A Successful CHC Appeal
When a loved one has complex and increasing care needs, being told that they do not qualify for NHS Continuing Healthcare (CHC) funding can be incredibly difficult to understand and challenge. For Ms A*, whose mother was living with advanced Alzheimer's disease and significant physical and healthcare needs, a CHC appeal was required.
When Ms A* contacted Winston Solicitors, she was deeply concerned about the decision to refuse NHS Continuing Healthcare (CHC) funding for her mother, Ms D*.
Ms D was living with advanced Alzheimer's disease and had been living in a care home for several years. Sadly, Ms D and had experienced a significant decline in her health. She was bedbound, unable to communicate her needs, experienced swallowing difficulties, required a pureed diet and had developed severe contractures affecting her limbs. Despite these difficulties, the NHS concluded that she remained ineligible for CHC funding.
To make matters worse, the family received a decision letter suggesting that reasons for appeal had to be submitted within 28 days. Concerned about the short timescale and unsure whether they would have enough time to obtain advice and prepare a detailed challenge, Ms A sought specialist legal assistance.
How Winston Solicitors Helped with a CHC Appeal
After reviewing the case, our Continuing Healthcare team identified concerns around the CHC appeal process being followed. We contacted the Integrated Care Board (ICB) and challenged the timescale that had been imposed on the family. The ICB subsequently accepted that the wrong correspondence had been issued and confirmed that the family would be afforded the appropriate period in which to pursue the appeal.
We then carried out a detailed review of the Decision Support Tool (DST), care records and assessment documentation.
A particular concern related to the Mobility domain. During the original assessment, the social worker involved in the multidisciplinary process considered that Ms D met the criteria for a Severe level of need, while the NHS assessor recorded a lower level. The distinction was crucial because Ms D had already been assessed as having a Severe level of need in Cognition.
Working closely with Ms A, we prepared a detailed witness statement documenting Ms D's decline and the reality of her day-to-day care needs. This evidence was supported by physiotherapy guidance demonstrating the complex positioning techniques required to safely move and reposition her due to severe contractures, pain and fragility.
Our appeal submissions challenged both the procedural handling of the assessment and the way in which the National Framework for NHS Continuing Healthcare had been applied.
A Successful Outcome
Following the appeal process, the ICB revisited the evidence and ultimately concluded that D did have a Primary Health Need and was eligible for NHS Continuing Healthcare funding.
The decision recognised the extent of her healthcare needs and the level of clinical oversight required to manage them safely.
For A, the outcome was about more than funding alone. It provided recognition that her mother's needs had not been accurately reflected within the original assessment and that the family had been right to challenge the decision.
Why This Case Matters
Many families assume that once an NHS Continuing Healthcare decision has been made, there is little prospect of overturning it.
This case demonstrates the importance of examining both the evidence and the assessment process carefully. A single disputed domain, particularly where there is disagreement between professionals involved in an assessment, can have a significant impact on the outcome of a case.
At Winston Solicitors, we regularly assist families with CHC appeals, helping them understand their rights, analyse the evidence and present the strongest possible case.
*Name changed for anonymity
