How to write an appeal for NHS Continuing Healthcare

Published 31/05/2018

Please note: This article was published prior to July 2022, and some information may be outdated.

What to include in an NHS Continuing Healthcare appeal

Tip no. 23 in our series of 27 top tips on NHS Continuing Healthcare

If you’ve been told your relative is not eligible for NHS Continuing Healthcare, you may be wondering what to do next.

The NHS Continuing Healthcare team at the CCG should have provided you with the funding decision in writing. In addition they should have given you a copy of the assessment notes (e.g. the Checklist and/or the Decision Support Tool).

You should also be given information how to appeal.

If you’ve been turned down at the full assessment stage, after a multidisciplinary team meeting, the CCG should give you a written rational for the funding decision. Your next task is to decide whether to appeal.

If you do decide to appeal, you need to pull together various types of information. You may already have done much of this for the full assessment meeting.

If you weren’t able to prepare properly for the full assessment, read more here about that here – it will help you with the appeal.

Here’s what to include when you write an appeal for NHS Continuing Healthcare

Essentially it will be a document that pulls together all the reasons why you believe the funding decision is wrong:

Make sure you’re familiar with the stages of the appeal process. If the CCG hasn’t given you any information about that, ask them for it.

Make sure you read the National Framework guidelines. The more informed you are, the better your chances with the appeal.

Highlight everything in the assessment notes that is incorrect, misleading or missing.

Pull together information about your relative’s care needs in every care domain, and suggest the correct scores. (A care domain is an ‘aspect’ of care, e.g. Mobiity, Behaviour, etc., and these are set out in the Checklist document and the Decision Support Tool.)

Familiarise yourself with the Coughlan case.

Make sure the local authority legal limit has been properly considered.

Check the care notes that are kept by the care provider. Do they let your relative down? It’s not unusual for care notes to be incomplete, inaccurate and lacking in detail. If this is the case, say so in your appeal and also take it up with the care provider; a failure to keep proper notes can put your relative at risk.

Consider what evidence should have been reviewed by the assessors, but wasn’t.

Refer to your own diaries and general notes about your relative’s care.

Highlight any actions or statements on the part of assessors that have been unacceptable, intimidating, unprofessional or that shows ignorance of how the assessment process is supposed to work.

And finally, pull together anything else that supports your case that has not been properly considered.

Once you’ve done all of that, send it to the NHS Continuing Healthcare team at the CCG. You may need to chase them regularly about your appeal. In all your dealings with them,be prepared to stand your ground.

Tip no. 22: What to say when denied NHS Continuing Healthcare

Tip no. 24: What is a joint package of care?

You don’t have to fight this battle alone

Fighting a Continuing Healthcare funding battle alone can feel daunting. If you need to talk to someone about your case, read more here.

Tagged Categories: Appeals and reviews, CHC essentials, CHC funding, NHS Continuing Healthcare, Ready to appeal

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11 Comments

Valerie Bradley December 5, 2023 at 10:00 pm

I have been denied continuing healthcare since 2004, this time l am recording the whole DST, l will be telling the DST lead nurse, that any inaccuracies, recorded by her will be breaking the law of the land established in 1999 the Coughlan Court case, that is the law of land still this day. I will also tell her that her nurses code states that a nurse has to obey the law of the land.that means her.
The above will be recorded before the DST, has been commenced.
If l am turned down, l will cover all the points as to why l should have been funded, and after all appeal efforts have been exhaustedl wilput my case to the health ombudsman.
If that fails l hope l will able to go for a judicial review on the grounds that the government are Disobeying the law pertaining,to the premise of NHS continuing healthcare is to be paid for, for everyone who's health needs are over mearly incidental and Ancillary.
The government and CCG'S are aware of the Coughlan case, the Grogan Court case, the health Ombudsman's decisions on continuing healthcare, the select committee's findings on continuing healthcare, and it's important to remember that the DST is a Guidence Tool not a discision making tool. The DST as we all know is set to high because they have a budget to protect.
So that is why a judicial review in needed on what the Law of the land says this l think is the way to go.

caroline nthiwa January 14, 2020 at 3:48 pm

thank you, very helpful

Frances Neville June 13, 2019 at 5:43 am

My father had motor neurone disease and had just been turned down his 4th CHC assessment with one of the nurse assessors saying to me that dad maybe was the type of person who liked staying in bed he was been bound and lived 2 weeks after the decision came back refused ! He was unable to do anything apart from his right hand allowed him to feed himself and use his phone or watch television he was 100% compus mentus. It was also noted he had a bowl of fruit in front off him on his tray . I had funded a solicitor for the last 2 attempts, still refused . From start to finish I felt the 2 assessors were not motor neurone aware . No time to grieve as I now have to try to claim retrospectively what a joke but that's my life after caring for dad at home with my uncle for the 2 previous years without any financial help for us it's to little to late .

Care to be Different June 17, 2019 at 7:20 am

Hi Frances - thanks for getting in touch. Do not hesitate to call us if you would like to chat it through with someone. 0161 979 0430 Kind regards

Lynn Delaney May 14, 2019 at 6:39 pm

Advice needed please. My mother had the MDT in December, however I was not at the meeting due to miscommunication via the carehome. My mother passed away at the end of March and when I asked the carehome about the decision they told me they had not heard anything yet as there was a backlog but they would chase it up. Today I have received a bill for her care (£70,000) so I contacted CHC myself to find out what the decision was only to find out they had informed the carehome back in December and because I wasn't present a letter had not come to me. They asked me to email them stating I was not happy and that I need the information so I can appeal. I did this and they emailed me a copy of the decision letter but nothing else. My question is how do I appeal this if I was not there and have no information about how they came to this decision. My mum had MS and could not do anything. I have just gone through the checklist myself and I would score her an A in 5 of the categories!

Care to be Different May 16, 2019 at 9:15 am

Hi Lynn - This is awful but not uncommon I'm afraid. Do get in touch if you would like to discuss this with us 0161 979 0430 Kind regards

Michael Riggs November 30, 2018 at 2:32 pm

My local CCG ( clinical commissioning group) assessed my terminally ill wife in April and decided she was not eligible for continuing healthcare or Fast Track funding despite the supporting evidence of her consultant neurologist and GP. My request that she be assessed by the Coughlan Test has been ignored though I had sent evidence of her meeting and exceeding the Test's criteria. My wife died in October, so survived 6 months following the assessment.
Now I am appealing against the CCG's decision. The CCG want a copy of her will . When I asked why , they said that their procedures require me to establish my identity and eligibility to receive money that might be paid into my late wife's estate. The CCG has not offered any information about the state of my appeal, either to reject or accept it. Why is the Will relevant? Some kind of hidden means test? And what happens about Coughlan now that my wife is dead ?

Care to be Different December 1, 2018 at 8:44 am

Hi Michael. Sorry to hear this. Requesting the Will is the only way that the CCG can ensure that you are the person who has legal authority to handle you late wife's affairs - it has nothing to do with what's in the estate. Hope that helps but contact us if you would like help with the Appeal. Kind regards enquiries@caretobedifferent.co.uk

Keith July 18, 2018 at 3:03 pm

Does anybody have the phone number for the solicitor that was posted on here thanks

Jane Doe June 26, 2018 at 7:32 pm

I'm in the middle of dealing with this for my father at the moment, and it occurs to me that an assessor who wilfully disregards the law and legal precedents in pursuit of getting a lower result may well be guilty of misconduct in a public office which carries a prison sentence in fact up to a life sentence. Has this avenue ever been explored?

Kerry buckley June 4, 2018 at 9:00 pm

If I could give any advice it’s please take up the advice!
I am now in my 7th year appealing retrospectively against my fathers care home fees. He was never given an assessment only a financial assessment. The authorities have NO records from social care or any of the care homes my dad stayed in. If it were our family who had no reports or assessments our case would have been thrown out at the first hurdle but they have ignored the fact that all records have been illeagally disposed of! We have deadlines to ensure our appeal is placed but they ignore any deadlines they may have and I have had to constantly chase them for information. I am now waiting for an independent appeal (2 months) not expecting anything different so will be going to parliament, they want you to give up but my goodness just makes me want to go on even more. ??