NHS continuing healthcare - Challenging a decision

If your client has gone through the NHS continuing healthcare process and they disagree with the decision, they can challenge it by appealing. 

Once they receive the letter advising of the decision by the Clinical Commission Group (CCG), your client has six months from the date of the letter to start an appeal and request a review of the decision. The CCG has a further three months from the date of the request to undertake this appraisal and complete the local review stage. It is worth noting however that this process can take up to a year to complete and the time it takes varies depending on geographical location. 

The process normally consists of three stages: 

  • Stage 1 – local resolution procedure adopted by the CCG. It varies but it normally involves a meeting potentially followed by a panel review.
  • Stage 2 – is an Independent Review convened by NHS England, which, if accepted, may lead to a formal review of the CCG’s decision. Your client will be invited to attend part of the panel hearing.
  • Stage 3 – is the referral of your client’s case to the Parliamentary and Health Service Ombudsman for a full independent investigation. Depending on this outcome there may be further stages involved.

The NHS should include details of how to appeal their decision within their decision documentation. You and your client should follow their guidelines.

The appeal can be time-consuming and complicated and it may be in the person’s interests to seek professional advice.

NHS continuing healthcare

Being assessed for NHS continuing healthcare.

Local authority funding

Finding out whether your clients qualify for local authority funding is a two-stage process.

Funding nursing care

To understand funded nursing care we have written a summary for you.

Our sources

Challenging and appealing a decision you don’t agree with, View - Beacon 

Information researched and accurate 21 June 2019. Not to be relied upon by advisers or their clients.