NHS CHC Funding: Still a Postcode Lottery?

NHS Continuing Healthcare Funding: Still a Postcode Lottery?

by Ridley & Hall in Continuing Healthcare Funding, James Urquhart-Burton posted September 28, 2023.

Reading time: 0 min read

Public Awareness of NHS Continuing Healthcare
Eligibility for CHC Funding
Unequal Access: CHC Funding Disparities Across England
The Core Issue
How Ridley & Hall’s NHS Continuing Health Care Claims Solicitors Can Help

Public Awareness of NHS Continuing Healthcare

Back in March 2023, a new article published by Care Home Professional referred to research conducted for the annual Just Group Care Report, which found that 77% of over-45s were not aware of NHS Continuing Healthcare Funding (“CHC Funding”). This is surprising, because NHS bodies are under a legal duty to assess anyone who might need CHC Funding, and because it pays for 100% of your care and is not means tested. Of the remaining 23% of people in the study, 14% had heard of CHC Funding, but didn’t know anything about it, whilst only 7% understood what it was and the financial benefits it brings.

Eligibility for CHC Funding

CHC Funding is the name given to a package of care which is fully funded by your local NHS Integrated Care Board (ICB) and is available to anyone who is assessed as having a “Primary Health Need”.

Whether or not you have a “Primary Health Need” and are eligible for CHC Funding is determined following a detailed assessment of your needs. Contrary to popular belief, diagnosis of a medical condition or residing in a nursing home do not, of themselves, indicate eligibility. Instead, consideration is given to the care needed to meet your needs and professional judgment is required to determine whether the majority of the care you need is focused around addressing health needs.

You are likely to be eligible for CHC Funding if your care needs are:

Intense
Complex; and/or
Unpredictable

The National Framework for NHS Continuing Healthcare lays down best practice and fleshes out the eligibility criteria.

Unequal Access: CHC Funding Disparities Across England

A recent request for data made to NHS England has revealed stark differences in the number of people awarded funding by different Integrated Care Boards (“ICBs”) across England.

The data is of CHC eligibility assessments completed between October and December 2022.

The most generous ICB appears to be NHS Blackpool, which awarded CHC Funding to 75 of the 120 people it assessed during that time (62.5% of applications for funding were approved.)

At the opposite end of the spectrum, NHS Bath and North East Somerset, Swindon and Wiltshire ICB awarded CHC Funding to only 7 of the 119 people it assessed in the same period (which equates to 5.9% of applicants for funding were approved.)

On a wider, regional basis, it seems that you’ve only a 17.7% chance of getting CHC Funding if you live in the South East of England, but if you were to move to the North West of England, that would jump to 31.3%

The Core Issue

It’s plain to see that your chances of getting CHC Funding vary based on your location in England, which is a problem, given that the criteria is nationalised and is the same wherever in England you are.

The problem lies in the fact that assessors will rely on their own judgment as to what constitutes needs which are intense, complex or unpredictable, and that is highly subjective. There is no reliance on established precedent to ensure consistent decision-making; each case is assessed on the individual’s own unique needs.