How to Appeal a CHC Decision: The Complete Family Guide (2026)

National eligibility at full NHS Continuing Healthcare assessment has collapsed from 31% in Q1 2017/18 to 17% in Q1 2025/26 (Healthwatch, October 2025). A refusal is now the statistical default, not a verdict on the individual case.

For families holding a decision letter, the practical question is no longer "did the system get it right?" — it is "what do we do in the next six months?". Knowing how to appeal a CHC decision matters more than ever: the 2022 National Framework sets out a two-stage statutory route with a 6-month time limit on each stage, and how a family uses that window decides whether the refusal sticks or is reversed.

This guide walks through every stage of a CHC appeal in 2026 — local resolution with the ICB, escalation to the Independent Review Panel administered by NHS England, and the final route to the Parliamentary and Health Service Ombudsman. It sets out the evidence rules, the time limits, and the decision points families need to make along the way. For the bigger picture on the funding itself, see our continuing healthcare funding family guide; for why eligibility has fallen so sharply, see our analysis of ICB CHC eligibility cuts.

Reviewed by legal professionals and social care professionals.

TL;DR: A CHC refusal isn't final. The 2022 National Framework gives families two formal appeal stages: local resolution with the ICB (request within 6 months of the decision letter), then the Independent Review Panel administered by NHS England. The final route is the Parliamentary and Health Service Ombudsman. National eligibility has fallen from 31% in 2017/18 to 17% in Q1 2025/26 (Healthwatch, 2025) — most refusals are systemic, not personal. Local resolution overturns about 13% of refusals on average (Nuffield Trust, 2024), and rises meaningfully with a targeted DST-domain evidence pack. You do not need a solicitor.

Acronym glossary

The CHC appeal world runs on five terms that decision letters and panels use without defining. The plain-English version:

• DST — Decision Support Tool. The 11-domain assessment form a multi-disciplinary team completes; each domain is scored against published descriptors.
• ICB — Integrated Care Board. The NHS body that makes the eligibility decision and runs Stage 1 (local resolution).
• IRP — Independent Review Panel. NHS England's Stage 2 review, independent of the ICB.
• PHSO — Parliamentary and Health Service Ombudsman. The final route for process complaints after the IRP.
• Coughlan — R v North & East Devon HA, ex parte Coughlan [1999] EWCA Civ 1871. The Court of Appeal judgment that defines the primary health need test underlying every CHC decision.

In Healthwatch England's October 2025 review of family experience, families described doing "everything right" only to be told their loved one's needs were "well-managed" and therefore not severe — and, in some cases, of having won appeals while still waiting for backdated payments months later (Healthwatch England, October 2025). The procedural map below is built around the points where that breakdown is most preventable.

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Can you appeal a CHC funding decision?

Yes. The 2022 National Framework for NHS Continuing Healthcare (paragraphs 117–144) gives every individual — or their authorised representative — a statutory right to request a review of an eligibility decision made by the Integrated Care Board (ICB). The process has two formal stages: local resolution with the ICB, then the Independent Review Panel (IRP) administered by NHS England.

Two practical points to get right at the start. First, the appeal route depends on the stage of refusal. A refusal at the Checklist screening stage is not an eligibility refusal — it declines referral to full assessment. The route there is a written request that the ICB reconsider the Checklist, supplying evidence that one or more domains were scored too low. A refusal at the DST/MDT (full assessment) stage is an eligibility refusal, and that is what triggers the two-stage appeal process described in the rest of this guide. For the wider context of who qualifies, see our guide to who qualifies for CHC funding in 2026.

Second, the appeal must come from someone with authority to act for the person assessed. That includes the person themselves (if they have capacity), a deputy appointed by the Court of Protection, an attorney under a registered LPA for Health and Welfare, or a family member with the person's written consent. Fast-track CHC refusals follow a different route — they are reviewed urgently, not under the standard appeal process. For families weighing a related route to past care fees, see retrospective CHC claims for past care fees.

A practical note on capacity. If the person assessed lacks capacity to consent to the appeal, the route depends on what arrangements exist. A registered LPA for Health and Welfare is the cleanest — the attorney acts in the person's best interests under section 4 of the Mental Capacity Act 2005. A Court of Protection deputyship for personal welfare is rarer but also serves. Without either, a family member can still pursue an appeal in the person's name on a best-interests basis, but the ICB may require evidence of the family's standing — typically a written explanation of the relationship, the person's documented lack of capacity, and (where appropriate) IMCA involvement. If the person assessed has died, an executor or personal representative of the estate may continue an appeal, normally focused on retrospective claims rather than future funding.

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What is the time limit to appeal a CHC decision?

Six months from the date of the written eligibility decision letter to request local resolution with the ICB. If local resolution does not resolve the dispute, a further six months from that outcome to request the Independent Review Panel. Once an IRP is requested, families have approximately six weeks to submit all written evidence to NHS England (NHS England Independent Review Process — public information guide, 2020).

The clock starts on the date written on the decision letter, not the date the family received it. If the letter is sent second class and arrives a fortnight late, the deadline does not move. And the deadline is for requesting the review, not for completing it — a written request in time stops the clock; the meeting itself can be months later. Missing the six-month window does not end the case: ICB discretion, a fresh referral, the PUPoC route, and a PHSO complaint all remain available in different circumstances.

For the full mechanics — when the clock starts in edge cases, how to write a "holding letter" within the window, ICB-by-ICB variation in late-appeal discretion, and the four fallback routes after the deadline — see our deep-dive spoke on the CHC appeal time limit and the 6-month rule.

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What are the grounds for a CHC appeal?

There are two recognised grounds under the National Framework: the eligibility decision was wrong on the evidence, or the process was not followed correctly. The strongest appeals combine both. A pure process challenge rarely changes a substantive outcome on its own; a pure evidence challenge can be dismissed for not engaging the published criteria. Together they create the conditions for a reasoned reversal.

Evidence grounds turn on the 11 care domains in the Decision Support Tool and the legal test sitting underneath them. The 2022 National Framework operationalises eligibility through four key characteristics — nature, intensity, complexity, and unpredictability — but those are indicators, not the test itself. The underlying test is the primary health need standard set by the Court of Appeal in R v North & East Devon HA, ex parte Coughlan [1999] EWCA Civ 1871 (BAILII). For a deep treatment, see our primary health need legal test guide.

Process grounds include: family input not sought or ignored; key medical records missing from the assessment; the multidisciplinary team not properly constituted (typically two professionals minimum from different disciplines); no Coordinating Assessor; decision-letter reasoning that is conclusory rather than reasoned. In R (Grogan) v Bexley NHS Care Trust [2006] EWHC 44 (Admin), the High Court held that decision-makers must apply the Coughlan test with reasons — assertion is not application. A decision letter that simply states "the needs are not severe enough" without engaging the Coughlan limbs is legally vulnerable.

The four key characteristics in plain English

The National Framework operationalises eligibility through four key characteristics. Most decision letters reference at least one. Knowing what each actually means is the difference between accepting the language and challenging it.

• Nature — the type of intervention required and the skill needed to deliver it. Skilled clinical care (PEG feeding, complex medication titration, pressure-damage management, dysphagia handling) sits at the NHS end of the boundary. Personal care alone does not.
• Intensity — the quantity and continuity of intervention. Continuous monitoring, multiple skilled interventions per day, or care that requires two people are intensity indicators. The test is the input the person actually needs, not what is currently being delivered.
• Complexity — the interaction between conditions and needs. A single straightforward condition is rarely complex; multiple interacting conditions producing fluctuating or hard-to-predict needs typically are. Polypharmacy, multi-system disease, and behaviour-cognition interactions are typical complexity triggers.
• Unpredictability — the risk that needs change suddenly or without warning. Seizure activity, hypoglycaemic episodes, unpredictable aggression, falls history, and rapidly evolving conditions all sit here. Documented incidents over a defined period are the evidence; "stable presentation" claims should be tested against the incident log.

The four are not a scoring rubric. The National Framework treats them as indicators the assessor should consider in deciding whether, taken together, the person has a primary health need. A successful appeal usually shows that two or more characteristics are engaged on the evidence and that the ICB either ignored them or misapplied them.

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How does Local Resolution (Stage 1) work?

Local resolution is a formal review run by the ICB itself, with a senior reviewer (often a clinical lead and an appeals or IFR officer) and the family present. Every ICB must publish its local resolution process and timescales on its website. In Q4 2023/24, there were 596 local resolution requests across England, of which 13% resulted in eligibility being granted (Nuffield Trust, June 2024).

Request local resolution in writing to the ICB's Continuing Healthcare team. Recorded delivery, with a copy retained. The request letter should: identify the person assessed; cite the date and reference of the decision being appealed; state the grounds (evidence and/or process); list the disputed DST domains; and request a copy of the full assessment file under a Subject Access Request at the same time. A holding letter that asks for the file before submitting full grounds is acceptable — and often necessary — because the family rarely has the assessment notes by the time the decision letter arrives.

The meeting itself is usually two to three hours, in person or on Microsoft Teams. The agenda typically covers each disputed domain, the process points raised, and the family's representations. The ICB cannot make a binding decision in the meeting — the reviewer produces a written outcome afterwards, normally within four weeks. The outcomes are: the original decision stands, a full reassessment is convened, or the decision is reversed. A reassessment is not the same as a reversal — it is a fresh DST/MDT, with the same evidence rules and the same right to appeal again.

What to bring to the local resolution meeting

The meeting is short and the ICB will speak first. Families who prepare a one-page agenda of their own — listing the disputed domains in the order they want to discuss them, with the specific descriptor level they are asking the panel to apply — tend to keep the discussion focused on the evidence rather than the original assessor's conclusions.

Bring three documents in addition to the appeal letter: a copy of the DST and decision letter annotated with the family's challenges; the structured evidence pack (records, dated and indexed, mapped to the disputed domains); and a one-page family statement that captures the lived presentation between formal assessments. Have a written list of the specific paragraphs of the National Framework being relied on — paragraph 56 (no diagnosis-led decisions), paragraphs 117–144 (dispute resolution), paragraphs 119–121 (the well-managed-needs test) — and the case-law citations (Coughlan, Grogan, Pointon). Ask for the meeting to be minuted, and request a copy of the minutes within two weeks of the outcome letter.

The 13% headline figure is a national average; appeals built around a structured domain-by-domain evidence pack and a focused agenda typically perform meaningfully better, which is the focus of the next section.

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What evidence wins a CHC appeal?

Three categories of evidence carry weight: DST-domain-specific evidence (dated, sourced, mapped to the descriptors); process evidence showing the original assessment was rushed, incomplete or based on stale records; and case-law-grounded reasoning showing the decision misapplied the primary health need test. The strongest appeal packs combine all three — the evidence supports the domain scores; the process points explain why the ICB missed them; and the legal framing forces the panel to engage with what it means.

The core craft is mapping the medical record to the DST descriptors. Each of the 11 domains is scored against published descriptors — no needs, low, moderate, high, severe, priority (where applicable). The ICB's DST records its conclusion; the family's job at appeal is to show that the recorded evidence, properly assembled, supports a higher level. That means dated entries from care home daily notes, GP records, district nurse logs, hospital discharge summaries, specialist letters (consultant, OT, SLT, dietitian, palliative care), incident logs, and a structured family statement that adds first-hand observation. Our DST evidence builder guide walks through the mapping for each domain; the DST domain evidence worksheet download is the working template.

The records have to come first. A Subject Access Request to the GP, hospital, ICB and care home is the foundation — see our guides to obtaining medical records and the NHS Subject Access Request family guide. Without the records, the family is arguing from memory; with them, every claim is dated and sourced.

A worked example from our casework — de-identified. A family at local resolution disputed the Behaviour domain score. The ICB had recorded "moderate". The family submitted 14 dated incident reports from the care home over a six-month period, each describing an episode of unpredictable aggression requiring two-person intervention. They cross-referenced the entries to the published Behaviour descriptors for "high" and "severe", and to the unpredictability indicator in the National Framework. The submission did not assert the higher level — it showed the evidence that supported it, descriptor by descriptor.

Where the evidence usually lives, domain by domain

Three of the eleven DST domains carry most appeals because they are where ICBs most often undersore against the published descriptors. Knowing where the evidence sits saves weeks of searching.

• Behaviour — care home daily notes, incident logs, body-map records, DoLS authorisation paperwork, and any behaviour support plans from specialist nursing or community mental health teams. Each incident should be dated, with the trigger, response, and clinical input recorded. Frequency over a defined window (typically 6–12 months) is the headline; severity and unpredictability come from the narrative entries.
• Cognition — GP records, memory clinic letters, neuropsychology reports, MMSE/ACE-III scores over time, and care home notes covering disorientation, wandering, refusal of care, and capacity-related incidents. The Mental Capacity Act 2005 record, if any, sits here too. Track change — a stable cognitive impairment scores differently from a rapidly progressing one.
• Mobility — physiotherapy and occupational therapy assessments, falls records, hoisting and manual handling plans, pressure damage records (cross-link to Skin), and any community equipment provided. The volume of intervention is the indicator: two-person transfers, hoist requirements, and recurrent falls all support higher descriptors.

The same logic applies to the remaining domains: Communication, Psychological and Emotional Needs, Nutrition, Continence, Skin, Breathing, Drug Therapies, Altered States of Consciousness, and Other Significant Care Needs. The single most common mistake is to assemble evidence by source (everything from the GP, then everything from the care home) rather than by domain. The DST is read domain by domain — the evidence pack should be too. Our DST evidence builder guide walks through the mapping for each domain in turn.

The family statement — the part assessors most often miss

The family statement is one piece of evidence the original assessor almost never has. It is a structured first-hand account from the people who know the person best — partner, adult children, long-term carers — covering what daily care actually looks like, what changes between formal assessments, and what the records do not capture. The National Framework expressly invites family input; in practice, it is often added late, written reactively, and ignored.

A useful family statement runs four to six pages and follows the DST's domain structure. For each disputed domain, it describes a typical week in concrete terms — what tasks the person needs help with, what staff do (and what they have to do twice when the first attempt does not work), what incidents happened in the last month, what the person was like before the deterioration that triggered the assessment. It is descriptive, not argumentative — the panel will reach the conclusion if the description is specific enough. Our guide to writing a compelling family statement shows the structure with worked sections; the SAR letter pack download covers the medical record side of the same exercise.

Two craft points. Date everything — "last Tuesday morning" is harder for the panel to weigh than "Tuesday 18 March 2026, 7:15am". And cross-reference the statement to the records: where the statement says "needs two staff for transfers", note the matching entries in the daily notes by page reference. The statement becomes another exhibit in the evidence pack, not a separate emotional plea.

For families who need help building an evidence pack at this depth, our Checklist Evidence Pack (£597) is an assessor-facing document that maps every record to a domain and descriptor — for one fixed fee, with human-in-the-loop review. The lower-cost first step is a Case Strength Report at £97, which tells families whether the evidence supports an appeal before they commit time and money to one.

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The "well-managed needs" trap — and how to beat it

"Well-managed needs" is the single most-cited refusal reason in CHC decisions across 2024–26. The argument runs like this: the person's current care package — whether at home, in a nursing home, or in supported living — is keeping them stable. Their needs, by the ICB's reading, are therefore not severe, not complex, and not unpredictable. The decision letter concludes that there is no primary health need. This inverts the test.

The 2022 National Framework is explicit. Paragraphs 119–121 require assessors to consider what would happen if the current care input were removed. Stable needs that require skilled nursing or specialist intervention to be stable are not, by virtue of that stability, "well-managed away". They are well-managed because of clinical input — and that input is what CHC funds. The Court of Appeal in Coughlan set the test on what care a person needs, not on how successfully it is currently being delivered. The Health Service Ombudsman's 2003 finding in the Pointon case confirmed that nursing provided in non-clinical settings — including the family home — still counts as health care, not social care.

The rebuttal in an appeal letter has three steps. First, identify the specific phrase in the decision letter ("needs are well-managed", "presentation is stable", "no significant complexity"). Second, cite paragraphs 119–121 of the National Framework and the what-would-happen-without-the-care test. Third, show the evidence — incident logs, medication regimes, hospital admissions, specialist input — that demonstrates the latent severity the care package is suppressing. For a fuller treatment of the legal mechanics, see our deep guide to well-managed needs in CHC.

A short worked rebuttal — the pattern in three sentences:

The decision letter records that "needs are well-managed by the current care package and therefore do not amount to a primary health need". This applies a stability test the National Framework does not authorise: paragraphs 119–121 require the assessor to consider what would happen if the skilled inputs supporting that stability were withdrawn. The incident log (Evidence Pack pp. 22–47) and the medication regime (pp. 60–63) show that the stability is achieved by skilled clinical input — and is therefore the very intervention CHC is designed to fund, not evidence against eligibility.

This single argument changes more refusals at local resolution than any other. It is the section most worth reading twice.

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How does the Independent Review Panel (Stage 2) work?

If local resolution fails to resolve the dispute, the next stage is the Independent Review Panel — a panel administered by NHS England, independent of the ICB. The IRP is the final formal stage before the Parliamentary and Health Service Ombudsman or judicial review. The request goes to NHS England (see NHS England's IRP referral page) within six months of the local resolution outcome. Once requested, families have approximately six weeks to submit written evidence (NHS England, 2020).

The panel is made up of an independent chair, a clinical reviewer with relevant healthcare experience, and a lay member. The chair is not employed by the ICB, NHS England, or the local NHS trust. The panel's job is not to redo the assessment from scratch — it reviews three things: whether the ICB followed the process correctly; whether the DST scoring was supported by the evidence; and whether the eligibility decision itself was reasonable on the record before the original decision-makers.

The hearing is now typically held on Microsoft Teams and lasts about two hours (Care To Be Different, industry commentary, 2024). Wait time from local resolution to IRP meeting ranges, in current industry commentary, from 3–6 months in the fastest cases to 8–12 months in many (Care To Be Different, 2024). The compressed two-hour format makes preparation decisive. Families who arrive with a structured written submission — a fresh appeal letter, the original DST cross-referenced to evidence, and a one-page summary of the disputed domains — get a meaningfully better hearing than those who rely on the meeting itself to argue the case.

What the IRP looks at, and what it does not

The IRP is not a re-assessment. It will not commission new clinical evidence, interview professionals afresh, or score the DST domains again from first principles. Its remit is to review the original ICB process and decision on the record before it — augmented by the family's written submission and any new documentary evidence the family supplies within the six-week window.

That has two practical consequences. First, evidence the family wants the panel to consider must be in the submission pack — not introduced verbally for the first time at the hearing. Second, the hearing is best treated as an opportunity to direct the panel to the key passages of the pack: which incident on which page in which file supports which descriptor on which domain. The chair is reading a substantial bundle in a short time; signposting saves the case from getting lost in volume.

NHS England does not publish a comparable national overturn rate for the IRP stage — a notable transparency gap given the volume of cases. What is published is the existence of the right, the procedure, and the panel's powers: it can recommend the ICB reconsider, can make findings of process failure, and (in exceptional cases) can directly recommend eligibility. The recommendation goes back to the ICB, which is expected to accept it; in rare cases of dispute, the route is then to the Ombudsman.

What actually happens at the IRP hearing

The hearing opens with the chair confirming attendees and the panel's remit. NHS England, the ICB, and the family each present in turn. The ICB's representative will run through the original decision-making — usually anchored to the DST, the MDT minutes, and the published criteria. The family is then invited to present its case; this is where the structured submission earns its place, because the panel can follow the argument from the documents rather than reconstructing it from speech.

Expect direct questions from the clinical reviewer about specific domains, from the chair about process, and from the lay member about how the decision affected the person and the family. The questions are not adversarial — they are checking whether the panel has understood the evidence. Concise, evidence-referenced answers ("the response time is recorded on page 28 of the evidence pack, and the medication change followed the incident dated 4 February") are markedly more effective than long re-arguments of the case. Families can bring an advocate or supporter; representation by a solicitor is permitted but rare, and the NHS does not reimburse legal fees.

The panel deliberates in private after the hearing and the chair's written recommendation is sent to the family and the ICB, typically within 28 days. If the recommendation is for the ICB to reconsider, the ICB convenes a fresh MDT — a process that takes a further two to four months. A direct recommendation of eligibility is rarer but possible; it is the strongest outcome from the IRP route.

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How do you write a CHC appeal letter?

A winning appeal letter is short — two to four pages — and structured by DST domain. It refers to specific evidence with page references, cites named paragraphs of the National Framework, and ends with a clearly stated outcome the family is asking the ICB to reach. Length is not authority; structure is.

The full anatomy is six sections in a specific order: header and reference details, grounds for appeal, DST domain-by-domain rebuttal, evidence map, primary health need argument, and outcome sought plus IRP escalation notice. The domain-by-domain rebuttal is the section families most often skip — and the one ICB reviewers most need to map your argument back to the DST scoring.

For the full section-by-section walkthrough, a four-line domain rebuttal pattern, a worked multi-domain example, and the editable downloadable template, see our spoke: what to include in a CHC appeal letter. The draft sits on top of a structured evidence pack — the letter signposts to the pack, it does not contain the evidence.

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What if the IRP rejects your appeal? PHSO and judicial review

Two final routes remain after the IRP. The first is a complaint to the Parliamentary and Health Service Ombudsman (PHSO) (ombudsman.org.uk) on the grounds that the process was unfair or maladministered. The second is judicial review in the High Court, on the grounds that the decision contained a legal error. Both are last resorts, and both have strict scope and time limits.

The PHSO investigates process rather than re-deciding eligibility. Its job is to look at whether the public body followed its own rules, applied the right framework, and made a decision a reasonable body could have made on the evidence. It cannot order the NHS to fund care; it can recommend reconsideration, financial redress for distress or wasted private fees, and policy change. The time limit is 12 months from when the complainant knew about the problem, and the PHSO will normally only investigate after NHS England's own complaints process has been exhausted (PHSO annual data 2023–24).

Judicial review is a court-supervised review of the lawfulness of the decision, not a re-hearing of the facts. The grounds are narrow: illegality, irrationality, procedural unfairness, breach of human rights. The time limit is three months from the decision, the costs risk is significant, and independent legal advice from a solicitor is essential. CareAdvocate does not provide legal advice or representation; for judicial review, families should seek a solicitor with public-law experience in health and social care.

When the PHSO route makes sense

The PHSO route makes sense in two specific situations. The first is where the process failed in a way that the IRP did not fully address — assessment notes withheld until after a hearing, professional input excluded, a panel that did not actually engage with submitted evidence. The PHSO can find maladministration even where the substantive eligibility decision is one a reasonable body could have reached. The second is where there has been delay so severe that it has caused independent harm — private care fees paid for many months while a process drags, distress and inability to plan, a relative dying before the appeal completes. The PHSO can recommend financial redress that no other route in the CHC system delivers.

What the PHSO will not do is re-decide eligibility on the same evidence the panel saw. If the family's argument is that the panel weighed the evidence wrongly but followed the process, the Ombudsman is the wrong route — the answer there is the IRP, then, if that has been exhausted, a careful look at whether judicial review grounds exist. The Ombudsman publishes anonymised case digests; reading two or three CHC findings before drafting a complaint helps calibrate which grounds the PHSO actually upholds in practice.

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Should you appeal yourself, or get professional help?

Two questions sit underneath this one: is the appeal worth pursuing at all? and if it is, who should do the work? The first is a decision-support question — does the evidence support a primary health need, and what is the expected value of pursuing the appeal — and we cover it separately in our deep-dive on whether it's worth appealing a CHC decision. This section focuses on the second: assuming you have decided to appeal, what level of support is right.

The honest answer is that the spectrum runs from "do it yourself with free templates" to "buy full preparation support" — there is no single right answer, but there is a wrong one: appealing without a structured evidence pack. The route depends on the complexity of the case (number of disputed domains, volume of records), the time available (a thorough appeal pack is 30–60 hours of family work), and whether the refusal is at Checklist or DST stage.

Three rough levels work for most families:

• DIY — use the free CHC eligibility screener, download the appeal letter templates and the DST domain evidence worksheet, and assemble the pack yourself. Low cost, high time, viable for clear-cut cases with good records.
• Mid-priced help — for families who want the evidence pack assembled and reviewed but do not need full representation. Our Case Strength Report (£97) gives a five-day evidence-strength view before any appeal letter is written. The Checklist Evidence Pack (£597) is the full assessor-facing document, mapped domain by domain, human-reviewed.
• Full advocacy retainer — for complex appeal-stage cases or where the family genuinely lacks capacity to manage the process. Several specialist organisations offer this. Beacon CHC is NHS England's named partner for free 90-minute CHC information and advice (beaconchc.co.uk) — a sensible first call before paying for anything. Beacon also offers paid Expert Analysis services from £1,600 plus VAT; firms like Care To Be Different (Farley Dwek) operate a solicitor-led model.

CareAdvocate is an evidence preparation service, not a legal recovery firm. We do not guarantee outcomes. Families using a prepared evidence pack tend to make better-supported appeals than those relying on memory and the original DST alone — that is what the structure is for.

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What this means for your next six months

A CHC refusal is the start of a process, not the end of one. The 2022 National Framework gives families a clear two-stage route through local resolution and the Independent Review Panel, with the PHSO and judicial review as backstops. The 17% national eligibility figure tells families that most refusals are systemic, and the 13% local resolution overturn rate tells them that a meaningful share of those refusals are reversible — particularly with structured, domain-mapped evidence. None of this requires a solicitor.

The first three actions are the highest-leverage. Read the decision letter carefully and identify the specific phrases that signal weak reasoning ("well-managed", "not complex", "no significant unpredictability"). Request the full assessment file via a Subject Access Request — the decision letter is the summary, the SAR brings back the actual reasoning. Decide on the appeal route before you write anything — Checklist reconsideration, full local resolution, or IRP if local resolution has already failed.

Two things to avoid. Do not write the appeal letter from memory — the National Framework rewards evidence-led submissions and treats unsupported assertions sceptically. And do not let the six-month clock drift while waiting for the full file to arrive; the holding letter exists precisely to stop that happening. Most of the procedural failures we see in family-run appeals are failures of sequencing, not of substance.

If you would like a quick view of whether your case is worth appealing, start with the free CHC eligibility screener. For a deeper, five-day evidence-strength view before you commit time to a full appeal, see our Case Strength Report at £97. The combined cost of those two steps — free and £97 — is less than the wasted-fees cost of an average single week of unfunded nursing care in 2026.

Continue learning

Foundations

• Continuing Healthcare Funding 2026: The Family Guide
• Who Qualifies for CHC Funding in 2026?
• CHC Funding Criteria 2026: What the Framework Actually Requires
• Primary Health Need: The Legal Test Behind Every CHC Decision

The appeal process

• Well-Managed Needs in CHC: What the Law Says
• What Happens at an NHS CHC MDT Assessment?
• NHS Subject Access Request: 2026 Family Guide (Free Pack)

The system context

• ICBs Are Cutting CHC Eligibility — What Families Need to Know
• The CHC Postcode Lottery: Why Geography Decides Outcomes
• What CHC Families Told Healthwatch — And What to Do Now

Tools and templates

• How to Obtain Medical Records via a SAR
• How to Write a Compelling Family Statement
• CHC Appeal Letter Templates Guide
• DST Evidence Builder Guide

This guide is reviewed by legal professionals and social care professionals. CareAdvocate provides advocacy and evidence preparation, not legal advice. The published outcomes referenced are national figures — individual cases vary, and no outcome is guaranteed.