How to Appeal Continuing Healthcare Decisions: A Step-by-Step Guide

If you need to know how to appeal continuing healthcare decisions made by the NHS, the short answer is: write to the Integrated Care Board (ICB) within six months of the decision letter and ask for a local resolution review. If that fails, you can ask NHS England for an independent review, and after that complain to the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman). Each stage is free.

Appeals succeed when families challenge the reasoning and the scores with evidence, not when they simply say the decision feels wrong. This guide shows how to do that, step by step, wherever in England your relative lives.

In short: diarise the deadline, request the full records, go through the Decision Support Tool domain by domain, and put your points in writing.

The three stages at a glance

How to appeal continuing healthcare decisions: the six-month local resolution window

You normally have six months from the date on the eligibility decision letter to ask the ICB to look again. Beacon, an independent CHC advice service, notes that some ICBs have given shorter deadlines. If yours does, challenge it and send a holding letter anyway.

The simplest approach is to send a short letter or email straight away saying you disagree with the decision and want local resolution, then follow with detailed reasons once you have the records. Keep proof of the date you sent it.

Each ICB runs its own continuing care team and publishes its own appeals route, usually on its website and in the decision letter. ICBs have merged and been renamed in recent years, so check the current page before you write. For example, in Sussex appeals go to the All Age Continuing Care team at NHS Surrey and Sussex ICB, which formed when NHS Sussex merged with NHS Surrey Heartlands in April 2026.

Local resolution usually involves a meeting with the ICB, sometimes followed by a formal review of the evidence. You can bring someone with you.

Request the records before you argue the case

You cannot challenge scores you have not seen. Ask the ICB for the full CHC file, including:

• the checklist and the completed Decision Support Tool (DST);
• notes from the multidisciplinary team meeting and any ICB panel or verification notes;
• every piece of evidence they relied on, such as care home charts, nursing notes and professional reports.

Also ask the care home or agency, GP, hospital and council social care team for their records covering the same period. A living person, or someone acting for them with authority such as a lasting power of attorney for health and welfare, can make a subject access request. Organisations normally have one month to respond. For someone who has died, the personal representative can apply under the Access to Health Records Act 1990.

Ask for records early. A slow response is not a reason to miss the deadline, so send your holding letter first.

How to challenge the domain scores

This is where most appeals are won or lost. Take the DST and, for each of the 12 domains, compare three things: the descriptor the assessors chose, the wording of the level above it, and your evidence.

1. Quote the descriptor. For example, if behaviour was scored “high”, read the “severe” descriptor and set out which parts your evidence meets.
2. Cite dated evidence. “Care home incident log, 3 to 17 March: 14 incidents of resisting personal care needing two staff” is far stronger than “he is often aggressive”.
3. Challenge “well managed”. The National Framework says well-managed needs are still needs. If a need is only controlled because of skilled care, say so.
4. Look at interaction. Explain how needs affect each other, for example how confusion makes swallowing risks harder to manage.
5. Test the conclusion. Check the recommendation addresses nature, intensity, complexity and unpredictability, and does not rest on diagnosis, the care setting, or whether the provider can cope.

Also check the process. Was the family invited? Was the assessment done in hospital when the Framework says it should normally happen in the community? Did the team make a clear recommendation, rather than just recording scores? Procedural failures can lead to a fresh assessment. For dementia-specific points, see our guide to continuing healthcare for dementia.

The NHS England independent review panel

If local resolution does not change the decision, you can ask NHS England to arrange an independent review. The local resolution letter should explain how. The panel has an independent chair and representatives from an ICB and a local authority who were not involved in the case, and may be supported by a clinical adviser. You can attend and speak.

Deadlines here are tighter than many families expect. Beacon says you have six months from the local resolution outcome to request a review, but NHS England’s public guide gives a six-week window for returning the application and your evidence. Follow the deadline in your letter, and have your written case ready before you apply.

The panel makes a recommendation to the ICB, which ICBs are expected to accept except in exceptional circumstances. Beacon notes reviews should not normally take longer than three months, though some take much longer.

The Public Service Ombudsman

If you are still unhappy after the independent review, you can complain to the Public Service Ombudsman. The Ombudsman looks at whether the NHS acted properly and fairly, and can recommend that it puts things right. It is free. Complaints should usually be made within 12 months of when you became aware of the problem.

Where the complaint also involves the council, for example over a joint package, the Local Government and Social Care Ombudsman may be involved too.

Retrospective claims and previously unassessed periods

If someone paid for care in the past and was never properly considered for CHC, you may be able to ask the ICB to look at that “previously unassessed period of care”. The current government guidance, last updated in March 2025, says:

• ICBs will generally only consider periods of care after 1 April 2012, with earlier periods considered only in exceptional circumstances;
• you must show the care was paid for, in full or in part, and give objective evidence that the person should have been considered for eligibility;
• application forms should be returned within 28 days, and for an estate, proof of authority such as probate within eight weeks;
• ICBs should normally complete the review within six months for periods of up to 12 months, and within 12 months for longer periods.

These cases rely heavily on old records, so request them early. If eligibility is found for a period you paid for, ask the ICB how and when it will reimburse the fees.

Free help with a CHC appeal

• Beacon: free initial advice on NHS continuing healthcare on 0345 548 0300, plus written guides on appeals.
• Age UK: the Age UK Advice Line (0800 678 1602) and Factsheet 20 on continuing healthcare.
• Your local carers’ centre: support for unpaid carers, including with paperwork. Your council’s adult social care team can tell you who runs it, or find your area.

Be careful with firms that charge a percentage of any refund. Many families succeed on their own with free advice. If you instruct a solicitor, get the fees in writing first.

While the appeal runs, care still has to be paid for. Our guide to how to pay for home care and free funding checker show what help is available in the meantime, such as Attendance Allowance and council support. For how CHC works once awarded, see NHS continuing healthcare at home.

Frequently asked questions

How long do I have to appeal a CHC decision?

Normally six months from the date on the decision letter to request local resolution from the ICB. Some ICBs have set shorter limits, so check your letter and send a holding letter straight away if time is short.

Can I appeal a CHC decision after someone has died?

Yes, if you are acting for the estate and within the time limits. You will usually need proof of authority, such as a grant of probate or letters of administration, and records can be requested under the Access to Health Records Act 1990.

Will the NHS refund care fees if the appeal succeeds?

If eligibility is established for a period you paid for, the ICB should reimburse the care costs for that period. Ask the ICB in writing how it will calculate and pay the refund.

Do I need a solicitor to appeal continuing healthcare?

No. The process is designed for families to use, and Beacon and Age UK give free advice. A solicitor can help with complex or high-value cases, but agree the fees before you start.

What is a Decision Support Tool appeal based on?

It is based on whether the evidence supports the scores given in each of the 12 domains, and whether the overall conclusion fits the four characteristics of a primary health need. Point to specific dated evidence for each score you dispute.

The Care Panel is an independent publication. We are not a care provider and are not regulated by the Care Quality Commission, because we do not deliver care. Always check a provider’s own CQC registration and inspection report before you commit.

Written and fact-checked by The Care Panel. Last updated September 2026. Sources: NHS England National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care; NHS England independent review process public information guide; GOV.UK guidance on previously unassessed periods of care; NHS Surrey and Sussex ICB; Beacon CHC; Age UK Factsheet 20. General information, not financial, legal or medical advice — figures are indicative and subject to change.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.