The latest report ‘All or nothing? Access and variation in NHS continuing health care’ published by the health think tank, The Nuffield Trust has reported that NHS continuing healthcare (CHC) is failing to reach some of the most unwell patients in England.
Overall, the number of people eligible for CHC fell from 57,216 at the end of June 2017 to 52,008 at the end of December 2024 – a drop of 9.1%.
The research has been highlighted in The Daily Mail and Independent, who report CHC as being an unfair system.
Key findings from the report:
- Fewer people eligible, more variation – the number of people eligible for CHC has fallen over time and varies widely across England. Eligibility rates can’t be fully explained by local population needs.
- Spending is unequal – while overall spending on CHC has increased, the amount spent per person is lower in the north of England, even after adjusting for local costs.
- Complex causes of variation – differences in CHC eligibility are driven by many factors, including how local areas run their CHC processes, awareness and understanding of CHC, where referrals come from, and the quality of relationships between local services.
- Financial pressures – there are concerns that financial pressures on the NHS and local authorities are affecting how CHC is delivered. The focus on keeping costs down sometimes outweighs people’s needs.
The need for reform
Many of the problems with CHC come from the fact that health and social care are run as separate systems, with different funding and accountability. This can lead to unfair financial situations where individuals find themselves suddenly facing large care costs. The report calls for comprehensive reform to create a fairer, more joined-up system that puts people’s needs first.
The Nuffield Trust makes several recommendations to make CHC fairer and more consistent. These include; sharing good practice, better monitoring of access to CHC to address inequalities, closer working across the NHS and local authorities, strengthening accountability with clear governance and involving regulators like the Care Quality Commission and National Audit Office to monitor how CHC is delivered.
Louis Seymour, Legal Services Director at Compass CHC said:
“NHS Continuing Healthcare is vital for individuals with the most complex health needs. But the system is complicated and can be incredibly stressful for individuals and families. The families we support often describe the process of being assessed for CHC as challenging and unfair. And the consequences of receiving an ineligible outcome can be devastating, both financially and emotionally.
We welcome any scrutiny which leads to improvements in the CHC process. The CHC system must be more transparent, fair, and consistent, ensuring that individuals with complex health needs are assessed based on need, not postcode or wider economic financial pressures.”
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