After a not-eligible decision

If an assessment finds someone not eligible.

The national approval rate for standard NHS Continuing Healthcare assessments is approximately 16.7%, which means most assessments end in a not-eligible decision. There are three routes after that point: request a review, fund the care directly, or restructure funding via the property.

Scale, last quarter

10,387 standard CHC assessments in 2025-26 Q4 resulted in a not-eligible decision.

England, all ICBs. Source: NHS England CHC and FNC quarterly data.

Your three real options

Appeal, self-fund, or restructure.

Option 1

Appeal the decision

If you believe the Decision Support Tool was scored incorrectly, the Multi-Disciplinary Team weighting was wrong, or the National Framework was not properly applied, you can ask the ICB for a local review. If that fails you can escalate to NHS England's Independent Review Panel.

Appeals work when there is concrete evidence the assessment missed something material. They take time, often six to twelve months. They cost nothing if you handle them yourself, or a few thousand pounds with a specialist solicitor for complex cases.

Free option: Beacon CHC is NHS-funded and offers free independent advice on whether to appeal and how to present the case. Use this before paying anyone.

Option 2

Self-fund from savings and property

If your loved one has assets above £23,250 (the upper capital limit in England) and the property is occupied only by them, they are expected to self-fund. The local authority can run a financial assessment to confirm. Care home fees range from £900 to £1,800+ per week depending on region and care complexity.

Selling the property to fund care is one route. Many families prefer to delay this through a Deferred Payment Agreement with the local authority. The LA pays the fees on an ongoing basis and recovers the money when the property is sold or from the estate. There is interest and a setup fee. Terms vary by LA.

Option 3

Equity release on the property

If selling the property is not practical and a Deferred Payment Agreement does not fit (for example, the property has someone else living there who cannot be displaced), an equity release lifetime mortgage releases tax-free cash against the property without forcing a sale. The loan plus interest is repaid when the property is sold or on death.

Equity release is regulated. Get advice from an FCA-authorised adviser before committing. Compare three to four lenders. Look for products approved by the Equity Release Council.

Factors that bear on the choice

Three considerations

1. The clinical evidence. The 12 Decision Support Tool domains are the framework the assessment uses. Severe scores in multiple domains or a Priority in one are the indicators the National Framework treats as eligibility-supporting.
2. The local approval rate. Approval rates vary across the 42 ICBs: from 2.3% in Gloucestershire to 35.4% in Cambridgeshire and Peterborough. Look up your ICB to see where it sits.
3. The household financial position. Property value, savings, occupancy, dependants, and pension income shape which self-funding or restructuring options apply.