Care & support · England
When you disagree about CHC
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CHC means NHS Continuing Healthcare.
It can pay for some adults’ care.
You can challenge a decision you disagree with.
Keep your decision letter.
Find the date and the reasons.
Was it a Checklist result?
Ask the ICB to look again.
The ICB is your local NHS board.
Was funding refused after a full assessment?
Ask the ICB for its local review process.
Ask when you must make your challenge.
Do this quickly, even if you are waiting for help.
Ask for the assessment records.
Write down what is missing or wrong.
Explain the support you need.
Show useful records and real examples.
You can have someone help you.
Ask for information and meetings you can understand.
Still disagree after the ICB reviews eligibility?
Ask about NHS England’s independent review.
Has funding been agreed, but your support is wrong?
Ask for a care-plan review and the NHS complaints process.
Say straight away if missing support makes you unsafe.
Ask who will arrange the help you need now.
You can ask the Ombudsman about unresolved complaints.
The Ombudsman checks whether things were done properly.
What you can do next
You can ask: Which challenge process should I use?
Please tell me the deadline and how to get help.
Read the independent review guide Web pageThis link opens another website.
It may use harder words.
More useful links
- NHS England: independent review guide Web page
What eligibility review can consider and how to prepare.
- Ombudsman: CHC complaints Web page
Different routes for screening, eligibility and care-package complaints.
- Find community care legal aid advice Web page
An adviser checks the issue and financial eligibility; legal aid is not automatic.
- Find your ICB Web page
Ask for local resolution or the complaints team, depending on the issue.
These links open other websites.
They may use harder words.
Challenging a CHC decision or care package
Choose the right route for a negative Checklist, refused eligibility, delays, a reduced award or a care package that does not meet needs.
England · Adults aged 18 and over · People and their supporters
First identify what you are challenging
Keep the decision letter and its date. Is the problem a negative Checklist, a full eligibility decision, delay, removal of existing CHC, or the support offered after funding was agreed? The routes differ. An NHS England independent review considers full-assessment eligibility and related procedure. It does not decide a negative Checklist refusal, the type or location of a care package, the treatment delivered, or calculation of a redress payment. Ask the ICB to confirm the correct route without losing your deadline.
Negative Checklist: ask the ICB to reconsider
Explain which needs, evidence or screening descriptions were missed or inaccurately recorded. Include corrections and relevant information available at the time. Ask for a written reconsideration with reasons. The ICB must consider your request but need not repeat the Checklist. If still dissatisfied, use the NHS complaints procedure, then the Public Service Ombudsman where appropriate. A new deterioration may also justify new screening; that is different from challenging what was decided before.
Full eligibility refusal: local resolution comes first
Ask the ICB CHC team for local resolution of the full assessment decision. Obtain the completed DST, MDT recommendation, final decision, reasons and local procedure. State that you disagree and identify the decision and period concerned. Many ICBs require a request within six months of the written decision; check your own letter immediately. Ask for any separate deadline for full reasons or evidence. Do not assume waiting for records, a complaint or an advocate extends a deadline. Request extra time promptly if necessary and keep the reply.
Build a clear evidence-based challenge
Read each disputed account beside the care records. Explain the inaccuracy, the relevant dated evidence and why it affects the level or overall interpretation of need. Include your own account and evidence from people providing daily and night care. Explain nature, intensity, complexity and unpredictability, including interactions between needs. A diagnosis list or disagreement about a score without reasons is less useful. Do not suggest all four characteristics must be present or that a fixed points total determines eligibility.
Examples of questions to ask
Was support that successfully manages a need recognised? Were communication difficulties mistaken for absence of need? Were night care, fluctuating needs and skilled interventions recorded? Were relevant professionals and the person involved? Did the MDT recommend eligibility, and if the ICB disagreed, what exceptional reasons were given? State which issues relate to evidence or clinical judgement and which relate to process. A procedural mistake does not automatically prove eligibility; explain its effect on the fairness or completeness of the decision.
If local resolution does not settle eligibility
Ask for the final local resolution outcome and NHS England independent review contact details. Request independent review promptly and check the applicable deadline in the outcome letter. NHS England’s public guide requires its application form to be returned within six weeks of issue; ask for support or an agreed extension if needed. NHS England first checks the case and may seek more local resolution, obtain independent consideration or arrange a panel. Not every application leads to a panel hearing.
Preparing for independent review
Focus on needs during the disputed assessment period. NHS England restricts new evidence to material the ICB could reasonably have been expected to obtain or consider but failed to do so. Later deterioration usually needs a current assessment as well. Ask to see the case file and flag missing evidence promptly. You can provide written views or attend with support. Ask early for access adjustments or a suitable meeting format. The panel includes an independent chair and NHS and council representatives not previously involved; a clinical adviser may assist.
After independent review
If still dissatisfied, you can approach the Public Service Ombudsman. Explain the specific unfairness or fault and how your concerns were handled, rather than asking the Ombudsman simply to choose a different score. The Ombudsman examines decision-making and can recommend action; it does not itself award CHC eligibility. Its usual complaint limit is one year from when you knew about the problem. Contact it promptly about the effect of a lengthy review process or a late complaint; do not assume the year starts with the final letter.
If the amount or arrangement of support is wrong
Ask the ICB case manager for a care-plan review. Identify unmet assessed needs, actual gaps in support, consequences and the changes requested. Compare the written plan with what is provided, including staffing skills, night cover, communication, equipment and your preferred outcomes. Disputes about an awarded package’s amount, location or service quality normally use NHS complaints, rather than the eligibility independent-review process. Ask for urgent interim arrangements where a delay puts you at risk.
When funding is being removed
Ask for the reassessment, proposed change, start date and plan for continuity of care. National guidance requires reassessment, consultation and alternative funding arrangements before an existing arrangement is withdrawn. An individual’s eligibility appeal does not automatically keep CHC funding in place until the appeal ends. Make an urgent written request for safe interim support and coordinate with the council where necessary. If essential care or your home is threatened, obtain prompt advice from a community care or public law solicitor; legal deadlines may be short.
Delay, reimbursement and past care
Ask the coordinator for the timeline and reasons for delay. If CHC is awarded after an unjustified delay beyond the usual 28-day decision period, reimbursement rules may apply to qualifying care costs from day 29. Keep invoices and payment records and ask for the calculation. A delayed decision does not automatically create entitlement to every cost. Previously unassessed periods of care have a separate retrospective process: identify the dates and ask the ICB for that procedure rather than treating it as an ordinary current appeal.
Support and keeping track
You can pursue a challenge yourself or with someone you choose. Ask the ICB about independent advice and local NHS complaints advocacy. A paid representative is not required for independent review and their fees are not normally reimbursed by the NHS. Keep a short chronology, copies, delivery confirmation, agreed extensions and the name of your contact. Use the worksheet to separate the decision, evidence, requested remedy and urgent care needs.
The Ombudsman’s new name
The Public Service Ombudsman was previously called the Parliamentary and Health Service Ombudsman, or PHSO. The name changed on 1 October 2026. Its legal powers and complaint processes stayed the same. Older letters and information may use the former name.
Words you could use
“I disagree with the decision dated [date]. Please confirm the correct review route and deadline, provide the decision records and reasons, and explain what support will remain in place. My main concerns are [needs or errors], supported by [evidence].”
More useful links
- NHS England: independent review guide Web page
What eligibility review can consider and how to prepare.
- Ombudsman: CHC complaints Web page
Different routes for screening, eligibility and care-package complaints.
- Find community care legal aid advice Web page
An adviser checks the issue and financial eligibility; legal aid is not automatic.
- Find your ICB Web page
Ask for local resolution or the complaints team, depending on the issue.
These links open other websites.
They may use harder words.
Where the information comes from
Links checked 1 November 2026.
These links open other websites.
They may use harder words.
- DHSC: Checklist guidance Web page
Reconsideration after a negative Checklist.
- DHSC: national framework Web page
Eligibility decisions, continuity of care, dispute routes and reimbursement for unreasonable delay.
- NHS England: independent review guide Web page
Exclusions, six-week form return, evidence limits, panel and participation.
- NHS Gloucestershire: continuing healthcare Web page
Official ICB example of a six-month local review request deadline.
- NHS Dorset: CHC process Web page
Official local six-month appeal deadline; appeal does not itself preserve funding.
- Public Service Ombudsman: CHC complaints Web page
Ombudsman’s role and limitations after NHS review or complaint.
- Public Service Ombudsman: bringing an NHS complaint Web page
Usual one-year time limit measured from awareness of the issue.
- DHSC: previously unassessed care Web page
Separate process for previously unassessed periods after 1 April 2012.
- Ministry of Justice: community care advisers Web page
How to find a legal aid adviser and check eligibility.
- Public Service Ombudsman: name change Web page
Official announcement on 1 October 2026; name changed, powers and processes unchanged.
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