How to Appeal a CHC Decision: Complete Family Guide 2026

Key Facts

National eligibility at full CHC assessment fell from 31% in Q1 2017/18 to 17% in Q1 2025/26 (Healthwatch, October 2025)
A CHC refusal is not final — the 2022 National Framework gives families two formal appeal stages (local resolution, then Independent Review Panel), plus a final route to the Parliamentary and Health Service Ombudsman
The clock starts on the date of the written decision letter — six months for local resolution; a further six months for IRP (NHS England, 2023)
In Q4 2023/24 there were 596 local resolution requests; 13% resulted in eligibility (Nuffield Trust, June 2024) — meaningfully higher when appeals are evidence-led
Average CHC spend per eligible person was £65,012 a year in 2023/24 (Nuffield Trust, 2024) — what a successful appeal protects per year of care
The legal test was set in 1999 by R v North & East Devon HA, ex parte Coughlan (BAILII); it has never been overturned

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. For the whole journey from first application to outcome, see the full NHS CHC pathway guide.

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, set by your ICB's policy), 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 12-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). For what other families went through at this stage — including families rejected twice before winning — see our composite case stories. The procedural map below is built around the points where that breakdown is most preventable.

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 how to reclaim fees for a past period of care.

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.

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.

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 12 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.

CHC appeal escalation pathway — from ICB refusal to Ombudsman

How does Local Resolution (Stage 1) work?

Local resolution is a formal review the ICB runs on its own decision, with a senior reviewer and the family present. Request it in writing, typically within 6 months of the decision letter (the deadline is set by your ICB's published policy), citing the date and reference, the grounds (evidence and/or process), and the disputed DST domains — and submit a Subject Access Request for the full assessment file at the same time. In Q4 2023/24 there were 596 local resolution requests, of which 13% resulted in eligibility being granted (Nuffield Trust, June 2024) — a national average that rises meaningfully with a structured, domain-by-domain evidence pack.

Crucially, this is the one appeal stage that still welcomes new evidence — the National Framework calls it an opportunity to provide information "that had not been considered." The meeting runs two to three hours and ends in a written outcome: the decision stands, a reassessment is convened, or it's reversed. For the tactical play-by-play — what to bring, what to say, and how to handle the room — read the full deep-dive: running the local resolution meeting: 11 plays families use to reverse a CHC refusal →.

For where this stage sits in the wider journey, see Stage 4 of the full NHS CHC pathway; for the deadline mechanics, see the 6-month time limit explained.

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 12 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.

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.

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

If local resolution fails, the Independent Review Panel — administered by NHS England, independent of the ICB — is the final formal stage before the Parliamentary and Health Service Ombudsman or judicial review. Request it from NHS England within six months of the local resolution outcome, then return the application form within six weeks (NHS England, 2023). The panel is an independent chair, an ICB representative, and a social services representative — with a clinical adviser sometimes present — and it reviews whether the ICB followed the process, whether the DST scoring was supported by the evidence, and whether the person has a primary health need.

The IRP is not a re-assessment — it won't commission new clinical evidence or re-score the domains from scratch, so anything you want considered must be in the written submission, not raised for the first time at the roughly one-hour, Teams-based open session. The panel recommends rather than imposes, and NHS England publishes no national IRP overturn rate — a notable transparency gap.

For the full day-by-day preparation walkthrough — the consideration-process gateway, the six-week application form, working the ICB case file, and the open session itself — read our deep-dive: Inside the CHC IRP Hearing. For where this sits in the wider journey, see the full NHS CHC pathway; to weigh whether to take a case this far, see whether it's worth appealing.

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.

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.

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 — a sensible first call before paying for anything. Paid full-representation models exist beyond the free tier; pricing varies by provider.

Route	Typical cost	Family time	Best for
DIY	Free templates	30–60+ hours	One or two disputed domains, complete records, family bandwidth to manage
Mid-priced help (CSR / CEP)	£97 / £597	5–10 hours of family input	Three or more disputed domains, sparse or scattered records, well-managed-needs reasoning to rebut
Full advocacy retainer	£1,600+ (Beacon Expert Analysis) to £10,000+ (solicitor-led)	Minimal — provider runs the case	Capacity issues, IRP-stage cases, parallel PUPoC claim, or where the family genuinely cannot run the process

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.

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

The appeal process

The system context

Tools and templates

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.

Frequently asked questions

How long do I have to appeal a CHC decision?

Six months from the date of the written eligibility decision letter for local resolution. A further six months from the local resolution outcome to request the Independent Review Panel. Once an IRP is requested, families must return the Application for Independent Review form within six weeks (NHS England, 2023).

What is the success rate of CHC appeals at local resolution?

In Q4 2023/24, 596 local resolution requests resulted in eligibility for 13% of cases — roughly one in eight ICB decisions overturned at first review (Nuffield Trust, June 2024). NHS England does not publish a comparable national overturn rate for the Independent Review Panel.

Do I need a solicitor to appeal a CHC decision?

No. Solicitors are permitted at any stage, but the NHS does not reimburse their costs. Most successful appeals are run by families with a structured evidence pack — domain-by-domain references to the medical record, mapped against the descriptors in the Decision Support Tool.

What is the Independent Review Panel (IRP)?

A panel administered by NHS England, independent of the ICB, that reviews whether the ICB followed the process, whether the DST scoring was supported, and whether the person has a primary health need. Hearings are normally held on Microsoft Teams; the open session is expected to last about an hour (NHS England, 2023).

What is 'well-managed needs' and why is it cited so often?

It is the assertion that current care has stabilised needs, so they are not severe enough for CHC. The 2022 National Framework requires assessors to consider what would happen without the care input — not the stabilised state with it. Many refusals invert this test.

Can I appeal a Checklist (Stage 1) refusal?

Yes, but through a different route. A low Checklist score does not refuse CHC eligibility — it declines a referral to full assessment. Families can request the ICB reconsider the Checklist on the basis of additional or overlooked evidence, before any formal appeal route is engaged.

Why has CHC eligibility dropped so sharply since 2017?

National eligibility at full assessment fell from 31% in Q1 2017/18 to 17% in Q1 2025/26 (Healthwatch, October 2025). Drivers include ICB cost pressure, sharper variation between ICBs, and stricter interpretations of 'well-managed needs' that critics argue invert the Coughlan test.

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