NHS continuing healthcare appeal letter: free template

Send a continuing healthcare (CHC) appeal letter to the integrated care board (ICB) as soon as you receive a decision that your relative is not eligible, and within the deadline in the decision letter. The letter asks the ICB to review its decision through its local resolution process, requests the assessment records, and explains which needs were underscored and why. If the ICB does not change its mind, you can ask NHS England for an independent review panel, and after that complain to the Public Service Ombudsman.

In short

• The current guidance is the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, July 2022 (revised), corrected in July 2023.
• Paragraph 215 says every ICB must have, and publish, a local resolution process with timescales; there is no single national deadline, so check the decision letter.
• After local resolution, you can apply to NHS England for an independent review. You must return its application form within six weeks, and the process typically takes three to six months.
• The panel’s recommendation should be accepted in all but exceptional circumstances (paragraph 223).
• After independent review, you can complain to the Public Service Ombudsman, normally within 12 months.
• If the decision is revised, the Framework’s refunds guidance says care costs paid in the meantime should be repaid.

When to use this letter and what to gather

Use this letter after a full assessment, when the ICB has decided your relative does not have a primary health need. If the ICB refused a full assessment after a negative checklist, the route is a complaint rather than this review. NHS England’s guide says the independent review process cannot look at that refusal. If your relative is near the end of life, ask about the fast track pathway instead.

Gather before you write:

• The decision letter. The Framework says it should include the reasons, a copy of the completed DST and how to request a review.
• Care home or home care daily notes, behaviour and falls charts, medication records, pressure area charts and turning charts covering the assessment period.
• Letters from the GP, consultants, community nurses, mental health team or speech and language therapist.
• Your own diary of what care was needed, how often and what happened when it was late.
• Authority to act: your relative’s written consent, or a lasting power of attorney or deputyship. Without it, the ICB may check whether the request is in line with their wishes or best interests.

The appeal letter template

Focus on the DST domains you dispute. Use exact frequencies, such as “three or four times a night”, rather than words like “often”. The 12 domains are breathing, nutrition, continence, skin integrity, mobility, communication, psychological and emotional needs, cognition, behaviour, drug therapies and medication, altered states of consciousness, and other significant care needs.

Print or save this letter as PDF

How the DST points support your letter

The Framework says the tool cannot decide eligibility on its own, but gives indicative thresholds. Practice guidance note 34.3 gives the examples of a priority level in one domain or severe levels in two domains. Only the breathing, behaviour, drug therapies and altered states domains have a priority level. Even without those scores, the team can still find a primary health need using professional judgement about the nature, intensity, complexity and unpredictability of needs, so explain how the needs interact. Eligibility depends on needs, not diagnosis; our guide to CHC and dementia shows how this works in practice.

How to send it

• Send it to the contact in the decision letter, by email with a read receipt or by post with proof of delivery.
• Note the ICB’s deadline and send well before it. If you need more time to collect records, write within the deadline asking for the review and say evidence will follow.
• Keep copies of everything and a log of calls.

What happens next

NHS England can send a case back to the ICB for more local resolution, or skip it if local processes would cause undue delay (paragraph 217). For independent review, you can only add new evidence if the ICB should reasonably have obtained or considered it and did not, so put everything into the local resolution stage. The panel is not a legal hearing; you can attend online or send your views in writing, and the NHS does not pay solicitors’ costs.

If the decision is changed, Annex E of the Framework says the ICB should refund the council’s care costs from the date of the original decision, so the council can repay your relative’s contributions with interest, or make an ex gratia payment if your relative paid privately. Our guide to appealing a continuing healthcare decision covers the whole process, and NHS-funded nursing care explains the payment your relative may get if they are in a nursing home but not eligible for CHC.

The Public Service Ombudsman

If the original decision is upheld after independent review and you still disagree, the Framework says you can complain to the ombudsman. Since 1 October 2026 it has been called the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman). Complain within 12 months of knowing about the problem; the Health Service Commissioners Act 1993 lets it accept a later complaint if it considers that reasonable. Call 0345 015 4033 or use its online complaint checker.

Free independent advice is available from Beacon on 0345 548 0300, as listed on nhs.uk. Use our NHS continuing healthcare checker to sense-check needs before a reassessment, and find more templates on our letter templates and checklists page.

Scotland, Wales and Northern Ireland

This letter is for England. Scotland, Wales and Northern Ireland have separate systems, and complaints go to the Scottish Public Services Ombudsman, the Public Services Ombudsman for Wales or the Northern Ireland Public Services Ombudsman. See our guides to NHS continuing care in Scotland, continuing healthcare in Wales and continuing healthcare in Northern Ireland.

Frequently asked questions

How long do I have to appeal an NHS continuing healthcare decision?

The National Framework does not set one national deadline for asking the ICB to review its decision. Each ICB must publish a local resolution process with timescales, and the deadline should be in the decision letter, so check it and write as soon as you can. For NHS England’s independent review, you must return the application form within six weeks.

What should a CHC appeal letter say?

Say that you are asking for a review of the eligibility decision under the ICB’s local resolution process. Ask for the full assessment records, then explain which care domains you think were scored too low and why, with dated examples. Mention the well-managed needs principle if it applies, and ask for a meeting with someone who has authority to decide next steps on behalf of the ICB.

What is an Independent Review Panel for continuing healthcare?

It is a panel arranged by NHS England after local resolution with the ICB has failed. It has an independent chair, a representative from a different ICB and a social services representative from a local authority outside the area of the ICB that made the decision. It makes a recommendation that NHS England and the ICB should accept in all but exceptional circumstances. It typically takes three to six months.

Can I appeal a negative CHC checklist?

Not through an independent review. NHS England’s guide says the independent review process cannot look at an ICB’s refusal to carry out a full assessment after a negative checklist. Use the NHS complaints procedure instead, within 12 months, and ask for a copy of the completed checklist, which you should be given anyway.

Do you get care fees back if a CHC appeal succeeds?

Usually, yes. The National Framework’s refunds guidance says that where an ICB revises its decision, it should refund the council the care costs from the date of the original decision, so the council can repay your relative’s contributions with interest. If your relative paid privately, the ICB should make an ex gratia payment directly to them.

Who can I complain to after the Independent Review Panel?

If the original decision is upheld after independent review and you still disagree, you can complain to the Public Service Ombudsman, formerly the Parliamentary and Health Service Ombudsman. You normally need to do so within 12 months of knowing about the problem, although it can look at older complaints if it considers that reasonable. Its helpline is 0345 015 4033.

Sources

• DHSC: National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care (July 2022, revised)
• NHS England: NHS Continuing Healthcare independent review process (public guide)
• NHS: NHS continuing healthcare
• Public Service Ombudsman: Making a complaint about the NHS in England
• Health Service Commissioners Act 1993, section 9
• NHS and social services complaints regulations 2009, regulation 12 (time limit)

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

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.