How to appeal an NHS continuing healthcare decision

A plain-English guide for families in England. In July 2025 to June 2026, 42,044 people were turned down after a full assessment, and only 2,733 local appeals were completed.

Deadline first. Most NHS areas give you 6 months from the date on the decision letter to ask for a review. The letter should state the deadline. If you are close to it, write now to say you are appealing, and send the detail later.

1. Ask for the full file

Write to the NHS area (the integrated care board) and ask for:

the checklist, if one was done;
the completed Decision Support Tool, with the level given in each care area;
the multidisciplinary team's recommendation and the reasons for the decision;
the records the assessors relied on.

Ask the care home or care agency for the daily care notes and charts covering the weeks before the assessment. To get records you usually need your relative's consent, a health and welfare lasting power of attorney, or to be their deputy. If they have died, their personal representative can ask.

2. Go through the 12 care areas

The assessment scores 12 areas: breathing; nutrition; continence; skin and tissue viability; mobility; communication; psychological and emotional needs; cognition; behaviour; drug therapies and medication; altered states of consciousness; and other significant care needs.

For each one, compare the level given with what the records show. The written descriptions of each level are in the assessment form itself. Look for dated examples: incidents, falls, refusals of care, how often staff had to step in, and how unpredictable the needs were.

3. Check the eligibility rule

The national guidance says a clear recommendation of eligibility would be expected with a priority level in any one of the four areas that have it, or severe in two or more areas. Other combinations may also show a primary health need. Use the score checker to test the levels.

Two points that are often missed:

Well-managed needs are still needs. Good care keeping a need under control does not make the need disappear.
The whole picture counts: the nature, intensity, complexity and unpredictability of the needs, together, not only the levels.

4. Write the request for a review

Keep it plain and factual. For each care area you disagree with:

the level given, and the level you believe is right;
the evidence, with dates, and where it is in the records;
how that evidence matches the wording of the higher level.

Legal arguments are rarely needed at this stage. Facts from the records carry the weight. NHS areas are expected to finish this "local resolution" stage within 3 months.

5. If the answer is still no

Ask NHS England for an independent review. The local decision letter should explain how and by when.
After that, you can complain to the Parliamentary and Health Service Ombudsman, usually within 12 months.

Help with this

Beacon gives up to 90 minutes of free advice, funded by NHS England. The Alzheimer's Society has a volunteer appeals support service. Solicitors and specialist advocates charge, sometimes on a no-win, no-fee basis.

We offer a free written review (join the waiting list) of the decision while we test our service.