How to Escalate a Delayed CHC Assessment: 2026 Playbook

A woman in Oxfordshire wrote five times to her ICB over eight months. Her father was in a care home, paying out of pocket. The Checklist was never booked. The week she copied her MP, the booking arrived. Her case is unusual only because she escalated; the wait isn't. Nationally, one in four CHC referrals miss the 28-day target. Most families don't know that the National Framework offers a sequence of remedies — and that the NHS is supposed to meet care costs from day 29 of an overdue decision.

TL;DR: Escalating a delayed CHC assessment is a sequence, not a shout. Step 1 is a written chase to the ICB CHC team. Step 2 is a formal complaint citing the National Framework 28-day target and invoking the day-29 NHS funding principle most families never hear. Step 3 is a written escalation to the ICB Chief Executive. Step 4 is the Parliamentary and Health Service Ombudsman, available after the ICB issues a final response or after six months of silence. Step 5 — a solicitor letter — is rare but fast when justified. This guide gives you the letter scaffold, the citations to use, and the decision tree for which step applies to your wait.

How Long Should a CHC Assessment Actually Take?

The National Framework sets a two-week target for the initial Checklist and a 28-day target from a positive Checklist to a Standard CHC decision (National Framework, July 2022). Both are practice targets in guidance — they are not statutory deadlines, and that distinction matters when you sit down to write a complaint.

The full sequence runs: referral → initial Checklist (14 days) → Multi-Disciplinary Team meeting → Decision Support Tool (DST) completion → ratification by the ICB → decision letter to the family. The 28 days runs from a positive Checklist, not from first contact with the ICB, which is the most common point of confusion. Families who count from the date they first asked about CHC are often working from a target that hasn't started.

A separate pathway exists for people who are rapidly deteriorating or approaching the end of life. The fast-track route is designed to deliver a funding decision within 48 hours of a clinician's recommendation. It does not require a full Checklist or DST. If your relative is in the last weeks of life and a fast-track recommendation has not been made, ask the named clinician why — fast-track is the most under-used pathway in the system.

For the longer walk-through of the MDT meeting itself and what an assessor is looking for, see the full MDT process explained.

Just How Common Is a Delayed CHC Assessment?

Roughly one in four. NHS Digital's most recent published figures show 76% of CHC referrals were completed within the 28-day target in Q3 2025/26 — meaning 24% were not (NHS Digital, February 2026). Reports from independent advocacy providers describe a long tail behind that headline — small numbers of families waiting six months or more, and backlogs of up to 18 months in the worst-affected ICB areas.

In other words: a Checklist past 28 days is not unusual. It is, statistically, the experience of roughly a quarter of all families who reach this stage. For a fuller statistical picture, including the Q3 2025/26 breakdown by ICB and the new Management Information format on the NHS England page, see our complete CHC data update.

Why CHC Assessments Stall in 2026

Three structural drivers explain most delays. First, workforce: there are not enough CHC-trained nurses to chair MDT meetings, so case-loads back up before they begin. Second, ICB financial pressure — every approved CHC case is a cost line for the ICB, which creates a quiet incentive not to clear the backlog quickly. Third, the April 2026 ICB reorganisation: twelve ICBs were abolished and six new ones took their place, and the transitional handover has produced fresh paperwork drift on top of the existing pressure.

For families with a case mid-merger, the practical effect is that letters sent to old ICB addresses may not have been forwarded. The 28-day clock continues from the original referral, but the file may have moved. Our breakdown of the April 2026 ICB merger disruption covers that handover in detail.

What CHC Delays Actually Cost Families

Care fees during the wait are typically paid out of pocket. UK residential care averages £1,128 a week and nursing care £1,372 a week (Laing Buisson, 35th Edition, 2025) — so a six-month delay at residential rates alone accumulates to roughly £29,300, and at nursing rates to nearly £35,700. That is money most families don't have ready and which is difficult to recover later. The emotional cost is harder to quantify but easy to recognise: families describe the wait as a full-time job of phone calls, chase letters and uncertainty.

The day-29 NHS funding principle. The single most under-used right in the CHC system. The National Framework states that where a Standard CHC decision is not made within 28 days of a positive Checklist, the NHS — not the family — should meet the cost of care while the eligibility decision is being finalised. ICBs rarely volunteer this. Asking for it in writing is one of the most effective things a family can do during a delayed assessment.

Two further consequences are worth flagging. First, retrospective claims — Previously Unassessed Periods of Care (PUPoC) — become significantly harder to win when the evidence has gone stale. The longer the delay, the harder the later claim. Second, deteriorating health during the wait can change the clinical picture so substantially that a Checklist eventually completed reflects a different person from the one the original referral described. For more on regional care home costs, see our 2026 care home cost breakdown.

These figures are illustrative — your relative's actual weekly fee, and the length of the delay, will determine the real number. But £29,000 to £36,000 is the right order of magnitude for a six-month stalled case, and it is exactly the sort of sum a family should be writing to recover when invoking the day-29 principle.

How to Escalate a Delayed CHC Assessment — Step by Step

Five steps, in sequence. Which step you start at depends on how long you have been waiting. Skipping ahead is rarely effective — the Parliamentary and Health Service Ombudsman will not normally investigate until the ICB process is exhausted, and a solicitor letter at week three reads as disproportionate. The rule is: chase, complain, escalate, refer.

Decision tree — match your wait to the right step

• 0–28 days from positive Checklist. Chase, don't escalate. A short written confirmation request keeps the file active without raising the temperature.
• 28–60 days. Move to Step 1 (written chase) immediately. Invoke the day-29 NHS funding principle in writing.
• 60–90 days. Move to Step 2 (formal complaint). Cite the National Framework target and request a final response within 25 working days.
• 90+ days without final response, or final response received and unsatisfactory. Move to Step 3 (CEO escalation), then Step 4 (PHSO).
• 6+ months, or rapid deterioration documented. Step 5 (solicitor letter) becomes proportionate.

Step 1 — A written chase to the ICB CHC team

Do not phone. Phone calls leave no paper trail. Send a short letter or email to the ICB CHC team naming your relative, the date of the original referral, and the fact that the 28-day target has passed. Request a named CHC nurse-assessor, a written timeline for next steps, and written confirmation that the 28-day clock is running from the original referral date.

In the same letter, invoke the day-29 NHS funding principle: state that you understand the National Framework requires the NHS to meet the cost of care from day 29 of an overdue Standard decision, and ask the ICB to confirm what interim funding arrangements apply. This single sentence does more work than any other you can write.

Step 2 — A formal complaint to the ICB

If Step 1 produces no substantive reply within ten working days, escalate to a formal complaint addressed to the ICB's complaints office. The complaint should:

• Name your relative, the date of the referral, and the dates of all correspondence to date
• Cite the National Framework July 2022 target of 28 days from positive Checklist to Standard decision
• Invoke the day-29 NHS funding principle and ask explicitly what interim funding has been arranged
• Request a substantive response within 25 working days, as required under the NHS complaints procedure
• State that you reserve the right to refer the matter to the Parliamentary and Health Service Ombudsman if the response is unsatisfactory or absent

Keep the letter short — one side of A4 is enough. The strength is in the citations and the specificity of dates, not the length.

Step 3 — Written escalation to the ICB Chief Executive

If the complaints office issues no substantive response within 25 working days, or the response is procedurally unresponsive, write directly to the ICB Chief Executive. ICB Chief Executives are listed on the ICB's website; address the letter by name. Attach copies of your previous correspondence, restate the National Framework citations, and ask for personal intervention to resolve the delay. Copy in the named CHC coordinator from your earlier letters.

This step exists because complaints offices often pass cases between team members without ownership. A letter to the CEO names an individual the case is now visible to.

Step 4 — Parliamentary and Health Service Ombudsman

The Parliamentary and Health Service Ombudsman (PHSO) is the independent body for complaints about NHS services in England. The PHSO will not normally investigate until the ICB has issued a final response, or six months have passed with no substantive engagement. Once that threshold is met, you have 12 months from the date of the final ICB response to refer.

The PHSO can find maladministration where a delay was unreasonable. It cannot directly enforce the 28-day target — but a finding pressures the ICB to act, can attract symbolic remedy payments, and creates a public record that affects how the ICB handles similar cases. The PHSO is the appropriate body for "process went wrong" complaints; it is not the right route for disputes about eligibility decisions themselves, which run through the separate CHC appeal process. For appeal mechanics see how to appeal a CHC decision.

Step 5 — A solicitor letter

Rare, and disproportionate for most families, but worth knowing about. A formal pre-action letter from a solicitor familiar with NHS administrative law will often produce ICB action within days. The cost typically runs into hundreds rather than thousands of pounds for a single letter — but it is rarely necessary if Steps 1 to 3 have been done properly. Reserve this for cases of rapid clinical deterioration, sustained ICB non-engagement after CEO escalation, or where the wait has already exceeded six months.

A separate consideration: requesting your relative's medical records via a Subject Access Request strengthens every step of this sequence. The records show what care has already been delivered and at what cost. See our guide to the NHS Subject Access Request process.

When the 28-Day Clock Doesn't Apply — and What That Means for Your Complaint

The 28-day target is practice guidance under the National Framework — not a statutory deadline. That doesn't make it useless, but it changes how you phrase the complaint and which body has teeth. Courts do not enforce the framework directly. The Parliamentary and Health Service Ombudsman does, through the maladministration route.

Three points of precision matter. First, the 28 days runs from a positive Checklist, not from first contact with the ICB — counting from the wrong date weakens the complaint. Second, fast-track cases run to a separate 48-hour expectation; they are not "delayed" under the same target. Third, the framework target applies to Standard CHC decisions; it does not apply to subsequent reviews or to appeals, which run under their own timelines.

The practical effect for your complaint letter is to be precise about which target you are citing and from what date. Generic letters that say "you broke the law" get filed away; letters that say "the National Framework sets a 28-day target from the positive Checklist on 14 March 2026; today is 22 May; please confirm the interim funding arrangements that apply from day 29" get answered. Specificity is the difference between a complaint that drifts and one that moves.

This precision is also what separates an advocacy-grade letter from a generic family complaint. It is the single biggest reason ICBs respond differently to identical situations described in different language.

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Citation Capsule — The 28-day target and what it does and doesn't mean: The National Framework for NHS Continuing Healthcare (July 2022) sets a 28-day target from a positive Checklist to a Standard CHC decision and requires the NHS to meet care costs from day 29 where the decision is overdue (National Framework, July 2022). The target is practice guidance, not statute; enforcement runs through the NHS complaints procedure and, ultimately, the Parliamentary and Health Service Ombudsman, which has a 12-month referral window from the final ICB response.

Citation Capsule — The scale of the delay problem: In Q3 2025/26, 24% of CHC referrals breached the 28-day decision target, with 76% completed within the framework window (NHS Digital, February 2026). Independent advocacy reporting describes a long tail behind that headline — small numbers of families waiting six months or more, with backlogs of up to 18 months in the worst-affected ICB areas.

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A delayed CHC assessment is rarely a personal misfortune; it is a quarter of the national caseload. The system fails on timing for one in four families, and the people who get a result are the ones who write the letters that name the framework. The five-step sequence above is documented, well-trodden, and works when followed in order — chase first, complain second, escalate third, refer fourth, instruct counsel only when the earlier steps have been exhausted.

The day-29 NHS funding principle is the single most under-used lever families have. Asking for it in writing — clearly, with dates, and citing the National Framework — is the action most likely to produce a response. The April 2026 ICB mergers are likely to keep CHC delays elevated through 2026, so escalating early in your timeline is the rational response, not impatience. If you would like a Step 2 complaint letter drafted from your relative's specific timeline, or an independent view on whether your evidence supports a formal CHC pursuit, our Case Strength Report is the starting point.

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This article is for general information for families and is reviewed by legal professionals and social care professionals. It does not constitute legal advice or representation for an individual case. CareAdvocate provides CHC evidence preparation and advocacy support, not solicitor services. The National Framework citations refer to the Department of Health and Social Care National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, July 2022, and statistical citations refer to the NHS Digital Q3 2025/26 CHC and NHS-funded Nursing Care statistical publication (NHS Digital, February 2026). The £29,300 to £35,700 cost-of-delay figures are illustrative, drawn from Laing Buisson 2025 weekly averages applied to a six-month wait; individual outcomes vary and no result is guaranteed.

Frequently asked questions

How long should a CHC assessment take?

The National Framework sets a two-week target for the initial Checklist and a 28-day target from a positive Checklist to a Standard CHC decision. Both are practice targets in National Framework guidance, not statutory deadlines. The fast-track pathway for people approaching end of life runs to a separate 48-hour expectation.

Can I claim the cost of care during a delayed CHC decision?

Yes. The National Framework states the NHS should meet the cost of care from day 29 of an overdue Standard CHC decision until eligibility is determined. ICBs rarely volunteer this, so you usually need to ask in writing, citing the framework target and the date your relative's positive Checklist was returned. Keep receipts for any care already paid out of pocket.

Who do I complain to first about a CHC delay?

Your ICB's CHC team and complaints office. Escalate to the Parliamentary and Health Service Ombudsman only after the ICB issues a final response, or after six months of no substantive response. The PHSO will not normally investigate until the ICB process has been exhausted.

Can I get compensation for a CHC delay?

Parliamentary and Health Service Ombudsman maladministration findings can attract symbolic remedy payments where delay caused distress or financial loss. The day-29 NHS funding principle covers ongoing care costs once a Standard decision is overdue. Full recovery of out-of-pocket fees already paid is harder and is decided case by case.

Does instructing a solicitor speed up my CHC assessment?

Sometimes. A formal letter from a solicitor often prompts faster ICB action, particularly where deterioration is documented. For most families, however, it is disproportionate cost as a first step. Steps 1 to 3 — written contact, formal complaint, and CEO escalation — usually move a stalled case before legal involvement becomes worth the fee.