NHS Continuing Healthcare Appeal
If your relative has been refused NHS Continuing Healthcare (CHC) funding, you may still be entitled to challenge the decision.
Many families are told they do not qualify, only to later discover the assessment did not fully reflect their health needs.
Where a person’s primary need for care is due to health needs, the NHS may be responsible for the full cost of care, whether care is provided in a nursing home, care home or the person’s own home.
There are time limits to request a CHC appeal, so it is important to act as soon as possible.
If you are unsure whether the decision was correct, we can help you understand your options
📞 Call 0345 548 0066 or click here to request a call backÂ
Challenging a CHC Funding Decision
Many families are told their relative does not qualify for NHS Continuing Healthcare (CHC) funding following an assessment. In some situations families later discover the assessment did not fully reflect the person’s health needs.
Acorn Continuing Healthcare provides independent support to families who wish to review and challenge NHS Continuing Healthcare decisions.
We support families through CHC assessments, reviews and appeals, helping them challenge incorrect decisions and pursue funding where appropriate.
Why NHS Continuing Healthcare Funding Is Sometimes Refused
Eligibility for NHS Continuing Healthcare is determined through a detailed assessment carried out by a multidisciplinary team (MDT).
This process considers whether the individual has a Primary Health Need, which is the key test used to determine whether the NHS should be responsible for funding care.
In some situations, families may feel that the assessment outcome does not fully reflect the level or complexity of the person’s needs. This can happen for a number of reasons, including:
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important evidence within care records not being considered or missed
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care needs changing over time
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misunderstandings during the assessment process
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the Decision Support Tool (DST) not accurately reflecting the person’s needs
Where families have concerns about an assessment outcome, they have the right to request a review of the decision.
Speak to us today 📞 Call 0345 548 0066 or click here to request a call backÂ
How NHS Continuing Healthcare Eligibility Is Assessed
Eligibility for NHS Continuing Healthcare (CHC) is determined through a detailed assessment carried out by a multidisciplinary team (MDT).
The outcome of the assessment is recorded within the Decision Support Tool (DST), which considers a number of care domains.
These domains include:
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Breathing
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Nutrition – Food and Drink
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Continence
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Skin (including tissue viability)
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Mobility
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Communication
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Psychological and Emotional Needs
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Cognition
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Behaviour
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Drug Therapies and Medication
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Altered States of Consciousness
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Other Significant Care Needs
The assessment must also consider the four key characteristics used within the National Framework:
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Nature
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Intensity
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Complexity
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Unpredictability
These factors help determine whether the person has a Primary Health Need.
How to Appeal an NHS Continuing Healthcare Decision
If NHS Continuing Healthcare funding has been refused, families have the right to request a review of the decision.
The appeals process may involve several stages, including:
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requesting a Local Resolution Panel Meeting (LRP/LRM) with the local NHS Integrated Care Board (ICB)
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reviewing the evidence used during the assessment
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further consideration of the Decision Support Tool
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referral to an Independent Review Panel (IRP) with NHS England, where appropriate
During the appeals process it can be important to carefully review care records, medical evidence and the original assessment documentation to determine whether the decision accurately reflects the person’s health needs.
📞 Call 0345 548 0066 or click here to request a call backÂ
Care Home Fees and NHS Continuing Healthcare
Many families pay significant amounts towards care, particularly where nursing care is required.
Care home fees in the UK can often exceed £1,500–£2,000 per week depending on the level of care required.
Where a person is eligible for NHS Continuing Healthcare, the NHS becomes responsible for the full cost of care, regardless of the person’s financial circumstances.
This can amount to tens of thousands of pounds per year.
For this reason, it can be important to ensure that eligibility decisions are carefully reviewed where families believe the outcome may not accurately reflect the person’s needs.
Frequently Asked Questions About CHC Appeals
Can you appeal an NHS Continuing Healthcare decision?
Yes. If NHS Continuing Healthcare funding is refused following an assessment, families have the right to challenge the decision through the NHS appeals process.
How long does a CHC appeal take?
CHC appeals can take several months depending on the stage of the review and the complexity of the case.
What evidence is used during a CHC appeal?
Appeals usually involve reviewing care records, medical evidence and the original assessment documentation.
Speak With Us About a CHC Appeal
If your relative has been refused NHS Continuing Healthcare funding, we can help you understand the appeals process and the options available.
📞 Call 0345 548 0066 or click here to request a call backÂ