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24 Jul 2019

NHS postcode lottery persists for most vulnerable patients

Which? analysis finds that where you live has a huge bearing on deciding whether the NHS will fund your continuing healthcare

People with the most complex medical needs continue to contend with a postcode lottery in having their care costs outside of hospital paid for by the NHS, according to new Which? analysis.

NHS Continuing Healthcare (CHC) is for anyone aged over 18 years who is assessed by the NHS as having a 'primary health need', where health care is considered to be that person's primary care need - and it isn't means-tested. It's most often used to cover the full cost of someone's care home fees.

But the chances of the most vulnerable patients receiving this largely depends on where they live, according to the latest NHS England Statistics.

For the most extreme comparison, just 13 patients per 50,000 in Berkshire West received it, while 209 had it in Salford. That's around 16 times as many people.

NHS Continuing Healthcare (NHS CHC) - what it is, whether you're eligible, how to apply, and more.

Best and worst NHS areas for CHC funding

See below for the best and worst Clinical Commissioning Groups (CCGs) on continuing healthcare across England.

If you or someone you know has been denied CHC funding but you don't agree with the decision, consult our advice on how to complain about an NHS assessment.

A story of stagnation

The picture for the last quarter of 2018/19 shows little improvement on the same statistics collected at the end of 2017/18.

This year, across England, an average of 59 patients per 50,000 were funded, compared to 58 last year.

Interestingly, more people are receiving short-term fast-track CHC funding because of urgent needs, such as a terminal illness. However, more than 10,000 fewer people receive longer-term care funding than five years ago.

The health system think-tank The King's Fund has reported on the reasons for this decline. It says that NHS England told it that, while eligibility criteria haven't changed, reduced numbers are partly due to more assessments taking place at home rather than in hospital.

Huge difference in waits for decision

The national framework states that people should not wait more than 28 days for a decision to be made about whether they're eligible for continuing care funding. However, Which? analysis reveals a persistently huge variation in how long referrals are taking.

100% of people in 11 CCGs had a decision within 28 days, including St Helens, Sunderland, Doncaster, Hull, Luton, Southampton, Ashford, and Richmond.

On the other end of the spectrum, 0% had a decision within 28 days in Ashford. Other low-performing CCGs here include Portsmouth (9%), and Herefordshire (10%).

Head to our article on NHS Continuing Healthcare for what should happen if you are kept waiting longer than 28 days.

If you're looking into care options but you're concerned about costs, take a look at our advice on financing care.