CHC COMPLAINTS • ENGLAND
CHC appeal unsuccessful: when can the Ombudsman help?
Care Home Cost Claims · 27 September 2026
An unsuccessful CHC appeal can leave a family wondering whether anyone will look at the case again. The Parliamentary and Health Service Ombudsman may be able to consider a complaint about how the decision was reached. It does not carry out a fresh assessment of eligibility.
Where does the Ombudsman fit?
The Ombudsman’s CHC guidance distinguishes three situations: a disputed Checklist outcome after the NHS complaints process; a refusal following full assessment and independent review; and a complaint about an awarded package after the NHS has considered it.
For a full eligibility dispute, your starting point will usually be the integrated care board’s review process, followed where appropriate by NHS England’s independent review. See our guides to local resolution and the Independent Review Panel. Keep the decision letters: they explain the stage reached and the next route.
What can it examine?
The focus is whether the decision-making followed the National Framework properly. After independent review, explain which concerns the review failed to address and how its handling was unfair or unreasonable. The Ombudsman normally considers issues already raised at that review.
It can recommend that the NHS explain or reconsider a decision. It cannot substitute its own CHC eligibility decision. Simply preferring a different care-domain score does not establish a procedural fault.
Turn the complaint into a clear evidence trail
Before drafting a long account, make a short working table with four columns: the concern, the relevant document and page, when you raised it, and the response. This helps separate a point the panel rejected with reasons from one it apparently overlooked.
For example, you might identify a dated care record you submitted, show where your written representations referred to it, and then explain why you believe the panel’s reasoning did not address the issue. This is an illustration of organising a complaint, not a finding that any particular omission would change eligibility.
- Start with the decision or review you are complaining about and its date.
- State each alleged fault separately, using a short heading.
- Attach the relevant evidence rather than an unexplained bundle of records.
- Explain the practical effect on the person or family.
- Say what you are asking to be put right.
Keep a copy of what you submit and an index of attachments. Our guide to CHC evidence and records can help you organise the underlying material.
Do not assume the clock starts with the final letter
The Ombudsman’s published time limit for NHS complaints is normally one year from becoming aware of the problem. It has some discretion to consider late complaints, including where the organisation took a long time to respond, but an extension should not be assumed.
If an NHS process is dragging on or you are unsure about timing, contact the Ombudsman promptly. Keep a chronology of your requests and replies. Do not wait for perfect paperwork before finding out how the time limit applies.
Do you need a solicitor?
No. You can complain yourself, and free advocacy support may be available. The Ombudsman also explains that reimbursement of paid representation fees is unusual.
Legal help may be useful where you need an independent view of a complex record or the distinction between a funding appeal, a complaint and another legal route. Agree the scope and cost before instructing anyone. If court action is being considered, obtain timely advice: an Ombudsman complaint should not be assumed to protect a separate legal deadline.
Prepare for an initial case review
Send the CHC decision, independent review outcome, your previous submissions and the dates of key correspondence. That is a more useful starting point than a diagnosis alone. Contact Care Home Cost Claims to discuss whether further review of the case is appropriate, or read about our CHC appeal service.
Sources
General information for England, checked against the linked sources on 27 September 2026. This is not advice on an individual case. Eligibility, refunds and complaint outcomes depend on the facts.