New data gathered from Winston Solicitors via a Freedom of Information (FOI) request to NHS England reveals the stark differences in NHS funding for continuing healthcare (CHC) across England’s 42 integrated care boards (ICBs).
Described as a “postcode lottery”, the FOI suggests that patients are at risk due to the stark regional disparities in NHS CHC spending. The full FOI dataset can be found here.
CHC is a package of care arranged and fully funded by the NHS for adults with long-term, complex health needs. It can apply in a care home, hospice care, or the individual’s own home. Unlike social care, CHC is not means-tested but eligibility criteria are strict, and assessments can be complex.
ICBs must assess an individual for NHS CHC if it seems an individual may need it. Despite a single national eligibility framework, the figures show huge variation in how CHC is funded from region to region.
For example, NHS North East & North Cumbria ICB spent more than £382 million on CHC in 2023/24, while NHS Bedfordshire, Luton & Milton Keynes ICB spent just £86.4 million. Even after accounting for population differences, North East & North Cumbria still allocated more per capita than the Bedfordshire-based ICB.
The FOI also revealed inconsistent use of the fast-track pathway, the statutory route for patients who are approaching the end of life and require care to be arranged within 48 hours. Several ICBs, including Beds, Luton & Milton Keynes and Birmingham & Solihull, reported spending £0 on fast track CHC in 2023/24.
This is despite Age UK’s ‘Continuing to Care report’, which highlighted that referrals for fast track increased nationally as the standard CHC became more difficult to access.
While ICBs were only formed in July 2022 under the Conservative Government, half-year expenditures on CHC were available and compared to the 2023/2024 data. While some categories like adult personal health budgets saw localised growth, overall, every ICB reduced their CHC expenditures.
Overall CHC spending appears to have decreased by 42 percent in 2023/24 compared to a full-year estimate for 2022/23, according to Winston Solicitors.
James Urquhart-Burton, Head of Continuing Healthcare Claims at Winston Solicitors, specialising in CHC and care compensation, commented: “The data reveals striking regional disparities in CHC spending, with some ICBs allocating more than four times as much per year as others.
“These differences raise serious questions about equity and access to care. It’s more important than ever for individuals and families to have expert support when navigating this system, especially in areas where funding appears constrained.”
The findings are based on FOI responses from all ICBs in England regarding their CHC spending in 2022/23 and 2023/24. Figures were normalised to account for ICBs being formed partway through 2022 and represent adjusted year-on-year comparisons.
ICBs with the highest total CHC expenditures included NHS North East & North Cumbria ICB (£382.7), NHS Cheshire & Merseyside ICB (£357.5 million), and NHS Lancashire & South Cumbria ICB (£303.3).
ICBs with the lowest total CHC expenditures included NHS Somerset ICB (£53.4 million), NHS Cornwall & Isles of Scilly ICB (£56.4 million), and NHS Lincolnshire ICB (£60.9 million).
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