New Nuffield Trust research shows significant regional variation in NHS Continuing Healthcare, with access and funding often depending on where patients live, highlighting a postcode lottery in care provision
A recent Nuffield Trust analysis has revealed significant inequalities in access to NHS-funded care packages across England. The study shows that eligibility for Continuing Healthcare and the level of funding patients receive can vary widely depending on their postcode, creating what experts describe as a “luck of the draw” system, commonly known as a ‘postcode lottery’. These findings raise urgent questions about fairness, consistency, and the need for reform in the allocation of vital care.
Barriers to access
NHS Continuing Healthcare (CHC) is a package providing free health and social care outside the hospital, which the NHS pays for. However, new reports indicate that the service is failing to reach some of the most severely ill patients in England at their time of need. CHC funding supports individuals with significant ongoing care needs. However, if someone is found ineligible, they are expected to pay out of pocket for support, or local authorities may step in.
The report found that overall demand for health and care services is rising, and spending on CHC increased by 17% between 2017 and 2023. However, the number of people eligible for the service decreased by 9% during the same time, with variations that are significant across the country.
Lack of consistency in NHS Continuing Healthcare affects the most vulnerable
The analysis highlights a lack of awareness and understanding of NHS Continuing Healthcare amongst the public and healthcare professionals. Furthermore, a lengthy and complex application process is a significant barrier to access.
Despite the existence of a National Framework setting standards to improve consistency, concerns persist about the subjectivity of the funding process. This leaves many people without access to the care they desperately need. The findings underscore the urgent need for reform in the NHS Continuing Healthcare system to ensure fair and consistent access for all.
Key findings
- There is a nearly five-fold variation in Continuing Healthcare (CHC) eligibility rates across Integrated Care Boards, only partly explained by population need. Older and more disadvantaged populations tend to have higher eligibility rates, but this does not account for the full disparity.
- Spending per eligible CHC recipient is uneven, with lower funding in northern England. In 2022/23, a Standard CHC recipient in the North West received on average £22,432 less than the England average of £65,012.
- Deprivation affects spending: the median expenditure per recipient was £47,300 in the most deprived areas, compared to £95,085 in the least deprived areas.
- These findings highlight a postcode lottery, with inconsistent access influenced by local NHS-authority relationships and financial pressures.
- Average costs per recipient for both Standard and Fast-track care packages are rising, reflecting more complex and intensive care needs.
Nuffield Trust Fellow, Rachel Hutchings, said: “For people grappling with the bewildering CHC process, the stakes couldn’t be higher. Being eligible can be the difference between having all of your health and social care funded and being faced with catastrophic care costs, often during times of crisis. But our research suggests that access to this vital funding is unfair and inconsistent.
“Not only is the assessment process itself challenging, but the toll it takes on families is long-lasting, part of an ongoing struggle to access good-quality, timely care for their loved ones. CHC is a window into the stark divide in our system between care that is funded by the NHS and care that isn’t, and it exposes yet more flaws with our wider social care system.”
