Age UK Report finds that NHS Continuing Healthcare (CHC) funding regime is an “extreme postcode lottery”
Several reviews for CHC during her eight-year stay in a nursing home, during the last five of which she needed continuous and ALL personal care. She fulfilled all published criteria for CHC but was always denied it - no reason given officially but told because budget insufficient and others worse. This whole aspect was time-consuming and a total farce.
A report published in December 2024 by leading charity of the elderly, Age UK has found that the current CHC funding regime in England is an “extreme postcode lottery” - disproportionately affecting older people with ongoing chronic health problems and their families.
What is NHS Continuing Healthcare (CHC) funding?
CHC Funding is a package of care for an individual who is over 18, which is arranged and funded solely by the NHS for people who have been assessed as having a ‘primary health need’ under a legally prescribed decision-making process. Instead of the usual local authority route for accessing social care, which is means tested, their care costs are met by the NHS and is free.
Eligibility for the funding is based on whether the main aspects, or the majority part of the care of an individual is focused on addressing and/or preventing health needs and the quality and quantity of their healthcare needs are over and above what the local authority is lawfully able to provide, i.e. they meet the “primary health need” test set in law.
An individual is likely to be eligible for CHC Funding if their care needs are:
- Intense.
- Complex; and/or
- Unpredictable.
The report states that eligibility decisions should be independent of budgetary constraints and finance officers should not be part of a decision-making process. However, in practice, NHS bodies have been under pressure to make savings from their CHC budgets for at least the last seven years.
What are the concerning trends of CHC funding?
Age UK’s analysis of published data over the last seven years have identified several concerning trends in the awarding of CHC funding:
- The system seems to be moving away from being a source of longer-term care funding for profoundly frail and unwell older people, to one focused on short-term cash injections to support those at the end of life. Evidence: the numbers on the Standard pathway have reduced by 43%, whereas those on Fast Track CHC have increased by 30%.
- Individuals who do not die as quickly as expected are at increasing risk of having CHC funding removed. Evidence: CHC funding is subject to periodic reviews. The numbers of those losing eligibility for Fast track CHC after those reviews have increased by 35 per cent since 2017/18.
- CHC funding statistics show an extreme postcode lottery. This suggests that the awarding of funding can be influenced by the state of local NHS finances as well as the varying knowledge and confidence of local authority staff in navigating the legal framework and processes. Evidence: the proportion of assessments for CHC that result in a person being found eligible varies from 3.4% to 57.9%, depending on where they live. For example, between 1/1/24 and 31/3/24, 21% who were assessed for standard CHC funding were found to be eligible – although only 7.3% were eligible in Gloucestershire ICB and 42.5% in Leicester, Leicestershire, and Rutland ICB.
What does this mean for local authorities?
The current system is not working. But it is not only older people with ongoing chronic health problems and their families who are unjustly losing out. Some local authorities are paying far more than they should to support those failed by a flawed CHC funding system.
Overhauling the current system is likely to take some time. But one of the key steps that local authority staff can take is to ensure that they are properly prepared in CHC funding meetings with ICBs. This involves familiarising themselves with the law that underpins CHC funding and receiving the tools and support they need to confidently tackle any pitfalls in the decision-making process.
Bond Solon offers a whole raft of practical courses to prepare local authority staff for CHC meetings, including our one-day NHS Continuing Healthcare (CHC) Advanced (England) course, helping professionals navigate the law, process, and best practice standards effectively and our one-day NHS CHC for Managers (England) course, which provides an in-depth exploration of the duties and responsibilities under the NHS CHC National Framework 2022 (Revised).