Understand why your CHC application was rejected

Before diving into the appeals process, it’s important to understand why your application was turned down in the first place. The reason behind the rejection will determine how best to approach your appeal and what evidence you’ll need to support your case.

Some common reasons for rejection include:

Key evidence was missing or misinterpreted
The criteria were applied incorrectly
Verbal evidence from you or the care team was ignored
Care needs were minimised

Understanding the rationale for the decision (as explained by the Integrated Care Board – ICB) is a vital first step. It helps you spot any errors or gaps in the assessment that you can challenge during the appeal.

Are you eligible for CHC funding?

Before appealing, take a moment to check whether you are likely to meet the criteria for NHS Continuing Healthcare (CHC) funding, as explained in the National Framework.

The assessment process usually begins with a CHC checklist which is a screening tool to determine whether you should move on to the next stage. If you pass the checklist, you’ll then go through a full assessment using the Decision Support Tool (DST). Both tools assess your care needs across various domains, such as mobility, cognition, behaviour, and medication.

To be eligible for CHC, your “primary need” must be for healthcare, rather than social care. This means that the majority of care interventions are aimed at addressing or preventing health needs. One of the biggest challenges for the NHS and families alike is the subjectivity of the criteria – taking professional advice at this early stage can be invaluable.

If you’re unsure whether you meet the criteria, it might be worth reviewing your care situation against the official eligibility guidelines or speaking to our specialist team for advice.

Gathering the right evidence for your appeal

If you believe you meet the eligibility criteria but have been turned down for CHC funding, the next step is to start building a strong appeal. That begins with gathering the right evidence.
The NHS often works on the principle that if something isn’t written down, it didn’t happen — so detailed documentation is vital.

At a minimum, you should request:

Copy of GP and care home records
Specialist reports, such as tissue viability, neurology, or mental health assessments (if applicable)
Any evidence of 1:1 care, including care logs and ABC charts
Records that demonstrate challenging behaviour, high levels of need, or frequent interventions

Families should not rely on the NHS or care providers to collect this information. To maximise your chances of a successful appeal, leave nothing to chance — and make sure your documentation clearly reflects the full extent of the care being provided.

How to appeal a CHC decision

Once you’ve identified the reason for your rejection and gathered supporting evidence, the next step is to begin the official appeals process. This follows a statutory procedure and starts with a stage known as local resolution.

At this stage, you’ll work with your local ICB to try and resolve the issue. This will usually involve reviewing documentation, attending a local resolution meeting, and submitting additional evidence.

If the matter can’t be resolved locally, your appeal can then be escalated to an Independent Review Panel at NHS England. This panel, made up of professionals with healthcare and social care expertise, will carefully review whether the original decision was made fairly, in line with national guidelines, and based on all the relevant information.

Each stage of the process gives you an opportunity to make your case – and having clear, well-documented evidence can make a big difference.

The NHS Appeals process

Once you’ve submitted your CHC appeal, the process typically follows three key stages:

Stage 1 – Local resolution

This is the first step, where your local ICB reviews the original decision and attempts to resolve the issue through further discussion and investigation. You may be asked to provide additional evidence and attend a local resolution meeting (LRM).

Stage 2 – Independent review panel

If local resolution doesn’t lead to a satisfactory outcome, the next step is an independent review carried out by an Independent Review Panel (IRP) — a panel convened by NHS England and separate from your local ICB.

This panel is made up of health and social care professionals who will examine whether the ICB’s decision followed proper procedure and reflected your care needs.

Once it has heard from both parties and reviewed all the available evidence, the Panel will reassess the case against the CHC criteria and make a recommendation to the ICB on whether the original decision was appropriate.

Farley Dwek can support you throughout this stage by preparing written submissions and providing professional representation at the panel.

Stage 3 – Parliamentary & Health Service Ombudsman

If you still believe the decision was unfair, you can complain to the Parliamentary and Health Service Ombudsman (PHSO). This final stage considers whether the Independent Review Panel process was conducted fairly and robustly.

Note: The Ombudsman can only review the process and findings of the IRP — not the ICB’s original decision, which would need to be challenged through a separate complaint.

What to expect during your CHC appeal meeting

At both stages of the CHC appeal process — local resolution and independent review — you will be invited to discuss your case in more detail.

Local resolution stage

At the local resolution stage, the process is often twofold:

First, you may have an informal meeting with a nurse who will discuss the reasons for your appeal.
This is sometimes followed by a more formal panel meeting, attended by representatives from the ICB and Social Services, who have the authority to review and overturn the original decision.

Local processes can vary widely, so it’s a good idea to ask your ICB for a copy of its local resolution process to understand what to expect at each stage.

The independent review stage

The IRP is a formal panel convened by NHS England. It usually includes:

A chair — typically a non-clinician
An NHS representative — usually a Nurse Assessor from a different ICB
A social worker
A clinical advisor (if the case is particularly complex)

A representative from your ICB will also attend to present their perspective and explain the original decision.

During the appeal meeting, the panel will review:

Your original CHC assessment and decision
All available documentation (care and medical records etc.)
Any new medical evidence or documentation you’ve provided
The 12 care domains — especially those you dispute
Whether the correct process was followed during the initial assessment

You’ll have the opportunity to explain why you believe the decision was incorrect, particularly in relation to specific care domains such as:

Behaviour
Cognition
Mobility
Nutrition
Continence
Skin integrity
Breathing
Medication
Altered states of consciousness
Communication
Psychological/ emotional needs
Other significant care needs

Being clear about which domains were underestimated or misinterpreted can strengthen your case and help the panel understand the full extent of your care needs.

How long do you have to appeal?

You have six months from the date of your CHC funding decision letter to submit an appeal.

At Farley Dwek, our Appeal Advice Service will help assess your chances of success. If there’s a strong case for appeal, we can offer to represent you throughout the process via our Appeals Service.

We can also help with retrospective reclaims – meaning you may be able to recover care fees that were paid out-of-pocket if funding should have been granted earlier.

How long does a CHC appeal take?

The CHC appeal process can take months to years, depending on the capacity of the ICB, the complexity of your case, and how quickly each stage is progressed.

Does CHC continue during the appeal process?

If your CHC funding has been withdrawn, there is no provision for funding to continue pending the outcome of an appeal.

While some care providers may agree to suspend payment of fees while an appeal is ongoing, they are not obliged to do so, and you should expect to fund your care until the appeal is resolved. At that point, any fees wrongly paid will be reimbursed with interest.

It is worth noting that some ICBs will not pay the fees directly to the care provider, and some will even refuse to consider a case if no costs have been incurred by the appellant.

Some people choose not to pay care fees while their appeal is ongoing, but this is generally not advisable as it can lead to unnecessary stress and legal difficulties.

CHC appeal success rate

Although CHC appeals can be challenging, many are successful—especially where there’s strong supporting evidence and clear grounds to challenge the original decision.

At Farley Dwek, we’ll only proceed with your case if we believe there’s a good chance of success. Our initial advice service helps determine if you might be eligible and whether it’s worth pursuing an appeal.

Find out more about our pricing and care funding services.

How Farley Dwek can help you with your CHC appeal

At Farley Dwek, we support families at every stage of the CHC appeals process—from reviewing your case and gathering medical evidence to representing you at meetings.

If you’re unsure where to begin, start with our FREE 30-page CHC appeals guide or speak to a member of our team directly on 0161 272 5222 for expert advice and support.

We’re here to help you fight for the care funding your loved one deserves.

How to win a CHC Appeal