A refusal of CHC is not the end of the process. The NHS National Framework includes two formal stages of appeal: local resolution and the Independent Review Panel (IRP). Families who pursue appeals — particularly those who arrive with targeted evidence rather than general complaints — succeed in a meaningful proportion of cases. If you haven't yet built your evidence pack, start with our DST Evidence Builder guide.

TL;DR: CHC appeals follow two stages: local resolution with your ICB (submit within 6 months of the decision), then the Independent Review Panel (IRP) administered by NHS England if local resolution fails. You don't need a solicitor. Focus your appeal on specific DST domain scores, concrete evidence, and references to the NHS National Framework (2022).

Step 1: What documents should you request immediately after a CHC refusal?

Immediately after a refusal, ask for:

A copy of the completed Decision Support Tool (DST) showing the domain scores
The written decision letter stating the reasons for refusal
Information about your right to seek local resolution

You have the right to these documents. If they are not provided within 10 working days, write to the ICB's chief nurse.

Step 2: How do you identify errors in the DST domain scores?

Compare the domain scores in the DST with your own observations and evidence. Look for:

Domains scored lower than your evidence supports
Needs that were not mentioned or were minimised
Inconsistencies between the scores and the written rationale

Identify two or three domains where you have clear, specific evidence of a higher need level. A focused appeal on concrete domains is far more effective than a broad challenge to the whole assessment.

Our CHC Appeal Letter Templates guide shows exactly what to include and which legal references to cite.

Step 3: How do you submit a formal local resolution request?

Download the Local Resolution Request template (linked in the sidebar). Your request should:

Reference specific DST domains and the scores awarded
Include your evidence for why a higher score is justified — quotes from medical records, your family statement, professional letters
Be submitted within 6 months of the decision (though earlier is better)

For detailed guidance on structuring your argument, see how to write a CHC appeal letter.

Send the letter by recorded post to the ICB's CHC team and ask for written acknowledgement. Don't be discouraged if the ICB's initial response sounds defensive — local resolution is a formal process, and the ICB must engage with the specific evidence you submit.

Step 4: What happens at the local resolution meeting?

Local resolution usually involves a meeting with the ICB, often with a clinician present. You may bring a representative or advocate.

ICBs typically argue one of three positions: that needs are "well-managed" and therefore not severe, that the primary need is social rather than health, or that the overall profile doesn't meet the threshold for a Primary Health Need. Know which argument applies to your situation before you walk in.

The counter to the well-managed needs argument is to ask what would happen if that level of care were removed. The NHS National Framework requires assessors to consider the nature and intensity of care needed to manage needs — not just whether the current package is working. If your relative requires specialist nursing input, frequent monitoring, or skilled interventions, that care input is itself evidence of the level of need. Bring the incident history that demonstrates what happens when care lapses.

During the meeting:

Refer to specific evidence for each disputed domain
Ask for each domain to be reconsidered with reference to your evidence
Request that the revised scores and the reasoning be documented in the minutes

Step 5: When and how do you escalate to the Independent Review Panel?

If local resolution doesn't result in eligibility, you may request an Independent Review Panel. Download the IRP Appeal Notification template (linked in the sidebar).

The IRP is conducted by NHS England and is independent of your local ICB. Submit your request within 6 months of the local resolution decision. IRP hearings typically take several months to schedule — you may wait six months or more for a hearing date, so submit as soon as you decide to escalate.

The IRP panel reviews three things:

Whether the correct process was followed
Whether the DST was scored accurately
Whether the eligibility determination was correctly made

IRP decisions are binding on the ICB. If the IRP upholds your case, the ICB must carry out a full reassessment. Prepare your IRP submission with the same precision as your local resolution request — a clear timeline, the specific domain scores you dispute, and your evidence for each.

If the IRP doesn't find in your favour, two further options remain. You can complain to the Parliamentary and Health Service Ombudsman if you believe the process was unfair or decisions were made improperly. In cases where a serious process failure or legal error occurred, judicial review is available — though this requires legal advice and is rarely the right first step.

Sources: NHS National Framework for CHC and NHS-Funded Nursing Care (2022) | NHS England — IRP Appeals | NHS.uk — Continuing Healthcare | Parliamentary and Health Service Ombudsman