Home › CHC appeals › Local resolution

NHS Continuing Healthcare local resolution

Local resolution is usually the first formal stage when you disagree with an Integrated Care Board's NHS Continuing Healthcare eligibility decision following a full assessment. The aim is to give the ICB a proper opportunity to reconsider the decision before an Independent Review is requested from NHS England.

Written and reviewed by Paris Theodorou, Solicitor & Principal. Christodoulos Ltd is authorised and regulated by the Solicitors Regulation Authority (SRA 809508). Updated 16 September 2026.

What is local resolution?

The National Framework requires ICBs to have local resolution arrangements for people who disagree with a CHC eligibility decision. NHS England's public guidance also says that appropriate local steps should normally be taken before an Independent Review is set up.

Local resolution is not simply an informal complaint. It is the ICB's review of the CHC eligibility decision and the process by which that decision was reached.

How to prepare a local resolution challenge

1. Get the complete assessment record

Obtain the Decision Support Tool, decision letter and reasons, Checklist where relevant, care records and the key health and social care evidence used by the multidisciplinary team. If important records are missing, identify them specifically.

2. Separate scoring points from overall eligibility

If a domain score is wrong, explain exactly which descriptor is supported and cite the underlying records. Then go further: explain how the needs interact and what they show about nature, intensity, complexity and unpredictability.

3. Identify procedural issues

Check whether the multidisciplinary team was properly constituted, whether the person or representative had a proper opportunity to participate, whether the evidence was complete and whether the ICB gave clear reasons if it departed from the team's recommendation.

4. Put the chronology in order

A concise chronology often makes the case easier to understand. It can show deterioration, repeated incidents, escalation of support, hospital admissions, changes to medication, increasing supervision or other evidence that is hard to see in isolated domain entries.

Do not argue every point equally

A focused appeal is usually stronger than one that disputes every sentence. Concentrate on the findings that materially affect the care domains and primary health need analysis.

What happens at the local resolution stage?

The exact procedure varies between ICBs. It may include written representations, a review meeting or panel, further evidence and a fresh written outcome. The important point is that the ICB should engage with the grounds raised and explain the resulting decision.

If the ICB changes the decision, the consequences should be set out clearly, including the period of eligibility where relevant. If the decision is upheld, the outcome should explain the next review route.

What if local resolution does not resolve it?

Where the matter cannot be resolved locally, the individual or representative may ask NHS England for an Independent Review. NHS England's current guidance says an Independent Review Panel can consider both the procedure followed by the ICB and the eligibility decision itself.

The panel is normally chaired independently and includes an ICB representative from outside the ICB involved in the case and a local authority representative, with clinical advice available where required.

What evidence is most useful?

the DST and decision letter;

care plans and daily notes for the relevant period;

risk assessments and incident records;

GP, hospital, community nursing and specialist records;

medication, nutrition, skin, behaviour and mobility records where relevant;

family evidence addressing needs between professional visits; and

a schedule identifying missing records or evidence not addressed in the decision.