A step-by-step guide to appealing an NHS Continuing Healthcare rejection in England. What to expect at each stage, what evidence you need, and when to seek specialist help.
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Receiving a letter telling you that your relative does not qualify for NHS Continuing Healthcare is one of the most disheartening moments in an already exhausting process. You have gathered evidence, attended assessments, explained in detail how much care your loved one needs -- and the answer is no.
If this has happened to you, know two things. First, you are not alone. Approximately 60% of initial CHC applications in England are rejected. Second, a rejection is not the final word. Of families who go on to appeal, 56% eventually succeed in overturning the decision.
The system is tough, but it can be challenged. This guide explains exactly how to do it -- stage by stage, with practical advice on what evidence to gather, what to expect at each step, and when to seek specialist help.
Last updated: February 2026.
NHS Continuing Healthcare is worth up to 76,000 per year in fully funded care. It is not means-tested, which means anyone -- regardless of wealth -- can qualify if their care needs are primarily health-related. That makes it extraordinarily valuable, and it also makes the assessment process heavily gatekept.
The reality is that Clinical Commissioning Groups (now Integrated Care Boards) have finite budgets. Approving CHC shifts the cost of care from the individual or council to the NHS. There is an inherent financial pressure to keep approval rates low. This is not a conspiracy theory -- it is a structural incentive that the Parliamentary and Health Service Ombudsman (PHSO) has repeatedly criticised.
For families, this means that a rejection does not necessarily reflect the true severity of your relative's needs. It may reflect an assessment that underweighted certain domains, failed to consider the full picture, or applied the framework inconsistently.
If you are unfamiliar with how CHC eligibility works or want to understand the 12 care domains and the primary health need test, our care home funding eligibility guide explains the full framework in detail.
Before deciding whether to appeal, read the rejection letter carefully. It should include the completed Decision Support Tool (DST) with scores across all 12 care domains, plus a written rationale for the decision.
The domain scores. Check each of the 12 domains (breathing, nutrition, continence, skin integrity, mobility, communication, psychological needs, cognition, behaviour, drug therapies, altered states of consciousness, and other significant needs). Compare the scores with your own understanding of your relative's care needs. Are any domains scored lower than you would expect?
The rationale. The letter should explain why each domain was scored at its level. Look for vague language or generalisations that do not reflect the daily reality of care.
Evidence considered. Was all the evidence you provided taken into account? Were key documents -- such as care home daily logs, incident reports, or specialist assessments -- mentioned in the rationale?
Most CHC rejections fall into one of three categories:
"Needs are primarily social care." This is the most common reason. The assessors have concluded that your relative's needs are about personal care (washing, dressing, eating) rather than health-related interventions. This distinction is often contested -- particularly for people with advanced dementia, where the boundaries between social and healthcare needs are blurred. If your relative has dementia, our guide on whether dementia qualifies for NHS CHC explains how to build the case.
"Needs are not severe enough." The assessors acknowledge health needs but have scored the domains too low to meet the primary health need threshold. This often happens when care is well-managed -- the very fact that a care home is managing the needs effectively is used as evidence that those needs are not severe. This is a circular argument and a common ground for successful appeals.
"Needs are stable and well-managed." Similar to the above, this reason suggests that because the person's condition is not deteriorating or causing crises, their needs do not meet CHC criteria. The National Framework is clear that well-managed needs should be assessed at their full severity, not downgraded because good care is keeping them stable. If medication prevents seizures, the underlying need for seizure management still exists.
The CHC appeals process in England has three stages. You must work through them in order -- you cannot skip ahead to the Independent Review Panel without first attempting local resolution.
Local resolution is a meeting between you and the team that made the original decision. It is your first opportunity to challenge the assessment face-to-face.
How to request it. Write to your local Integrated Care Board (ICB) -- the contact details should be in your rejection letter -- stating that you wish to dispute the CHC decision and requesting a local resolution meeting. Do this within 6 months of the decision, though earlier is better.
What happens at the meeting. You will sit down with the assessors (usually a nurse assessor and possibly a social worker) and go through the DST domain by domain. You can present additional evidence, challenge specific domain scores, and explain why you believe the assessment does not accurately reflect your relative's needs.
What to bring:
How to present your case. Focus on the four tests that determine whether a need is health-related: nature, intensity, complexity, and unpredictability. For each domain you are challenging, explain how these four factors apply. For example, if continence was scored as "moderate" but your relative has a catheter requiring specialist management, frequent UTIs leading to hospital admissions, and episodes of confusion during catheter changes, that combination of complexity and unpredictability may warrant a higher score.
Typical timeline. Expect the meeting to take place within 8 to 12 weeks of your request. You should receive a written outcome within 2 to 4 weeks of the meeting.
Success rate. Some decisions are overturned at this stage, particularly when new evidence is presented that was not available during the original assessment. However, the same team that made the original decision is reviewing it, so there is an inherent bias towards upholding their own judgment.
If local resolution does not change the decision, the next step is to escalate to a formal review by your Integrated Care Board.
How to request it. Write to the ICB stating that local resolution has failed and you wish to request a formal review. Include a summary of why you disagree with the decision and what evidence supports your position. The ICB should acknowledge your request and provide details of the review process.
What happens. The ICB convenes a review panel -- separate from the original assessors -- to re-examine the case. The panel reviews all the documentation, the DST, the local resolution outcome, and any additional evidence you have submitted. In some cases, you may be invited to present your case to the panel; in others, it is a paper-based review.
What to submit. This is your opportunity to present a comprehensive evidence pack. Include everything from the local resolution stage plus any further evidence gathered since then. Pay particular attention to:
Typical timeline. The ICB review process typically takes 3 to 6 months. There is no statutory deadline, which means delays are common. Chase regularly and keep written records of all correspondence.
Success rate. The ICB review provides a genuinely independent look at the case, and a meaningful proportion of decisions are overturned at this stage -- particularly when families present well-organised evidence and articulate how the original assessment failed to apply the framework correctly.
If the ICB review upholds the rejection, the final stage is the Independent Review Panel, administered by NHS England.
How to request it. Write to NHS England requesting an IRP hearing. You must do this within 6 months of the ICB review decision. NHS England will write to you with details of the process, a timeline, and instructions for submitting your evidence.
What happens. The IRP is the most formal stage of the process. An independent panel -- typically comprising a panel chair and two clinical assessors who have no connection to your ICB -- reviews the entire case. You are invited to attend and present your case in person. The panel will also hear from representatives of the ICB.
The IRP does not make a binding decision. Instead, it issues a recommendation to the ICB. However, ICBs very rarely reject IRP recommendations, so in practice the IRP's finding is usually the final outcome.
What to expect at the hearing. The hearing is not a courtroom -- it is meant to be accessible and fair. You will have the opportunity to explain your case, present evidence, and respond to questions from the panel. The ICB will present their reasoning for the original decision. The panel then deliberates and issues its recommendation, usually within 4 to 6 weeks of the hearing.
Typical timeline. From your request to the hearing, expect 6 to 12 months. The entire appeals process -- from initial rejection through local resolution, ICB review, and IRP -- averages around 14 months.
Success rate. The IRP has a strong track record of recommending that decisions be overturned, particularly in cases where the original assessment failed to properly apply the nature, intensity, complexity, and unpredictability framework.
The strength of your appeal depends almost entirely on the quality of your evidence. Families who present thorough, well-organised documentation succeed far more often than those who rely on verbal arguments alone.
The DST is the core of the CHC assessment, and it is the core of most successful appeals. Understanding how to challenge specific domain scores is essential.
Every domain should be assessed against four criteria. If you believe the assessors have not properly considered any of these, you have grounds to challenge:
New evidence not considered. The most common reason appeals succeed is the introduction of evidence that was not available or not considered during the original assessment. A new consultant report, updated care logs showing deterioration, or specialist assessments conducted after the original DST can all shift the scoring.
Incorrect domain weighting. Assessors sometimes score individual domains accurately but fail to consider how multiple domains interact. Someone with moderate needs across seven or eight domains may have a stronger case than someone with severe needs in one domain, because the overall picture demonstrates a primary health need.
The "well-managed needs" error. If your relative's needs are well-managed because of the quality of care they receive, and the assessors have used that stability as a reason to score domains lower, this is a recognised error in the application of the framework. The National Framework is clear: needs should be assessed at their underlying severity, not downgraded because good care is keeping them under control.
Failure to consider unpredictability. Conditions that fluctuate -- COPD exacerbations, behavioural episodes in dementia, seizures, falls -- are inherently unpredictable. If the DST was completed on a "good day" or during a period of relative stability, it may not capture the true picture. Care logs and incident reports over a longer period provide the evidence to counter this.
You can navigate the entire appeals process yourself, and many families do so successfully. However, the statistics are stark: families with specialist advocacy support succeed 2.1 times more often than those who go it alone. And 68% of families give up after the first rejection, never reaching the stages where decisions are most frequently overturned.
Beacon is a specialist CHC advocacy organisation that supports families through the assessment and appeals process. They provide advice, help with evidence gathering, and can attend meetings on your behalf. Many of their services are free or low-cost.
CHC Action Group is a community-led organisation that provides information, peer support, and resources for families going through the CHC process.
Age UK and Citizens Advice offer general guidance on care funding, though they may not have the specialist CHC expertise needed for complex appeals.
For complex cases -- particularly where significant sums are at stake or where the case involves retrospective claims -- specialist CHC solicitors can be highly effective. They understand the legal framework, know how to present clinical evidence to panels, and can identify procedural errors in the original assessment.
Costs vary. Some solicitors offer no-win-no-fee arrangements, particularly for retrospective claims where the potential reimbursement is substantial. Others charge fixed fees (typically 1,500 to 4,000 for appeal support) or hourly rates. Given that CHC funding is worth up to 76,000 per year, the return on investment can be significant.
One of the few bright spots in the CHC appeals process is that it costs nothing to appeal at any of the three stages. The NHS cannot charge you for requesting local resolution, an ICB review, or an IRP hearing.
If you go it alone: The only cost is your time -- which, admittedly, is considerable. Expect to spend 40 to 80 hours over the course of the appeal gathering evidence, writing submissions, attending meetings, and chasing correspondence.
If you use an advocacy organisation: Many specialist organisations such as Beacon provide support free of charge or on a donations basis. Others charge modest fees for their time.
If you instruct a solicitor: Fees vary, but for a full appeal through to IRP, expect to pay 2,000 to 5,000. For retrospective claims, some solicitors work on a no-win-no-fee basis, taking a percentage (typically 15-25%) of the recovered amount.
If your relative has been paying for their own care -- or you have been paying on their behalf -- but should have qualified for CHC during that time, you can make a retrospective claim.
Retrospective claims can cover care costs going back up to 3 years. If successful, the NHS must reimburse the full cost of care for the period during which CHC eligibility should have applied.
When to consider a retrospective claim:
Retrospective claims can be worth tens of thousands of pounds. One common scenario: a family has been self-funding at 1,200 per week for two years. A successful retrospective claim recovers approximately 124,800.
If you are currently self-funding and believe your relative might qualify, it is worth exploring alongside any broader review of care home costs and funding options. You may also want to check whether Attendance Allowance could provide additional support in the meantime.
This section is not about process or evidence. It is about what it actually feels like.
Appealing a CHC decision is a marathon. The average timeline is 14 months. During those 14 months, you are likely also managing your relative's care, visiting them, worrying about their wellbeing, and dealing with care home fees that may be depleting savings you cannot afford to lose.
The process can feel adversarial. You are, in effect, arguing against the NHS -- an organisation you may depend on for your own healthcare. The meetings and panels can be stressful. The waiting -- weeks and months between each stage -- is draining. The bureaucracy can feel deliberately obstructive, even if it is not intentional.
Some honest realities:
But if you do decide to appeal, know this: 56% of families who persist through the process eventually succeed. The system is designed to be difficult, but it is not impervious. Families overturn CHC rejections every week across England. Yours could be one of them.
If you are still at the early stages and want to understand the full CHC eligibility framework before deciding whether to appeal, start with our care home funding eligibility guide. If your relative has dementia, our guide on dementia and NHS CHC eligibility addresses the specific challenges of building a case around cognitive and behavioural needs.