Appeal an NHS continuing healthcare (CHC) decision
This information applies to England and Wales.
If you’re disabled and have a primary health need, you could be eligible for NHS continuing healthcare (CHC). This is funding from the NHS to pay for the medical care and support you need.
NHS continuing healthcare (CHC)
You can ask your local integrated care board (ICB) for an appeal if you:
- did not qualify for continuing healthcare
- do not agree with your care and support plan
- were not offered a personal health budget
- your ‘well-managed needs’ (primary health needs managed by equipment or support) were not included in the assessment
It is often called a review. This review is different from a review of your needs and eligibility when you already have CHC.
There are 2 stages:
Continuing healthcare review of needs
When you have continuing healthcare, you will have an initial review after 3 months. After that, you are supposed to have an annual review.
This can be called a review of needs. If your needs have changed, you can ask for a review.
Contact your integrated care board (ICB) to find out when the next review is.
Support challenging a CHC decision
Access Social Care can help you:
- request a review of a negative NHS CHC checklist
- request a review of a negative NHS CHC eligibility decision
- request interim support pending an NHS CHC eligibility decision
- make a complaint about your care plan not working
Free letter templates (Access Social Care)
Beacon is the main organisation that gives advice and support on CHC challenges. You have to pay for their expert analysis service to look at your CHC case.
CHC is not just for people with physical impairments. It is also for people with mental health needs, learning disabilities and other health needs, providing they meet the CHC Decision Support Tool criteria.
There are slightly different procedures:
- if someone has dementia or severe learning difficulties
- if someone’s condition is terminal
National framework for NHS continuing healthcare (easy read)
Find an advocate
An advocate is someone who helps you to say how things affect you and speak up for what you need.
Advocacy services are usually free.
Advocacy (Disability Rights UK)
Someone to speak up for you: advocate (NHS)
It’s a good idea to mention you have an advocate, so they are included in meetings and emails.
Local independent organisations may also be able to provide you with an advocate.
Not including well-managed needs
‘A well-managed need’ is a primary health need managed by equipment or support. If your well-managed needs were not included on the checklist or decision support tool, you can appeal the decision.
For example, you are 19 and CHC funds your care and support. You want to stop relying on parents for personal care. You want to stay living at your parents’ house but want to choose your own personal assistants.
For example, you’re a wheelchair user and your mobility needs are well managed because you have a powerchair that you can operate independently. A CHC eligibility assessment must include that you cannot independently mobilise.
For example, you’re more prone to chest infections, but this is well managed because you use a cough assist machine twice a day. A CHC assessment must include your higher risk of chest infections as a health need.
If they did not include these health needs, you can appeal the decision and ask for a local resolution.
Local resolution
Your local integrated care board (ICB) is responsible for a local resolution. They should publish their process and timescales on their website. If not, ask your ICB.
Find your local integrated care board (NHS)
A local resolution is a meeting with your ICB. You decide how the meeting happens. For example, it can be in person or over the phone. The ICB should meet your access needs.
The meeting should look at:
- whether the CHC assessment was done correctly
- if the assessment looked at all your health needs
- if the assessment accurately assessed your health needs
If you think your eligibility was not assessed correctly, get evidence that shows your level of need and how the needs are met.
Evidence can include:
- care plans
- treatment plans
- letters from specialists
- hospital admissions
- discharge reports
Ask your ICB for their timescales for a meeting. If they do not stick to their timetables, you can ask to go straight to an independent review.
During the meeting, the ICB should listen to your concerns and look at the decision again.
You will receive a letter with the outcome of your local resolution. Possible outcomes are:
- they have changed the decision, and you are happy with the outcome
- they have changed the decision, but you are unhappy with the outcome
- they have not changed the decision and you are still unhappy with the outcome
If it’s not the outcome you want, ask your ICB for an independent review.
Independent review
The integrated care board will tell the NHS that you’d like an independent review. They will contact your ICB and find out what happened during the local resolution. You can ask your integrated care board for a copy of their report to the NHS.
If your ICB did not try to resolve the problem, you will have another local resolution meeting.
Independent review process – public information guide (NHS)
Starting the independent review process
If the NHS think your ICB did enough, you will start the independent review process. The independent review can take 3 to 6 months.
To start the process, you must complete the application for independent review form.
You can get a copy of the form by using the contact details on your local resolution decision letter.
Complete your application for independent review form
When you receive the form, you have 6 weeks to complete it.
If you need support or a format accessible to you, contact the NHS department that sent you the form.
You can use guidance from the NHS website to complete the form.
Independent review process – public information guide (NHS)
You should:
- be specific
- mention if your needs change over time
- mention your emotional and mental needs as they are just as important
- say if your family or friends help provide your care
You can only submit new evidence if you think the ICB should have had the information at the local resolution.
When they have received your application, you will get a caseworker. They will be able to answer any questions you have.
Independent review panel
The NHS looks at your application before you have the independent panel.
The possible outcomes are:
- the NHS needs more information from your integrated care board
- enough was not done during the local resolution, you have another local resolution
- your case is ready, the NHS will book an independent review panel meeting
NHS England will appoint an independent person to chair the panel. There will be representatives from the Integrated Care Board and the local authority’s social services department.
The chair of the panel has to decide how best to include all parties. They can include your advocate or family member if you agree to this or if you are ill.
If the person needing care and support lacks mental capacity, their appointed representative, such as a power of attorney, should be included.
An independent review panel will:
- look at your case
- decide if you’re eligible for continuing healthcare
The panel is separate from the NHS and your local authority.
Attending an independent review panel
You will receive a letter with the date of your independent review panel. The meeting is normally an online video call and lasts an hour. You can ask for a different format if this is not accessible.
You can:
- attend the meeting and share your views
- not attend the meeting and send a written statement
If you do not attend the independent review panel, you should let your caseworker know. They will need a written statement before your independent review panel.
Outcomes of an independent review panel
After the meeting, the panel will continue to discuss your case. They will then decide if you’re eligible for continuing healthcare.
They will write up a report and send you a copy. The report will:
- explain their findings and recommendations
- say if you're eligible for continuing health
- say what your care and support plan should include
- what the next steps are
If it’s not the outcome you want, you can submit an NHS complaint.
NHS complaints
If you want to complain, follow the NHS complaints procedure.
This is submitting a complaint to the NHS about how your local integrated care board has handled your case.
You must have tried to do a local resolution and independent review before submitting a complaint.
Last reviewed by Scope on: 09/09/2024
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