The NHS Continuing Healthcare Appeals Process

A decision that an individual is not eligible for NHS Continuing Healthcare funding can be profoundly unsettling. By this stage, families have often engaged fully with the assessment process, provided extensive records and waited for a considered outcome. When the conclusion is “not eligible”, it can feel as though the reality of day-to-day care has not been properly reflected.

An ineligibility decision is not necessarily final. The National Framework provides a structured appeal pathway through which the decision can be formally challenged. That pathway is governed by defined stages and strict deadlines. There are statutory time limits which must be met in order to preserve the right of appeal, alongside NHS target timescales for completing reviews and panels. Understanding both is essential before taking the next step.

💡The stages of the appeal process are outlined below, with the key deadlines clearly identified:

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1️⃣ Local Resolution (ICB stage)

Local Resolution is the first formal stage of challenge. Put simply, you are asking the Integrated Care Board (ICB) — the organisation responsible for the original decision — to look at it again.

In most areas, Local Resolution begins with an informal review, often a telephone discussion or “resolution meeting” with a CHC manager, designed to clarify the ICB’s position and explore whether concerns can be resolved without a full panel. If the dispute cannot be resolved informally, the matter progresses to a formal Local Resolution Meeting (LRM) or panel where the family and/or representative can set out why the Decision Support Tool (DST) has been scored incorrectly and why the Primary Health Need test has been misapplied.

Timescales (Local Resolution)
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You have 6 months from the date of the initial ineligibility decision letter to request Local Resolution. Some ICBs refer to shorter periods in local policies (for example, a request to notify an “intention to appeal” within 14 or 28 days), but the National Framework’s six-month window is the key deadline to protect.

Once your request is received, the NHS target is to complete the ICB’s Local Resolution process within 3 months, although in practice this may take considerably longer depending on local backlog.

2️⃣ Independent Review Panel (IRP stage) – NHS England

If Local Resolution does not result in the decision being overturned, you can escalate the appeal to NHS England for an Independent Review Panel (IRP).

The IRP is independent of the ICB. It is chaired by an independent Chair and includes experienced health and social care professionals who have not been involved in the case. The purpose is not to carry out a new assessment, but to consider whether the National Framework was followed and whether the eligibility recommendation was supported by the evidence available at the time.

This stage is more formal, and preparation matters. The panel will scrutinise the DST, how the MDT recorded and analysed needs, the ICB’s Local Resolution reasoning, and the written appeal submissions.

Timescales (IRP)
You have 6 months from the date of the Local Resolution outcome letter to request an IRP.
Once an IRP is requested, there is commonly a tight evidence submission window (often around six weeks) for the written bundle and arguments. In other words, it is usually unwise to “trigger” IRP until records and key evidence are in place and your written case is ready to be assembled quickly.
NHS England’s target is to hold the IRP and issue an outcome within 3 months of the request, but current reality in many areas is that panel dates can take 3 to 6 months (or longer) to come through.

3️⃣ Parliamentary and Health Service Ombudsman (PHSO)

If the IRP does not uphold the appeal, the final stage is the Parliamentary and Health Service Ombudsman.

This is not a further clinical appeal. The Ombudsman’s role is to consider whether there has been maladministration — for example, a failure to follow the correct process, failure to consider relevant evidence, or an unfair handling of the case. The Ombudsman rarely substitutes its own view on eligibility, but it can recommend remedies such as a fresh review or reassessment, and in some situations other corrective action.

Timescales (PHSO)
A complaint to the Ombudsman should generally be made within 12 months of the final NHS England decision.

⚖️ What to Expect in Practice

💡Although the appeals pathway is clearly structured, what to expect at each stage can vary considerably:

Appeal Stage	What to Expect
Informal Review	Discussions are often exploratory in tone. The Integrated Care Board may clarify how particular domain levels were selected and how the four key characteristics were analysed. Occasionally, factual inaccuracies are corrected at this stage. However, significant reversals are uncommon unless there is an obvious scoring anomaly. The principal value of this stage is often strategic: it reveals how the ICB is reasoning and where its analysis may be vulnerable to challenge.
Local Resolution	This is the first formal and substantive opportunity to challenge the decision. This is typically a structured panel meeting involving senior clinicians or managers who were not directly involved in the original assessment. The panel will reconsider the Decision Support Tool and the application of the Primary Health Need test. In practice, panels often focus closely on domain descriptors and may defend the original recommendation robustly. However, well-prepared Local Resolution challenges can and do succeed. This stage is frequently the most significant opportunity for change within the ICB itself.
Independent Review Panel	Convened by NHS England, this stage represents a different level of scrutiny. It is not a fresh clinical assessment. The panel’s role is to determine whether the ICB’s decision was consistent with the National Framework and supported by the evidence available at the time. The emphasis shifts from debate about individual descriptors to examination of whether the overall decision was rational, procedurally sound and properly reasoned. Preparation at this stage requires disciplined written submissions, clear referencing and careful articulation of why any identified errors were material to the outcome.
Parliamentary and Health Service Ombudsman	This stage is not a continuation of the clinical eligibility debate. The Ombudsman’s function is to examine whether the case was handled properly — whether the correct procedures were followed, whether relevant evidence was considered, and whether the process was conducted fairly. The Ombudsman does not normally replace the original eligibility decision with its own. However, where procedural failings are identified, it may recommend that the case be reviewed again, reassessed, or otherwise remedied.

⚖️ Why Structured Support Matters

The CHC appeals process is technical. Although it sits within a healthcare setting, eligibility is governed by a defined legal framework. Decisions turn not simply on how serious needs appear, but on how those needs are recorded, analysed and aligned with the four key characteristics of a Primary Health Need.

💡In practice, many appeals fail not because the individual’s needs are insufficient, but because the evidence has not been presented in a way that engages properly with the National Framework.

⚖️Professional, structured preparation ensures that:

• The Decision Support Tool is scrutinised carefully against underlying records
• The four key characteristics are analysed methodically
• Material errors are clearly identified and articulated
• Written submissions are coherent, proportionate and properly referenced
• Escalation to IRP or Ombudsman stage is undertaken strategically and within statutory deadlines

💡The strength of an appeal lies in the disciplined presentation of evidence and careful examination of process.

⚖️ ARROW Appeals Support

ARROW provides independent, evidence-led support across all stages of the CHC appeal pathway, including:

• Local Resolution Meetings
• Independent Review Panels (IRP)
• Complaints to the Parliamentary and Health Service Ombudsman (PHSO)

Each case is assessed carefully before escalation. Where there is a credible evidential or procedural basis for challenge, structured submissions and representation can be provided. Where prospects are limited, this will be explained at the outset.

If you have received an ineligibility decision and are considering your next steps — whether at ICB, NHS England or Ombudsman stage — you are welcome to arrange a confidential initial consultation to discuss your position and the appropriate course of action.

 💡Find out more about support with CHC appeals here:

Appeals Management Service

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