest-leverage document in the pack, because the DST is scored one domain at a time and the reviewer reads it that way. Build a table with one row per disputed domain: the domain name, the level the ICB gave, the level the evidence supports, and the specific dated items that back it. That single page decides whether the reviewer can find your evidence in a 20-minute read.
The mistake almost everyone makes is to organise by source: all the GP records, then all the hospital records, then the care notes. The DST isn't read that way, so a source-ordered pack forces the reviewer to hunt. Organise by domain instead. Under Cognition, put the memory-clinic letter, the relevant care-note entries, and the diary extracts together, each with a page reference.
What we've seen work: The packs that overturn refusals almost always lead with a one-page domain index and cross-reference every claim to a dated, page-numbered exhibit. It forces the reviewer to engage domain by domain, and it creates the paper trail that an Independent Review Panel or the Ombudsman needs later. A pile of records with no index gets skimmed; an indexed pack gets read.
This is the point where a pre-assessment tool and an appeal pack diverge. Our MDT evidence-pack mapping template is built for before the assessment, to shape the meeting. The appeal pack is built after a refusal, to dismantle specific rationales in the completed DST. Same domain-mapping discipline, different job. For the domain-by-domain descriptors themselves, the DST evidence builder walks through each one.
See how the full CHC process works, from checklist to appeal
When Must the Pack Be Ready, and Where Does It Go?
You normally have six months from the decision letter to request local resolution, with the exact deadline set by your ICB's published policy (National Framework, July 2022). That deadline is for filing the request, not for finishing the evidence. Lodge a short holding request inside the window, then assemble the pack during the review.
The sequence matters. File the appeal request first, naming the decision and the disputed domains. Send your Subject Access Requests the same day. Because the SAR response can take the full statutory month, starting late is the most common way families run out of time. For the full detail on discretion and late requests, see our guide to the six-month CHC appeal time limit.
The pack travels through the stages with the case. At local resolution, it goes to the ICB reviewer. If that fails, the same indexed pack supports an Independent Review Panel referral to NHS England, and ultimately a complaint to the Parliamentary and Health Service Ombudsman. Build it once, properly, and it carries through every stage. The covering letter is separate: our guide to what to include in a CHC appeal letter covers how the letter signposts the pack.
Five Mistakes That Weaken a CHC Appeal Pack
The most common failures aren't about missing records. They're about how the pack is built. Since only around 13% of local resolution requests succeed on average (Nuffield Trust, 2024), avoiding these five is often the difference between a pack that's read and one that's skimmed.
- Ordering by source, not by domain. The single biggest error. The DST is read domain by domain, so the pack must be too.
- Accepting a care summary instead of full records. The daily notes and MAR charts are where the evidence lives. A summary removes them.
- Skipping the specialist reports. A tissue-viability or SALT note settles a domain that general records only hint at.
- An undated, general diary. "He gets confused" carries little weight. "Tuesday 18 March 2026, 3:10am, found in the hallway, did not recognise me" carries a lot.
- No index. A pile of paper with no domain map forces the reviewer to hunt, and reviewers under time pressure don't hunt.
The pattern behind all five: every mistake makes the reviewer do work that the family should have done. An appeal pack isn't a submission of everything you have. It's an argument, pre-built, that a busy reviewer can verify in one sitting.
Should You Build the Pack Yourself or Get Help?
Most families can build a strong pack alone, and this guide is the method. But there's a real decision before you commit months to it: is the refusal actually challengeable on the evidence? A Case Strength Report (£97) answers exactly that, reading the file against the 12 domains before you invest the time. If you'd rather the full pack was built and indexed for you, our Checklist Evidence Pack (£597) maps every record to a domain and descriptor with human-in-the-loop review. Neither is required to appeal. Both exist because the evidence gap, not the information gap, is what decides most cases.
This article is based on the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022, revised July 2023), Nuffield Trust analysis (June 2024, retrieved 2026-07-24), The King's Fund's No man's land analysis (June 2026, retrieved 2026-07-24), and ICO guidance on the right of access (2024, retrieved 2026-07-24). It does not constitute legal advice. Content was last reviewed in July 2026 and has been reviewed by legal professionals and social care professionals.
Frequently asked questions
What is a CHC appeal evidence pack?
It is the bundle of records and documents you submit alongside a CHC appeal to show that the Decision Support Tool scored one or more domains too low. A strong pack maps each piece of evidence to a specific DST domain and descriptor, rather than dumping records in date order. In 2026, only about 13% of local resolution requests overturn a refusal (Nuffield Trust, 2024), and a domain-mapped pack is the single biggest lever families control.
What documents do I need for a CHC appeal?
Nine carry most of the weight: the completed Decision Support Tool and decision letter, GP records, hospital records, care-home or home-care daily notes, medication administration records, specialist and allied-health reports, incident and falls logs, a dated family observation diary, and a domain-mapping index that ties every item to the 12 DST domains. Six are obtained by Subject Access Request; two you write yourself.
How do I get medical records for a CHC appeal?
Send a Subject Access Request (SAR) to each record holder: the GP surgery, the hospital trust, and the care provider. Under UK GDPR the response is free and due within one month (ICO guidance, 2024). Request the full record, not a summary, and send the SAR the moment you lodge the appeal so the records arrive inside the local resolution window.
How long do I have to appeal a CHC decision?
You normally have six months from the date of the decision letter to request local resolution, with the exact deadline set by your ICB's published policy (National Framework, July 2022). The six months is the deadline to file the request, not to finish the evidence pack. Lodge a short holding request first, then build the full pack during the review window.
Do I need a solicitor to build a CHC appeal evidence pack?
No. CHC advocacy is not a regulated legal activity, and the National Framework does not require legal representation at local resolution or the Independent Review Panel. Most successful appeals are run by families using a structured, domain-mapped pack. Solicitors are normally engaged only if a case reaches judicial review, which is rare.