What to Do After a Negative MDT Decision: Your Guide to Appealing NHS Continuing Healthcare (CHC) Outcomes

After a positive Checklist Assessment, your relative’s case progresses to a formal assessment conducted by a Multi-Disciplinary Team (MDT) using the Decision Support Tool (DST). This assessment covers 12 Care Domains, and the team also considers the Four Key Characteristics—Nature, Intensity, Complexity, and Unpredictability—to determine whether your relative has a Primary Health Need and qualifies for NHS Continuing Healthcare (CHC) Funding.

Once the DST is completed, the  MDT recommendations are submitted to the local Integrated Care Board (ICB) for verification/ratification where a final decision is made.

If Your Relative Is Found Eligible

A care package, fully funded by the NHS, will be arranged to meet your relative’s assessed needs. Congratulations—this is the best possible outcome!

If CHC Is Refused: What Next?

If the MDT recommends against CHC funding, and the ICB upholds that decision, you have two choices:

1. Accept the outcome, knowing that you can request a reassessment if your relative’s condition changes or deteriorates.
2. Appeal the decision within 6 months of receiving written notification.

If you plan to appeal, it’s essential to base your case on solid and evidence-based grounds.

Here’s how to approach the process effectively, in line with the National Framework for NHS Continuing Healthcare.

Key Tips for Appealing a Negative MDT Decision

1. Check for Procedural Errors

Was the National Framework properly followed?

• Were at least two professionals involved in the assessment—ideally one health and one social care professional?
• Who attended the MDT? Did the carer or care home staff know your relative well and were they able to relay accurate evidence to the MDT?
• Were the MDT engaged, did they seek additional information and evidence to support their recommendation?
• Were they familiar with the National Framework? (See paragraphs 139–141)

If not, this could be a procedural breach and grounds for appeal.

2. Was the Assessment Truly Person-Centred?

The National Framework insists that the assessment should put the individual at the centre of the process:

• Were you or your relative present during the MDT assessment?
• Were you given reasonable notice to attend?
• Were you able to contribute meaningfully?

If the MDT failed to involve the individual and their representative or proceeded without their input, this may breach the Framework’s person-centred principles.

3. Were You Allowed to Speak Freely?

You have a right to participate and should be encouraged to:

• Share relevant observations
• Clarify misunderstandings
• Correct errors or omissions in the records

⚠️ Tip: Stay focused on needs relevant to CHC eligibility. Avoid anecdotal, emotional or superfluous commentary that may be seen as irrelevant, waste time and could actually weaken your case.

4. Scrutinise the DST Scores

Do the scores accurately reflect your relative’s needs?

• Are there domains where a higher level of need should clearly have been awarded?
• Have the Key Characteristics been applied consistently and thoroughly?
• Are there inconsistencies or contradictions in the scoring or narrative?

If care needs have been downplayed or misunderstood, this can strongly support an appeal.

5. Was All Relevant Evidence Considered?

The MDT should consider a broad range of clinical records to ensure a full picture of care needs.

• Were at least 3 months of care records reviewed? Some ICBs now limit this to 1 month post-COVID, which may skew the assessment unfairly, depending on the nature of the record requested. (Some records from 3 months ago can be very relevant, however, others may be outdated).
• Were relevant documents from the GP, physiotherapists, hospitals, or specialists included?

A limited evidence base can result in an inaccurate picture and a flawed outcome.

6. Did the ICB Overturn a Positive MDT Recommendation?

This can happen—but should only occur in exceptional circumstances, not for reasons of cost or resource management.

If the ICB rejected a positive MDT recommendation, ask:

• Was it reviewed by a panel or a single person?
• What were the justifications for overturning it?
• Were these reasons in line with the National Framework?

If not, this may be a significant procedural error.

7. Consider Whether the Outcome Is Reasonable

Sometimes the final decision seems clearly at odds with the evidence. If you feel that the outcome is unreasonable given your relative’s needs and the scoring in the DST, this is also a valid basis for appeal.

The National Framework states (Practice Guidance 32.3) that where there is disagreement over scoring, the higher level of need should be applied. Was this followed?

Preparing to Appeal

If you disagree with the outcome, you must submit your appeal within 6 months of receiving the decision.

Tips for a Strong Appeal:

• Take your time: Don’t lodge an appeal in anger or frustration.
• Gather your evidence: Review the DST, care records, and any supporting documentation.
• Identify clear grounds: Focus on process failures, misapplied scores, or overlooked needs.
• Plan your submissions: Be strategic. If you submit too early, the ICB may trigger deadlines before you’re fully prepared.

Recommendation #1: Read the full National Framework for NHS Continuing Healthcare before beginning your appeal.

Recommendation #2: Seek professional help with your appeal to improve your chances of success. Families who attempt to conduct an appeal on their own usually don’t know what evidence is required or how to present their appeal submissions ,and can become overwhelmed by the process – leading to failure and a wasted chance of appeal.

Final Thoughts

Preparation is critical—both for the initial MDT and for any appeal. The CHC system is complex, and unfortunately, it is often perceived as being weighted in favour of the NHS rather than individuals.

If you are unsure, seek professional support. Independent CHC advisers and legal professionals can help you navigate the process, prepare your evidence, and present your appeal effectively.

Resources and Support

• The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care
• Search ‘MDT’ on our Care to be Different website for more blogs and insights
• Buy our book: How To Get The NHS To Pay for Care
• Contact us:
  • ✉️ Email: enquiries@caretobedifferent.co.uk
  • Call: 0161 979 0430
  • Get professional advice from Farley Dwek Solicitors
  • ‍⚕️ Access our Nurse Advice Helpline