An ineligibility letter from your Integrated Care Board (ICB) is rarely the end of the road. NHS Continuing Healthcare (CHC) decisions can be, and regularly are, appealed — but the process runs on strict deadlines and a specific chain of evidence, not a general complaint. Understanding the stages before you write a single word gives a family the best chance of a decision actually being overturned rather than simply re-stamped.
Why CHC appeals succeed — and why most fail on process, not principle
A CHC appeal is not a request for the NHS to be more generous. It is an argument that the original Multi-Disciplinary Team (MDT) got something wrong — a domain in the Decision Support Tool (DST) was under-scored, a need was overlooked entirely, or the "Primary Health Need" test was misapplied against needs that are only manageable because of the care already being provided. Appeals that focus on the specific evidence gap tend to fare better than appeals that simply restate that a family disagrees with the outcome. Equally, most appeals that stall do so not because the underlying case was weak, but because a deadline was missed or the wrong evidence was submitted to the wrong stage.
Stage one: Local Resolution with your ICB
The first formal stage asks the ICB that made the original decision to review it. In practice this starts with a written appeal submitted to the ICB's CHC department, sometimes alongside a questionnaire the ICB sends out, and often followed by an informal discussion with a CHC manager to clarify the ICB's position. If that doesn't resolve things, the case proceeds to a formal Local Resolution Meeting, where you or a representative can set out why the DST was scored incorrectly or why the Primary Health Need test was misapplied. One point worth knowing before you prepare a submission: new evidence is not normally accepted at this formal meeting stage unless it genuinely wasn't available to the MDT at the time of the original assessment — so the strongest Local Resolution cases lean on evidence the assessors already had but under-weighted, not on brand-new material.
You generally have six months from the date of the ineligibility letter to request Local Resolution, and the NHS aims to complete the process within three months of your request, though it can run longer in practice.
Stage two: the Independent Review Panel
If Local Resolution doesn't change the outcome, the next stage is an Independent Review Panel (IRP), convened by NHS England rather than the local ICB — a genuinely separate body reviewing the case fresh. You apply using the independent review form referenced in your Local Resolution outcome letter. NHS England first checks whether it needs more information, whether a further local resolution attempt would be more appropriate, or whether the case is ready to book straight into an IRP hearing. Once a panel is booked, there is typically only a narrow window — around six weeks — to submit your full written evidence bundle and arguments, which is why the evidence-gathering described below is worth starting the moment an ICB decision looks likely to be contested, not after the IRP date is confirmed.
The window to request an IRP is six months from the date of the Local Resolution outcome letter. NHS England targets holding the panel and issuing an outcome within three months of the request, but in practice panel dates can take three to six months, sometimes longer, given demand on the system.
Stage three: the Ombudsman, as a last resort
If the Independent Review Panel does not uphold the appeal, the final avenue is a complaint to the Parliamentary and Health Service Ombudsman (PHSO). It is important to be realistic about what this stage can and cannot do: the Ombudsman does not re-examine clinical eligibility or re-score the DST. Its role is to investigate maladministration — for example, a failure to follow the correct process, a failure to properly consider the evidence submitted, or unfair handling of the case. A PHSO complaint should generally be lodged within twelve months of the final NHS England decision.
| Stage | Who reviews it | Deadline to request | Target timescale |
|---|---|---|---|
| Local Resolution | Your local ICB (CHC department) | 6 months from the ineligibility letter | 3 months (often longer) |
| Independent Review Panel | NHS England (independent panel) | 6 months from the Local Resolution outcome | 3 months (commonly 3–6 months) |
| Ombudsman complaint | Parliamentary and Health Service Ombudsman | 12 months from the final NHS England decision | Investigates process, not clinical scoring |
Building the evidence file: what actually moves a panel
Families who go into Local Resolution or an IRP with a organised evidence pack tend to make a stronger case than those relying on a general sense that "more care was clearly needed." Useful evidence generally falls into these groups:
- The original paperwork — the completed DST, the ICB's outcome letter, and any notes taken during the original assessment meeting.
- Medical and nursing records — care plans, letters from specialists, hospital admission and discharge summaries, and any clinical evidence documenting complex or intense needs, particularly anything recorded shortly before a hospital discharge.
- Care and social work records — social services care plans, needs assessments, and any documentation describing the nursing interventions or risk management the person actually requires day to day.
- A specific, domain-by-domain rebuttal — rather than a general objection, a note against each DST domain you believe was under-scored, including needs that were overlooked altogether (common with dementia or fluctuating mental health presentations) and so-called "well-managed needs" — needs that only look minor because of the care and equipment already in place, which is itself a recognised ground for challenge.
- Authority to act — if you are appealing on someone else's behalf, written consent or evidence of power of attorney, since the appeal cannot usually proceed without it.
Given the deadlines and the technical nature of DST scoring, many families choose to bring in a solicitor or CHC caseworker who specialises in this area to help identify scoring errors and structure the written argument, particularly ahead of an IRP where the evidence window is tight.
The practical takeaway
A refused CHC decision is a starting position, not a final one — but the system rewards families who move early, keep to the six-month windows at each stage, and build evidence around specific, documented gaps in the original assessment rather than a general appeal to fairness. Treat the ineligibility letter as the trigger to start collecting records immediately, and get independent advice before the formal Local Resolution meeting if the case is complex — by the time an Independent Review Panel is booked, the evidence window is measured in weeks, not months.