NHS Continuing Healthcare refused: local resolution and the independent review panel

If NHS Continuing Healthcare (CHC) has been refused, the decision is not necessarily final. Families often search for a CHC appeal, but in England there is no tribunal. Instead you ask the integrated care board (ICB) to review its decision through local resolution. If that does not settle matters, you can ask NHS England for an independent review by a panel, and after that you can complain to the Parliamentary and Health Service Ombudsman. Many pages still use the old CCG name, but since 1 July 2022 the ICB decides. This guide covers the decision letter, the time limits (and why your own letter has the last word), what to put in a local resolution letter and how the independent review panel works.

Start with the decision letter, not just the outcome

The ICB must notify the decision in writing with its reasons and, if the person is not eligible, tell them how and in what circumstances they can apply for a review (Standing Rules Regulations, regulation 21). The National Framework says the letter should include the decision, the reasons, a copy of the completed Decision Support Tool (DST), a contact for questions and how to request a review. If the DST is missing, ask for it.

Read the letter and the DST side by side. Note the level recorded in each domain and the evidence cited, any reasons that describe the care home or the provider instead of the person's needs and whether your information or the person's view appears at all. Write the date of the letter on the front, because most time limits run from it.

A negative Checklist is different from a refusal after a full assessment. You can ask the ICB to reconsider, but it is not obliged to carry out a further Checklist (see our Checklist guide).

What you can challenge in a CHC decision, and what you cannot

You can challenge the ICB's decision on whether there is a primary health need, and the procedure it followed in reaching it. NHS England's guide says the independent review process cannot look at:

• the content of the eligibility criteria
• the type and location of any CHC package offered
• alternative care packages the person has been offered
• the treatment or services the person receives
• an ICB's refusal to consider a full assessment after a negative Checklist
• the calculation of any redress payment

Those issues belong in the NHS complaints procedure. A review also should not go ahead if the person never had a comprehensive assessment. In that case NHS England refers the case back to the ICB for one.

Time limits: check your own letter first

These are the limits most often quoted. They come from 2012 guidance and are repeated in Age UK's July 2026 factsheet.

CHC local resolution, step by step

Every ICB must publish a local resolution process that is fair and transparent and includes timescales. The National Framework says it should take account of these steps:

1. An informal, two-way discussion between an ICB representative and you, with a written summary for both sides. You can have the decision explained, including how it relates to the completed DST, and provide information that was not considered.
2. A formal meeting, where needed, with someone who has authority to decide next steps, such as asking for further reports or sending the case back to the multidisciplinary team. You can explain why you remain dissatisfied, and there should be a full written record for both parties.
3. A decision. The ICB upholds or changes its original decision. If it does not change it, you should have a clear and comprehensive explanation of why.

You can ask to go straight to a formal meeting, and the framework says this should be considered. Ask for the ICB's written local resolution policy at the start so you know its steps and timescales. The request can come from the person or someone acting for them. If a relative or friend without a lasting power of attorney or deputyship makes it, the framework says the ICB should check with the person where they have capacity and use a best interests process where they do not.

Writing the local resolution letter, domain by domain

Age UK's factsheet suggests setting out your reasons, relating them to DST domains where possible and pointing to anything the DST did not capture or any failure to follow the framework. This is a skeleton, not a script. The content has to come from the person's real situation:

1. The basics: the person's name and date of birth, the ICB, the date of the decision letter, who you are, your authority to act and a plain request for local resolution of the decision and the procedure.
2. What you are asking for: a review and a meeting, plus copies of the DST, the MDT recommendation and the records the ICB relied on.
3. Domain by domain: for each domain you think was under-recorded, give the level recorded, what you say the evidence shows and where it is (care records, dated diary pages, clinical letters). Use frequencies and durations. The 12 DST care domains explains what each level describes.
4. The four characteristics: show how nature, intensity, complexity and unpredictability apply across the whole picture.
5. Interactions and well-managed needs: how needs in different domains affect each other, and where a managed need has been treated as no need.
6. Reasons that are not needs-based: see the next section.
7. Evidence not considered: anything the ICB should reasonably have obtained, such as provider records or a specialist assessment.
8. Involvement and timing: if the family or the person's own view was not sought, recorded or weighed, or if the process took longer than 28 calendar days from the positive Checklist. Our MDT meeting guide explains what should have happened.
9. Enclosures: a numbered list of what you are sending.

Be specific and accurate. NHS England's own advice is to say, for instance, that something usually happens two or three times a day rather than a lot, and to include mental and emotional needs and the care relatives provide. Leave out arguments about the criteria, the type of package offered or treatment, which cannot be decided through this route.

Reasons that should not decide the outcome

The framework says the reasons for an eligibility decision should not be based on:

• the person's diagnosis
• the setting of care
• the ability of the care provider to manage the care
• whether NHS-employed staff provide the care
• the need for, or presence of, specialist staff
• the fact that a need is well managed
• the existence of other NHS-funded care
• any other rationale about inputs rather than needs

Financial issues should not be considered either. If the letter leans on any of these, point to the sentence and say so plainly. A line such as "the home is coping well" describes the provider's input, not the person's needs, and the framework says well-managed needs are still needs.

The independent review panel (IRP) run by NHS England

Applying

If local resolution has not settled it, you can ask NHS England for an independent review (IR). It may ask the ICB to try further local resolution first, and it can agree to go straight to a review where waiting would cause undue delay. Use the contact details in the ICB's local resolution decision letter to request the Application for Independent Review form, and return it within six weeks.

On the form, explain your key reasons for disagreeing. NHS England asks you to be definite, to say what made the care more complicated and whether needs were hard to anticipate or fluctuated and to include relatives' care.

New evidence is limited. You can introduce it only if it would be reasonable to expect the ICB to have obtained or considered it when it decided, and it failed to. NHS England calls the application your final opportunity to provide further information. The ICB sends over what you submitted to it, so you do not need to resend it.

Will a panel be held?

NHS England previews the case from your form and the ICB's case file. It may ask the ICB for missing information, return the case if local resolution was never offered or refer it to what it calls the consideration process, where an independent chair and a clinical adviser review the papers. If they judge that the needs fall well outside the eligibility criteria, or that the case is very clearly not appropriate for a panel, the chair can recommend that no panel is held. You receive a copy of the chair's report, and the framework says NHS England should give you a written explanation and a reminder of your rights under the NHS complaints procedure. The process typically takes three to six months.

The panel itself

The panel has an independent chair who is not employed by the NHS, an ICB representative and a social services representative from organisations not involved in the case, and a clinical adviser may attend. The adviser helps with whether the assessors correctly interpreted the person's needs and does not give a second opinion on diagnosis or prognosis.

Panels are normally held online on Microsoft Teams, and you can ask for a telephone, face-to-face or hybrid format. The ICB sends you the case file, and you should tell NHS England if it has not arrived two weeks before the meeting. You are welcome to attend, but you do not have to: NHS England will accept your key views in writing. The open session is generally expected to last an hour, after which the panel deliberates in private. Legal representation is not necessary, there is no formal role for lawyers and the NHS does not reimburse their costs, so many people take a relative, an advocate or an adviser.

What the panel can recommend, and how binding it is

The panel can recommend that the case be reconsidered to put right deficiencies in the process or in how the criteria were applied, or that on the evidence the person should or should not be considered to have a primary health need. Procedural problems alone will not lead to a recommendation of eligibility unless they stopped the ICB making a fair and robust decision. In that situation the case can go back to the ICB for a full reassessment, and you can apply for a further independent review of the outcome.

The framework calls the panel's role advisory but says NHS England, and then the ICB, should accept its recommendation in all but exceptional circumstances. Regulation 23 goes further: the ICB must implement the panel's decision as soon as reasonably practicable unless there are exceptional reasons not to. A full record of the hearing goes to all parties. If a recommendation is not accepted, the body concerned should explain why in writing and you can use the NHS complaints procedure.

After the panel: the Ombudsman

If the original decision is upheld and you still disagree, you can complain to the Parliamentary and Health Service Ombudsman, usually within 12 months of written notification of the review outcome. The helpline is 0345 015 4033 and the website is ombudsman.org.uk.

Care and costs while you challenge

The ICB's original decision stays in place until it is revised. The framework says no individual should be left without appropriate support while awaiting the outcome. Depending on the person's finances, they may have to contribute to costs in the meantime. If the person already receives CHC and the ICB proposes to withdraw it, alternative funding arrangements should be agreed before funding stops and the proposal put to you in writing.

If the decision is later revised, Annex E of the framework says that where the council provided care, the ICB should refund the council's costs from the date of the not-eligible decision until the revised decision takes effect, and the council should repay the person's contributions with interest. Where the person arranged and paid for care themselves, the ICB should make an ex-gratia payment to put right the injustice. Keep receipts. These are duties in guidance and what applies depends on the circumstances, so ask the ICB, the council or a free adviser about your case. CHCexpert does not run refund claims.

CHC refused: what next if the answer stays no

A refusal does not always mean no NHS help. A person who is not eligible for CHC may still qualify for NHS-funded nursing care if they need care from a registered nurse and their overall needs are best met in a care home with nursing. The NHS pays a flat rate direct to the home, which is £267.68 a week from 1 April 2026, and a negative Checklist or DST does not prevent it. Age UK's factsheet adds that staff should ask whether you would like a Care Act assessment from the council, whose services are means-tested. Our guide to nursing care and CHC explains the difference.

If the person's health later changes and a clinician decides they have a rapidly deteriorating condition that may be entering a terminal phase, the Fast Track route replaces the Checklist and DST, and family can ask the clinician to consider it. See our Fast Track guide.

What the 2025/26 figures show

NHS England's data for 2025/26 show 50,402 standard CHC assessments completed, of which 8,776 found the person eligible (17.4%). The comparable figures were 19.5% in 2024/25 and 21.1% in 2023/24. At the local resolution stage, 2,666 requests to review an eligibility decision were completed in 2025/26 and 398 of them resulted in eligibility, about 15%.

These are national counts of completed requests. They say nothing about any individual case, and we do not use them to predict outcomes. NHS England stopped its PDF statistical release on 14 May 2026 and the data now continue as quarterly management information.

Free help

• Beacon (beaconchc.co.uk, 0345 548 0300) offers up to 90 minutes of free independent advice on CHC assessments and challenging decisions, funded by NHS England, plus paid casework.
• Age UK publishes Factsheet 20, which covers this process in detail.
• Alzheimer's Society publishes the booklet When does the NHS pay for care? and runs a helpline on 0333 150 3456.
• Local advocacy: the framework says advocates should be provided where this will support a person through the review process, so ask the ICB.

Common questions