Key Facts
- The Ombudsman is the final stage of a CHC appeal — it comes after local resolution with the ICB and the NHS England Independent Review Panel (IRP)
- The PHSO cannot overturn your decision: "We can't make the NHS change its decision, and we can't make our own decision about whether you are eligible for funding" (PHSO, 2026)
- It investigates whether the NHS followed the process — the National Framework, 2022 — not whether the outcome "feels" wrong
- Between April 2018 and July 2020 the PHSO decided 336 CHC complaints; of 150 it investigated, it found failings in 55 (PHSO, Getting It Right First Time)
- You do not need an MP to bring a health complaint to the Ombudsman — the MP filter applies only to complaints about government departments (PHSO, 2026)
- You normally have 12 months from the final response to complain (PHSO, 2026)
You have been refused CHC funding, you have been through local resolution, and the Independent Review Panel has still said no. Is there anywhere left to go? Yes — one stage. But the Ombudsman does not work the way most families expect, and walking in with the wrong expectation is how a genuinely strong case gets dismissed in a single letter.
This guide is the honest version. What the Parliamentary and Health Service Ombudsman can actually do, what it can't, when it's worth the months it takes, and — the part that decides everything — how to frame the complaint so it isn't rejected before anyone reads your evidence.
Reviewed by legal professionals and social care professionals.
TL;DR: The Parliamentary and Health Service Ombudsman (PHSO) is the final stage of a CHC appeal, after local resolution and the Independent Review Panel. It cannot overturn the decision or declare you eligible — it only checks whether the NHS followed the National Framework, and can recommend a re-assessment (PHSO, 2026). You have 12 months to complain, and no MP referral is needed.
Where this guide starts
This is the last rung of the appeal ladder, so it assumes you've already climbed the others. If you're earlier in the process, start with how to appeal a CHC decision for the full route, then running the local resolution meeting for Stage 1 and inside the IRP hearing for Stage 2. This post picks up the moment the IRP refuses — and answers the question almost no CHC content answers honestly: what is the Ombudsman really for?
Where does the Ombudsman sit in a CHC appeal?
The Parliamentary and Health Service Ombudsman is the independent, final stage of the NHS complaints process in England (PHSO, 2026). In a CHC appeal it sits above two earlier stages: local resolution, run by your ICB, and the Independent Review Panel, convened by NHS England. It is not part of the NHS, and it is not a court.
Think of it as a ladder with three rungs. First the ICB reviews its own eligibility decision at local resolution. If that fails, NHS England convenes an IRP. Only when the IRP has refused — or, for a Checklist or funding-amount issue, when the NHS complaints procedure has run its course — does the door to the Ombudsman open. In Wales, the equivalent body is the Public Services Ombudsman for Wales.
The reason the ladder matters is that each rung can decide something different — and the top rung decides the least of all.
Can the Ombudsman overturn a CHC decision?
No — and this is the single most misunderstood point in the whole CHC journey. The PHSO is explicit: "We can't make the NHS change its decision, and we can't make our own decision about whether you are eligible for funding" (PHSO, 2026). It does not re-run your assessment. It does not weigh the medical evidence afresh and reach its own verdict.
What it does instead is narrower, and getting this right is the difference between a complaint that lands and one that's dismissed. The Ombudsman investigates whether the NHS "carried out its decision making process in line with established guidelines (the National Framework)." It is looking for a specific fault in how the decision was reached. As the PHSO puts it, "a different opinion does not mean that there must have been a fault."
So what is a "process fault" worth complaining about? A domain scored against the published descriptor. Evidence that was in the file but never considered. Well-managed needs used to mark a need down as if the underlying condition were mild. An MDT that wasn't properly constituted. A decision letter that never explained its reasoning. Where the PHSO finds one, it can recommend the NHS re-does the assessment, puts right any financial loss, and apologises — a powerful outcome, but not the same as the Ombudsman handing you CHC.
When is it worth taking a CHC case to the Ombudsman?
It's worth it when you can point to a concrete departure from the National Framework — not when you simply disagree with the result. The distinction isn't pedantry; it's the filter the PHSO applies to every complaint, and cases that arrive as "the decision was unfair" tend to go no further than the first read.
Here's the reframe that changes everything. The Ombudsman won't act on "we think our mother is eligible." It can act on "the DST recorded three logged seizures a month as 'no needs' in the Drug Therapies domain, contradicting the care records, and the ICB never explained the discrepancy." Same case, two framings — only one of them describes a fault the PHSO is allowed to investigate.
| Grounds the Ombudsman can act on | Grounds it can't |
|---|---|
| A domain scored against the published descriptor | "The panel got it wrong" (opinion only) |
| Documented evidence in the file that was never considered | Disagreement with a clinical judgement, no fault shown |
| Well-managed needs used to score a real need down | "Other families got funding and we didn't" |
| The MDT not properly constituted or the Framework not applied | New evidence you never put to the ICB or IRP |
| A decision letter with no reasons you can follow | A general sense the process felt unfair |
This is also where retrospective cases surface. The PHSO's own review found failings specifically in how the NHS handled reviews of previously unassessed periods of care — so if your complaint touches a retrospective or PUPoC claim, a process fault there is squarely within scope. Before you commit the months an investigation takes, be honest about which column your case sits in.
How do you complain to the Ombudsman, step by step?
You start by confirming you've finished the NHS process, then you frame the complaint around process — not disagreement. In 2024/25 the PHSO investigated 9,692 complaints but dealt with 28,311 before the investigation stage (PHSO, 2025). Most cases are triaged early, so how you present yours decides whether it's picked up.
The route in five steps:
- Confirm you've completed the NHS stages. For an eligibility refusal, that means the Independent Review Panel has decided. For a Checklist decision or a dispute about the amount of funding, it means you've had the NHS's final complaint response.
- Gather the paperwork. The DST, the IRP outcome letter, the original decision letter, and the correspondence — the documents that show what the NHS did and didn't do.
- Frame the complaint around a National-Framework failing. Name the specific fault, point to the evidence, and say what the NHS should have done differently. Do not lead with the outcome.
- Submit within the deadline (see below).
- Wait for triage. The PHSO first assesses whether it can look at your complaint, then decides whether it needs a detailed investigation.
Myth to bust: You do not need an MP to complain to the Ombudsman about a health matter. The "MP filter" people remember applies only to complaints about UK government departments, not to NHS complaints. A continuing healthcare complaint goes to the PHSO directly.
The gathering of that paperwork — and the discipline of tying every point to a dated record — is exactly the evidence work an appeal turns on. A complaint built that way reads as a process case, not a grievance.
What's the deadline, and how long does it take?
You normally have 12 months from becoming aware of the problem to bring your complaint — in practice, within 12 months of the final IRP or NHS response (PHSO, 2026). The PHSO has discretion to accept a late complaint, but it is discretion, not a right, so treat the deadline as firm.
The bigger risk is the gap between stages quietly eating your window. Families often wait for the disappointment of the IRP to fade before acting, then find months have gone. Note the deadline the day the IRP letter lands. And be realistic about duration: once a case proceeds to a full investigation, it commonly takes the better part of a year — sometimes considerably longer where clinical expert evidence is needed. This is a marathon, and it runs alongside grief and exhaustion, so it's worth going in with eyes open (our standing advice on whether an appeal is worth pursuing applies here more than anywhere).
What has the Ombudsman found in CHC cases?
Process failings in CHC are real, and the Ombudsman finds them. In its report Continuing Healthcare: Getting It Right First Time, the PHSO decided 336 CHC complaints between April 2018 and July 2020; of the 150 it investigated, it found failings in 55, and resolved a further 40 without a full investigation (PHSO). Those aren't disagreements about clinical opinion — they're documented departures from the process.
The report named the patterns: significant failings in care and support planning, and failings in reviews of previously unassessed periods of care — mistakes that left people paying large sums for care they should not have funded, or going without care because of incorrect or delayed decisions. That's the encouraging read for a family with a genuine process complaint: the very things the Ombudsman can act on are the things it has repeatedly found.
For context, across all its work the PHSO upholds or partly upholds around three-quarters of the complaints it investigates in detail (PHSO, 2025). That figure spans the whole NHS and government, not CHC alone — but it tells you the Ombudsman is not a rubber stamp for the bodies it examines. A well-evidenced process case has a real hearing.
Where we see complaints fall down, it's almost never the merits — it's the framing. A family arrives certain the decision was wrong, writes pages explaining why they disagree, and never once names the point where the NHS departed from its own rules. The PHSO has nothing to grip. The cases that move are the ones that hand the Ombudsman a specific, evidenced fault and say, in effect, "here is where the process broke."
What this means for your appeal
Strip the Ombudsman stage back and it comes down to one reframe: this is not a fresh appeal on whether your relative is eligible — it's a check on whether the NHS followed its own process, and it can only send a faulty decision back to be re-done. That sounds like less than families hope for. Handled well, it's still worth having, because a re-assessment ordered on the record, with the fault named, is a genuinely different starting position.
So do three things. Note the 12-month deadline the day your IRP letter arrives. Build the complaint around a specific departure from the National Framework, evidenced with dated records, not around how unfair the outcome felt. And don't wait for an MP — a health complaint goes straight to the PHSO.
CareAdvocate is an evidence preparation service, not a legal recovery firm, and we don't guarantee outcomes. An Ombudsman complaint lives or dies on whether you can pin the NHS to a specific point where it left the National Framework — and that's an evidence job. If you want a read on whether your refusal has arguable process grounds before you commit the months an investigation takes, our Grounds of Appeal Assessment at £147 gives a written, three-day view of where the case actually stands. If you're earlier in the journey, the free CHC eligibility screener is the place to start.
Continue learning
- How to appeal a CHC decision: the complete family guide — the full appeal ladder, refusal to Ombudsman
- Running the local resolution meeting — Stage 1, the most winnable stage
- Inside the CHC IRP hearing — Stage 2, the step before the Ombudsman
- What to include in a CHC appeal letter — how to frame evidence against the National Framework
- CHC appeal time limits: the 6-month rule — every deadline that governs the process
- Well-managed needs explained — the process fault the Ombudsman most often finds
Frequently asked questions
Can the Ombudsman overturn a CHC decision?
No. The PHSO states plainly that it cannot make the NHS change its decision and cannot decide whether you are eligible for funding (PHSO, 2026). It checks whether the NHS followed the National Framework. If it finds a process fault, the most it does is recommend the case is re-assessed — not award CHC.
Do I need an MP to complain to the Ombudsman about CHC?
No. The 'MP filter' applies only to complaints about government departments, not to NHS health complaints. You can bring a continuing healthcare complaint to the PHSO directly, without a referral from your MP, once you have finished the NHS process (PHSO, 2026).
How long do I have to complain to the Ombudsman?
Normally 12 months from the date you became aware of the problem — in practice, within 12 months of your final Independent Review Panel or NHS complaint response (PHSO, 2026). The PHSO can use discretion, but do not rely on it. Note the deadline the day your IRP outcome letter arrives.
How long does a PHSO continuing healthcare investigation take?
Once a case proceeds to a full investigation it commonly takes many months — often the better part of a year or more, and longer where clinical expert evidence is needed. In 2024/25 the PHSO investigated 9,692 complaints and dealt with 28,311 before the investigation stage (PHSO, 2025).
What happens after the Independent Review Panel if I still disagree?
The Ombudsman is the next and final stage. Local resolution with the ICB and the NHS England Independent Review Panel come first; if the IRP still refuses, the PHSO is where the appeal ends (National Framework, 2022). There is no further appeal body for a CHC eligibility decision after the Ombudsman.