Challenging a CHC decision: reviews and appeals
7 min read · Written by the Future You CHC team
If you disagree with a CHC or CNHC eligibility decision you can challenge it. In both England and Wales there are two broad stages — local resolution with the body that made the decision, then an independent review — and both are won on evidence and process, not persistence alone.
Stage one: local resolution
Write to the ICB (England) or Local Health Board (Wales) asking for a review of the decision. Say clearly which domain scores you dispute, what evidence supports a higher score, and where you believe the process departed from the relevant National Framework. Request the full DST, the Checklist, and any MDT notes if you do not already have them.
Ask for a timescale in writing. Local resolution should not be open-ended.
Stage two: independent review
In England, if local resolution does not resolve matters you can ask NHS England for an Independent Review Panel. Requests should generally be made within six months of the ICB's decision. The panel considers both the eligibility decision and whether the correct process was followed.
In Wales, unresolved disputes go to an Independent Review Panel convened under the Welsh framework, with the Public Services Ombudsman for Wales as the final route if you remain dissatisfied. In England the equivalent final route is the Parliamentary and Health Service Ombudsman.
Grounds that tend to succeed
Strong challenges are specific. They point to a named domain, the evidence available at the time, and the reason the score does not reflect it.
- Evidence in the records that was not reflected in the domain scores
- Family or carer evidence excluded or not recorded
- Unpredictability and night-time needs not assessed
- No multidisciplinary input, or a single-professional assessment
- Reliance on diagnosis or setting rather than assessed need
Retrospective claims
Where care was paid for privately during a period when CHC should have been considered, a retrospective review of that period can sometimes be requested. These claims are evidence-heavy and time-limited, so seek guidance early.
Reviews when funding is already in place
CHC is normally reviewed at around three months and then annually. A review can result in funding being withdrawn, so treat it with the same preparation as an initial assessment: an up-to-date diary, current clinical evidence and a clear account of what has changed.
Still have questions about your own situation?
Guides explain the process; every situation is different. Our independent support, delivered by an experienced Mental Health Nurse, can help you understand where you are, prepare relevant information and think through your next steps. It doesn't guarantee an outcome, and not every family needs paid support.
Official guidance: the National Framework (England) and the Continuing NHS Healthcare Framework (Wales).
This guide is general information about the NHS Continuing Healthcare process in England and Wales. It is not legal advice and does not replace an individual assessment of your circumstances.