Understanding NHS Continuing Healthcare - How to Appeal a CHC Decision
If you’ve received a decision from the NHS stating that you or your loved one is not eligible for Continuing Healthcare (CHC) funding, you may feel frustrated, confused, or even defeated. But it’s important to recognise that you have the right to appeal following a full eligibility assessment, and with the right advice and strategy, decisions can be successfully overturned. We asked our Head of Continuing Healthcare Claims to give us expert advice on how to appeal a CHC decision.
As a solicitor specialising in CHC claims and appeals, I’ve helped thousands of families navigate this complex process over the course of my career. Here’s what you need to know. - James Urquhart-Burton
What Is NHS Continuing Healthcare?
CHC is a fully funded package of care provided by the NHS for individuals with a primary health need. It’s not means-tested, so your savings or assets don’t affect eligibility. If you qualify, the NHS covers the full cost of your care, whether at home, in a care home, or in a nursing facility.
To speak to a CHC expert call 0113 320 5000
Understanding the CHC Appeal Process
You typically have six months from the date of your decision letter to lodge a CHC appeal with your local Integrated Care Board (ICB). The appeal process has two main stages:
1. Local Resolution Meeting (LRM)
This is your first opportunity to appeal a CHC decision. You’ll meet with the CHC team to explain why you believe the decision was incorrect. It’s vital to prepare thoroughly. Ensure that you understand in advance of the meeting whether the ICB will be gathering medical records, care notes, and any supporting evidence. You may want to obtain them yourself so that you know what the evidence shows.
2. Independent Review Panel (IRP)
If the LRM doesn’t resolve the issue, you can request an IRP through NHS England. This panel includes an independent chair, a nurse assessor, and a social worker from outside your local area. The IRP has the ability to review your case afresh and issue a final recommendation to the ICB. It will usually recommend either that the original decision was SOUND or UNSOUND, and the ICB will usually accept its recommendation. You should be given an opportunity to present your case orally and in writing in advance of the panel date. The IRP will be interested to hear about any concerns you have about the procedure the ICB followed, any care domain levels you dispute, and why you consider your loved one has a Primary Health Need.
Tips to Strengthen Your CHC Appeal
1. Know Your Rights
- You’re entitled to a copy of the Decision Support Tool (DST) used in your assessment. If it wasn’t sent, request it.
- The National Framework for NHS Continuing Healthcare outlines the criteria and process. Familiarise yourself with it.
2. Gather Strong Evidence
- Consider why you believe the eligibility criteria has been met and then what evidence may be available to support that.
- Consider Medical records, hospital discharge summaries, GP notes and care home records. Ensure they are relevant to the question of eligibility at the time of the assessment.
- Highlight any procedural failings - e.g., missing professionals at the MDT, lack of proper documentation, or failure to consider “well-managed needs”.
3. Address Inconsistencies
Appeal panels don’t follow legal precedent. Different assessors may interpret the same evidence differently. That’s why it’s important to challenge any inconsistencies or subjective judgements in the Decision Support Tool (DST). A well-argued appeal that highlights overlooked or misinterpreted care needs can make a significant difference.
4. Don’t Miss Deadlines
- Diarise the six-month appeal window.
- If you’re requesting an IRP, have all of your documents and evidence ready at the point of submission if at all possible, as you may have difficulty submitting evidence late in the day.
5. Why Legal Support Matters
At Winston Solicitors, we offer different levels of support for appeal, which are tailored to meet your specific requirements where possible:
- Written Appeal Submission: Ideal if you want to submit the appeal yourself but need expert input in the drafting.
- Full Legal Representation: We handle everything - from drafting arguments to attending meetings and speaking on your behalf.
Our solicitor-led approach ensures your case is presented clearly, professionally, and with the strongest possible chance of success.
We Can Help You to Appeal a CHC Decision
If you are in a position where you need to appeal a CHC decision, it can feel daunting. However, you don’t have to do it alone. Whether you’re just starting out or already mid-way through the process, we’re here to help.
Contact Winston Solicitors for a free initial assessment and let’s explore how we can support you with your CHC appeal.
