Why you should appeal a CHC refusal
Around 80% of CHC applications are rejected at first attempt. That sounds discouraging — but the reality is that many of these refusals are overturned on appeal. The CHC process is complex, evidence is often incomplete at the initial assessment, and ICBs face strong budget incentives to refuse funding.
If your loved one has been refused CHC, there are three common reasons the decision may be wrong:
The evidence was incomplete
The MDT panel may not have had access to care home daily logs, GP specialist letters, or your personal observations. Hospital records alone rarely capture the full picture of someone's needs.
Domain scores were inaccurate
Individual DST domains may have been under-scored — particularly cognition and behaviour for people with dementia. If the Checklist or DST was completed without family input, key information was likely missed.
The "well-managed needs" argument was used
If the ICB argued that your loved one's needs are "well-managed" by their care package, this is contrary to the NHS National Framework. Needs must be assessed as if the care were removed.
The stakes are high. CHC funding is often worth £50,000+ per year. If your loved one qualifies, all care costs are paid by the NHS — including care home fees. An appeal that overturns a refusal could save your family tens of thousands of pounds. Read about the 7 most common CHC mistakes to understand what may have gone wrong.
The three stages of a CHC appeal
The CHC appeal process has three stages. You should work through them in order — each one builds on the last.
Challenge the DST domain scores
Write to the ICB's CHC team challenging the specific domain scores you believe are incorrect. Provide evidence for each domain you're disputing. This is the fastest route and should be your first action.
Request an ICB local review
If the domain challenge doesn't resolve it, request a formal local review. The ICB must reconsider the decision with your additional evidence. You may be invited to a review meeting — always attend.
Independent Review Panel (IRP)
If the local review upholds the refusal, escalate to NHS England for an Independent Review Panel. This is fully independent of the ICB and is the final stage of the NHS appeal process.
Stage 1: Challenge the DST domain scores
Your first step after a CHC refusal should be to challenge the specific domain scores you believe are incorrect. This is done by writing to the ICB's CHC team — not a formal complaint at this stage, just a reasoned letter explaining which scores are wrong and providing evidence.
For each domain you're challenging, you need to:
- State the current score and the score you believe is correct
- Explain why with specific evidence — dates, incidents, frequency, care interventions
- Quote the DST descriptor for the level you believe applies — show how your evidence matches it
- Address the interaction between domains — how needs in one area affect needs in another
If you're not sure which domains to challenge, our Case Strength Report (£97) maps your evidence against all 12 domains and identifies where scores should be higher. The CHC assessment preparation guide explains each domain in detail.
Stage 2: Request an ICB local review
If the domain challenge doesn't result in a changed decision, the next step is to request a formal local review from the ICB. This is the standard appeal route and the one most families use.
A local review should involve a fresh consideration of the evidence by assessors who were not involved in the original decision. You have the right to:
- Submit additional evidence that wasn't available at the original assessment
- Attend any review meeting and present your case in person
- Bring an advocate or support person with you
- Receive the outcome and full reasoning in writing
Common ICB tactic: Some ICBs try to conduct the local review as a “paper exercise” without inviting you. If this happens, insist on attending. The NHS National Framework states that the person and their representative should be involved.
Stage 3: Escalate to an Independent Review Panel
If the ICB's local review upholds the refusal, you can request an Independent Review Panel (IRP) through NHS England. This is the final stage of the NHS appeal process and is fully independent of the ICB.
The IRP is a panel hearing where you can present your case to independent assessors. The panel reviews all the evidence, hears from both you and the ICB, and makes a recommendation. While the recommendation is not legally binding, ICBs are expected to follow it — and most do.
To request an IRP, write to NHS England's Independent Review Team (england.irp@nhs.net). Include copies of all evidence, the original DST, the ICB decision letter, and the local review outcome. Our free appeal letter templates include a ready-to-use IRP request letter.
If the IRP recommends in your favour but the ICB still refuses, your final option is a complaint to the Parliamentary and Health Service Ombudsman (PHSO). Beyond that, judicial review is possible but rarely necessary.
How to build your appeal evidence
The quality of your evidence is the single biggest factor in whether an appeal succeeds. Here's what to gather:
Care home records
- Daily care logs
- Incident and accident reports
- Medication charts
- Weight and nutrition records
- Repositioning schedules
Clinical evidence
- GP letters and specialist reports
- Hospital discharge summaries
- SALT assessments
- Tissue viability reports
- Continence assessments
Your own evidence
- Written statement covering each domain
- Diary of care needs observed during visits
- Photos (with consent) showing condition
- Notes from meetings with care staff
- Timeline of deterioration
Process evidence
- Copy of the completed DST
- ICB decision letter
- Local review outcome
- Correspondence with the ICB
- Notes from MDT meeting
Need help identifying evidence gaps? Our Case Strength Report (£97) uses AI plus expert review to map your evidence against all 12 DST domains and tells you exactly where the gaps are — before you submit your appeal. Use our evidence templates to structure your written statement for each domain, and the 12 care domains guide to understand scoring levels.
Frequently asked questions about CHC appeals
How long do I have to appeal a CHC decision?
There is no strict legal deadline, but most ICBs expect a local review request within 6 months of the decision. The sooner you act, the better — evidence is fresher, records are more accessible, and the ICB is more likely to engage. If you miss the 6-month window, you can still try, but the ICB may refuse to conduct a local review.
What is the difference between a local review and an IRP?
A local review is conducted by your ICB — the same organisation that made the original decision, though ideally by different assessors. It's the first stage of appeal and the most common. An Independent Review Panel (IRP) is conducted by NHS England and is fully independent of the ICB. You can request an IRP if the local review upholds the refusal. The IRP makes a recommendation to the ICB, which the ICB should follow.
Can I submit new evidence during an appeal?
Yes. You can — and should — submit additional evidence at every stage of the appeal. This might include care home daily logs you didn't have at the original assessment, updated GP reports, specialist assessments, or your own detailed written statement. New evidence that demonstrates the level of need more accurately can change the outcome.
What are the most common reasons CHC appeals succeed?
The most common reasons appeals succeed are: (1) domain scores were inaccurate because key evidence wasn't considered, (2) the 'well-managed needs' argument was used incorrectly, (3) the interaction between needs across domains wasn't properly assessed, and (4) the family provided detailed additional evidence that painted a clearer picture of the person's actual care needs.
Do I need a solicitor to appeal a CHC decision?
No. CHC advocacy is not a regulated legal activity, and most successful appeals are handled without solicitors. What matters is the quality of your evidence and how well you present it. A specialist CHC advocate or case analysis can be just as effective as a solicitor — and much more affordable. Solicitors are generally only needed if the case goes to judicial review, which is rare.
What happens if the IRP recommends CHC should be awarded?
The IRP makes a recommendation to the ICB. While the recommendation is not legally binding, ICBs are expected to follow it. If the ICB disagrees with the IRP recommendation, they must provide a detailed written explanation. If the ICB still refuses to award CHC after an IRP recommendation in your favour, your next step would be to complain to the Parliamentary and Health Service Ombudsman (PHSO).
Can I claim back care fees if the appeal is successful?
Yes. If a CHC appeal is successful and it's determined that the person should have been eligible from an earlier date, the NHS must refund care fees paid during the relevant period. This applies whether the appeal changes the original decision or is part of a retrospective claim. Refunds can cover significant periods — up to 6 years under the Limitation Act.
What if my loved one has passed away — can I still appeal?
Yes. You can appeal a CHC decision or request a retrospective assessment after the person has died. If the appeal is successful, any refund of care fees is paid to the estate. Many families pursue retrospective claims after bereavement, particularly when they've been paying care fees for several years.
Related guides
NHS Continuing Healthcare Funding Guide
The complete guide to CHC — who qualifies, the assessment process, and what happens if you're refused.
CHC Evidence Templates
Domain-by-domain evidence templates to build your case before the assessment or appeal.
The 12 Care Domains Explained
How each DST domain is scored — with Severe vs High examples and evidence guidance.
CHC Assessment Preparation
How to apply for CHC — the 3-stage assessment process from Checklist to eligibility decision.
Retrospective CHC Claims
If CHC should have been awarded earlier, you may be entitled to a refund — up to 6 years of care fees.