Denied NHS Continuing Healthcare | What is your next step...

Being refused NHS Continuing Healthcare (CHC) can be overwhelming—especially when you're dealing with a loved one’s complex health needs. However, a refusal doesn't mean the end of the road. If you believe the decision was incorrect, you have the right to challenge it and that’s where we can help! 

Here, our Specialist Community Care Team take you through what to do if your CHC application is refused, including how to appeal, request reviews, and build a strong case in a few simple steps. 

What is NHS Continuing Healthcare?

Firstly, with so much overwhelming information out there it is important to understand exactly what NHS Continuing Healthcare is. NHS Continuing Healthcare (CHC) is a package of care fully funded by the NHS for individuals with significant ongoing health needs. It can be provided in any setting, including care homes or a person's own home.

To qualify, a person must be assessed as having a primary health need, based on the nature, complexity, intensity, and unpredictability of their condition.

What Happens If You're Refused CHC?

If the NHS has decided that the person is not eligible for CHC following a full assessment, you should receive:

• A written explanation of the decision
• A copy of the Decision Support Tool (DST)
• Information about your right to request a review of the decision

If any of these are missing, you can ask for them.

Step-by-Step: What to Do Next

Knowing and understanding the next steps to be taken, can often feel overwhelming especially during such a difficult time as trying to get the right help and support for a loved one’s care. Although some people navigate the appeals process successfully on their own, others often turn to us for professional advice and guidance to support them through the process. We are delighted to have 100% success rate for appeals and with different packages available HERE, our team can help you every step you need us to.

These are the steps that the ICB will take in the appeals process…

1. Review the Decision Letter and DST

Carefully read the Decision Support Tool and assess how the NHS reached its conclusion. Look for:

• Inaccuracies or missing evidence
• Downplayed health needs
• Inconsistent reasoning across domains

2. Request a Local Resolution Meeting

The ICB will arrange a Local Resolution Meeting, this is your first opportunity to:

• Present your concerns
• Ask questions
• Clarify any misunderstandings in the assessment

Useful Tip: You have 6 months from the date of the decision letter to request the Appeal. 

3. The ICB will gather additional evidence

This could include:

• GP letters
• Hospital discharge summaries
• Social care records
• Testimonies from carers or professionals
• Care home records 

Note: The goal is to demonstrate how the person's care needs are primarily health-related.

4. Appeal Outcome

•    If the appeal decision is still not eligible then a request can be made to the Independent Review Panel (IRP) through NHS England.

This is a more formal process, where a panel of professionals not involved in the original decision will review the case.

5. Consider Legal Support

CHC is complex and emotionally charged. Our specialist team of experts can:

• Check NHS CHC eligibility
• Attendance at DST Reviews | 3 Monthly & Annually
• Support with CHC Appeals 

You can find out more details about all of the options listed above by clicking HERE.  

Top Tips for a Strong Appeal

• Use the CHC framework language (e.g., intensity, complexity, unpredictability)
• Go through each domain of the DST and build your case
• Be persistent but polite—this is a legal right
• Keep copies of everything

If you feel the CHC decision was wrong, don’t give up. The appeal process exists to ensure fairness. By understanding the system and presenting a clear case, you stand a better chance of getting the funding your loved one may be entitled to.

If you feel overwhelmed by the process or need help navigating an appeal, please don’t hesitate to contact our team today on 01926 354704 or email our Clinical Advisor Judy Timson at JudyT@moore-tibbits.co.uk