CHC Appeals and Eligibility Disputes Solicitors

+ When Should You Consider Appealing a CHC Decision?

Many families sense immediately that something isn’t right, especially where day-to-day care is highly demanding, risks are significant, or needs fluctuate. You may wish to appeal if the decision letter doesn’t match your experience, or if you feel the meeting failed to capture key information from carers, family members, or clinical records.

Importantly, CHC Appeals are time-sensitive. Although local policies vary, there is commonly an expectation that challenges should be raised within six months of the decision letter. If an ICB suggests an unusually short deadline, that does not always mean you have lost your chance, but it does mean you should seek advice quickly so you can protect your position and present

+ What are the Most Common Grounds for Challenging a CHC Decision?

Successful appeals are usually grounded in clear evidence and a careful understanding of how the DST should be applied.

Often, the problem is that needs have been under-recorded or placed at a lower severity level than the care notes and clinical records support. This can be particularly relevant where there are significant challenges with behaviour, cognition, communication, medication management, skin integrity, or risk of deterioration.

Another common issue is where the primary health need test has not been applied properly. Some decisions focus too heavily on setting, diagnosis, or what appears to be “social care”, rather than analysing the real impact of needs in terms of intensity, complexity and unpredictability.

Procedural flaws can also be powerful grounds. If family members were not properly involved, key records were missing, meetings were conducted without the right professionals, or the process did not follow the ICB’s own procedures and the National Framework, these issues can carry real weight at IRP stage and beyond.

+ What Evidence do you Need for a CHC Appeal?

Evidence is the backbone of a persuasive CHC appeal. To successfully challenge a decision, it’s essential to gather a complete picture of the individual’s health and care needs during the relevant period.

That usually means obtaining and organising a wide range of care and medical records, which help us show how the individual meets the eligibility criteria. We then cross-check this against what has been recorded in the Decision Support Tool (DST), so the appeal is not simply a disagreement with the outcome, but a structured demonstration of where the decision is not supported by the records. Common examples of useful evidence include:

• Care home records that detail daily support and personal care routines
• GP and hospital records that reflect diagnosis and treatment history
• Medication charts that show frequency and complexity of prescriptions
• Incident logs that record falls, behavioural issues or safeguarding concerns
• Risk assessments that highlight needs relating to mobility or cognition
• Manual handling reports that evidence physical dependency
• Continence records that show catheter or stoma management needs
• Skin integrity and pressure sore care notes, including repositioning records
• Reports from therapists, nurses or mental health professionals
• Notes from multi-disciplinary team meetings about the assessment
• Statements from family or carers describing the daily care provided

Each piece of evidence helps us to demonstrate that the care needs go beyond what a local authority is legally responsible for — and that NHS funding should apply.

+ How can we Support you Through the CHC Appeal Process?

Families often tell us the hardest part is knowing where to start, especially while juggling care decisions, emotional strain, and urgent financial pressures. We will help you bring order and clarity to the process.

We can obtain and analyse records, identify the strongest legal and procedural points, and prepare a focused appeal submission that maps the evidence to the decision support tool and the primary health need test. If you are considering an appeal, attending a local resolution meeting or IRP, we will help you feel prepared, confident, and supported, and we will ensure your case is presented calmly and professionally.

If you are acting for someone else, we can also advise on the authority required to progress the appeal, such as a Lasting Power of Attorney, deputyship, or other acceptable consent and identification arrangements.

+ Who can launch a CHC appeal on behalf of a patient?

A CHC appeal can be launched by the patient themselves, where they have capacity, or by someone properly authorised to act for them. This is usually an attorney under a Health & Welfare (and sometimes Property & Financial Affairs) Lasting Power of Attorney, a Court of Protection deputy, or another representative acting with the patient’s clear written consent. If the patient lacks capacity and there is no formal authority in place, the ICB will usually look for an appropriate best-interests representative (often a close family member), but you may need to provide evidence of your relationship and authority to proceed.

+ Can I get backdated CHC funding if my appeal is successful?

Yes, if your appeal succeeds and CHC eligibility is confirmed for a past period, the NHS can award backdated funding for that timeframe. In practice, this often means you may be able to recover care fees that were paid during the period the person should have been CHC-funded, although the exact reimbursement process and figures depend on the dates covered and how the ICB implements the decision.

+ What are my options if my CHC appeal is unsuccessful?

If your CHC appeal is unsuccessful, you can usually escalate to the next stage of the process. That typically means requesting an Independent Review Panel (IRP) via NHS England, where the panel considers whether the ICB correctly followed the National Framework and applied the primary health need test. If concerns remain after that, you may be able to complain to the Parliamentary and Health Service Ombudsman, which looks at whether the process was fair and reasonable (rather than making a fresh eligibility decision). In some situations, if there are serious legal or procedural errors, judicial review may also be considered, but this is time-sensitive and usually needs to be considered very quickly (often within months), so early advice is essential.

+ Can I request a new CHC assessment instead of appealing?

Yes, in some situations you can ask for a fresh CHC assessment rather than (or as well as) appealing, particularly if the person’s needs have significantly changed since the decision or important new evidence has emerged. That said, if you believe the original decision was wrong at the time it was made, an appeal is usually the better route because it can cover the past period and may lead to backdated funding, whereas a new assessment is more likely to focus on needs from now onwards.

+ What is the difference between a CHC appeal and a complaint to the NHS?

A CHC appeal challenges the eligibility decision itself, in other words, you’re saying the ICB got it wrong when it decided the person does not meet the primary health need test, and you want that decision reviewed (potentially leading to CHC being awarded, sometimes backdated). A complaint to the NHS is usually about how the process was handled, for example poor communication, delays, missing records, or the way a meeting was conducted. Complaints can support an appeal by highlighting procedural failings, but they don’t usually result in the NHS making a fresh eligibility decision on their own.

+ Is there a cost to making a CHC appeal?

No, there’s no NHS fee to make a CHC appeal. The local resolution stage and, if needed, escalation to an Independent Review Panel form part of the NHS process and don’t come with a charge for submitting the appeal itself. Where costs can arise is in the support you choose to have around you. If you ask Farnworth Rose to help, we’ll be completely transparent from the outset about likely fees and what’s included, and we can tailor our involvement to suit you, whether that’s reviewing the decision and evidence, drafting appeal grounds, or supporting you through meetings and an IRP.

+ Can a solicitor help with a CHC appeal and what do they do?

Yes, a solicitor can absolutely help with a CHC appeal, and in many cases that support makes the process feel far more manageable and focused. At Farnworth Rose, we typically help by obtaining and reviewing the relevant medical and care records, then checking what the evidence actually shows against what was recorded in the Checklist and Decision Support Tool (DST). We identify the strongest points to challenge, draft clear written grounds that link back to the National Framework and the primary health need test, and make sure important needs haven’t been understated or miscategorised. We also support clients through the practical stages of the appeal, preparing you for local resolution meetings, helping you present your case calmly and confidently, and, where necessary, representing you through an Independent Review Panel (IRP). If eligibility is ultimately confirmed, we can advise on the next steps, including pursuing backdated funding where it applies.

+ What are common reasons CHC appeals succeed or fail?

CHC appeals most often succeed when the case is tightly evidence-led and clearly shows that the ICB’s decision doesn’t match the person’s real needs at the relevant time. They most often fail when the appeal is too general, relies on opinion rather than records, or doesn’t engage properly with the Decision Support Tool (DST) and the primary health need test.