Around 80% of NHS Continuing Healthcare applications are refused. But a significant number of those refusals are overturned on appeal — when families know how to challenge the decision effectively.
This guide explains exactly what to include in a CHC appeal letter, the legal references that may strengthen your case, the mistakes that undermine most appeals, and the deadlines you need to know. If you want ready-to-use templates, you can download our free appeal letter pack at the end.
Why are most CHC refusals worth appealing?
The CHC assessment process is subjective. Assessors must score needs across 12 domains — from cognition and behaviour to continence and skin integrity — and reach a judgement about whether the person has a “primary health need.” In practice, this means the outcome often depends on which evidence was considered, how clearly needs were described, and whether the assessors fully understood the day-to-day reality of care.
A refusal does not mean the person is ineligible. It may simply mean the assessment did not capture the full picture. Appeals exist precisely for this reason, and the NHS Continuing Healthcare appeals process provides two clear stages for families to challenge a decision.
If your family member has complex, intense, or unpredictable health needs and has been refused CHC, an appeal may be worth pursuing. The potential benefit — fully-funded care worth tens of thousands of pounds per year — makes it one of the most consequential letters you will ever write.
What are the two stages of a CHC appeal?
The NHS National Framework for Continuing Healthcare (2022 revision) sets out a two-stage appeal process. Understanding this structure is essential before you write a single word.
Stage 1: Local resolution
Your first step is to request a local review from your Integrated Care Board (ICB). The ICB should convene a fresh multi-disciplinary team (MDT) — ideally with different assessors — to reconsider the decision. This is your opportunity to submit additional evidence, correct factual errors in the Decision Support Tool (DST), and challenge specific domain scores. Most successful appeals are resolved at this stage.
Stage 2: Independent Review Panel (IRP)
If the local review upholds the refusal, you can escalate to an Independent Review Panel administered by NHS England. The IRP is entirely independent of the ICB. It reviews whether the correct process was followed and whether the decision was reasonable. The panel makes a recommendation that the ICB is expected to follow. Requesting an IRP does not require a solicitor.
At both stages, the quality of your written appeal and supporting evidence is what matters most. The templates and guidance below focus on the local review letter, which is the most common and impactful stage.
What should you include in a CHC appeal letter?
A strong appeal letter is structured, evidence-based, and references the correct legal and clinical framework. It is not a personal plea — it is a reasoned challenge to a specific decision. Here are the key elements your letter should contain:
- A clear statement of what you are challenging. Identify the specific decision (date, reference number) and state that you are requesting a local review under the National Framework.
- The DST domain scores you dispute. List each domain where you believe the score is too low, and explain why. Reference the domain descriptors from the National Framework to show which level the needs should be scored at.
- Specific evidence supporting higher scores. For each disputed domain, cite concrete evidence: care records, GP letters, specialist reports, hospital discharge summaries, continence logs, incident reports, or your own written observations.
- References to the National Framework. Demonstrate that you understand the legal test. Reference the "primary health need" test, the four key indicators (nature, intensity, complexity, unpredictability), and any relevant paragraphs of the 2022 National Framework.
- The interaction between domains. The National Framework requires assessors to consider how needs across different domains interact. If your family member has moderate needs across many domains, the combined effect may still indicate a primary health need.
- A challenge to any "well-managed needs" reasoning. If the DST downscored needs because they are "well-managed" by a care package, this is a common and often incorrect application of the Framework. Well-managed needs should be scored at their actual level of severity, not reduced because care is in place.
Want ready-to-use templates?
Download our free appeal letter pack — three editable templates covering local review, IRP escalation, and DST domain challenges, plus guidance notes on what to include and what to avoid.
Download free templatesWhat mistakes do families make when appealing CHC?
After reviewing hundreds of CHC cases, we see the same mistakes repeated. Avoiding these may significantly improve your chances:
1. Writing an emotional plea instead of a structured argument
Assessors need clinical evidence, not a description of how unfair the decision feels. Your appeal should read like a structured report, not a letter of complaint. Emotion is understandable, but evidence is what changes scores.
2. Not referencing the National Framework
The Framework is the document the ICB is supposed to follow. If your letter does not reference it, you are essentially arguing without citing the rules. Quote specific paragraphs, domain descriptors, and the primary health need test.
3. Missing the 6-month deadline
While there is no strict legal deadline, most ICBs apply a 6-month time limit for requesting a local review. After this window, the ICB may decline to review the case. Act as soon as possible after receiving the decision letter.
4. Accepting domain scores without scrutiny
Many families assume the assessors are the experts and do not question scores. In reality, assessment quality varies enormously. Compare each domain score against the Framework descriptors and your own knowledge of daily care needs.
5. Not submitting additional evidence
The original assessment may have been based on incomplete information. Care home daily logs, GP letters, falls diaries, medication charts, and your own written account of care needs can all strengthen the case.
Key phrases and legal references to use
Including the right references signals that you understand the framework and expect the ICB to follow it. Here are the most important ones to include in your appeal letter:
- The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (2022 revision). The governing document for all CHC decisions in England. Reference specific paragraphs when disputing domain scores.
- The "primary health need" test. The legal test for CHC eligibility. A person qualifies if their primary need for care is a health need, assessed by considering the nature, intensity, complexity, and unpredictability of their needs.
- R v North and East Devon Health Authority, ex parte Coughlan [1999]. The landmark Court of Appeal case that established the "primary health need" test. Still the foundation of CHC law. Citing Coughlan shows you understand the legal basis.
- The "well-managed needs" principle (National Framework, Practice Guidance). Needs should be assessed at their actual level, not reduced because they are currently being managed by a care package. If the care package were removed, what would the level of need be?
- The four key indicators: nature, intensity, complexity, unpredictability. These are the criteria used to determine whether a need reaches a particular level. Use these terms when explaining why a domain score should be higher.
What is the 6-month deadline for CHC appeals?
While there is no absolute statutory deadline for requesting a local review, the NHS National Framework states that requests should normally be made within 6 months of the decision being communicated. Most ICBs treat this as a firm deadline.
If you are approaching or have passed this deadline, you should still submit your request. Explain any reasons for the delay (for example, not receiving a written decision, being unaware of appeal rights, or the stress of managing complex care). ICBs have discretion to accept late requests where there is good reason.
The most important thing is to act. Even if the deadline has passed, a well-evidenced request for review may still be accepted. Not attempting an appeal because you think it is too late could mean losing access to care funding worth tens of thousands of pounds.
What to do next
If you are preparing to appeal a CHC decision, here is a practical starting point:
- Obtain a copy of the completed DST and the decision letter from the ICB.
- Review each domain score against the National Framework descriptors.
- Gather additional evidence for any domains you believe were scored too low.
- Write your appeal letter using the structure outlined above, or download our free templates.
- Submit your request for a local review to the ICB in writing, keeping a copy for your records.
Not sure whether your family member might qualify for CHC? Our free CHC eligibility screener can help you understand whether an application or appeal is worth pursuing. For a comprehensive overview of the appeals process, see our step-by-step CHC appeal guide.
Frequently asked questions
How long do I have to appeal a CHC decision?
Most ICBs expect a local review request within 6 months of the decision. While there is no absolute statutory deadline, submitting your appeal promptly strengthens your position. 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 request a review, but the ICB may decline.
Do I need a solicitor to appeal a CHC decision?
No. CHC advocacy is not a regulated legal activity, and many successful appeals are handled by families or specialist advocates without solicitors. What matters most is the quality of your evidence and how clearly you present it against the National Framework criteria. Solicitors are generally only needed if the case escalates to judicial review, which is rare.
Can I submit new evidence during the appeal?
Yes. You can and should submit additional evidence at every stage. This might include care home daily logs, updated GP or specialist reports, continence records, falls diaries, or your own detailed written account of care needs. New evidence that more accurately reflects the person's needs can change the outcome.
What happens if the local review upholds the refusal?
If the local review upholds the original decision and you disagree, you can request an Independent Review Panel (IRP) through NHS England. The IRP is fully independent of the ICB and will review whether the correct process was followed and whether the decision was reasonable based on the evidence. The IRP makes a recommendation that the ICB should follow.
What is the most common reason CHC appeals succeed?
The most common reason is that key evidence was not considered during the original assessment, leading to inaccurate domain scores. Other frequent reasons include incorrect application of the "well-managed needs" principle, failure to consider the interaction between needs across domains, and procedural errors during the assessment process.
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CareAdvocate provides advocacy and guidance, not legal advice. Every case is different and outcomes cannot be guaranteed. If you need legal advice, please consult a solicitor specialising in healthcare law.
Sources: NHS National Framework (2022) | R v Coughlan [1999] EWCA Civ 1871