NHS CHC Postcode Lottery Leaves Patients at Risk, New Data Shows
New data gathered from Winston Solicitors via a Freedom of Information request to NHS England reveals the stark differences in NHS funding for Continuing Healthcare (CHC) across England’s 42 Integrated Care Boards (ICBs).
Despite a single national eligibility framework, the figures show huge variation in how CHC is funded from region to region.
Continuing Healthcare (CHC) is a package of care provided and fully funded by the NHS for adults with significant ongoing health needs. It can apply in a care home, hospice care, or the individual’s own home, ensuring that individuals with complex conditions are not left to fund their care out-of-pocket. Unlike social care, CHC is not means-tested but eligibility criteria are strict, and assessments can be complex
For example, while NHS North East & North Cumbria ICB spent more than £382 million on CHC in 2023/24, 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.
ICBs with the Highest CHC expenditures (£M)
| ICB Name | CHC – Standard | CHC – Fast Track | FNC – Funded Nurse Care | Adult and Children PHBs | Total |
| NHS North East & North Cumbria ICB | 221.3 | 21.4 | 26.6 | 113.4 | 382.7 |
| NHS Cheshire And Merseyside ICB | 174.1 | 51.3 | 54.6 | 77.5 | 357.5 |
| NHS Lancashire & South Cumbria ICB | 167.8 | 65.0 | 25.5 | 45.0 | 303.3 |
| NHS North West London ICB | 166.3 | 46.5 | 24.9 | 20.6 | 258.2 |
| NHS West Yorkshire ICB | 155.4 | 14.0 | 23.1 | 51.0 | 243.5 |
ICBs with the Lowest CHC expenditures (£M)
| ICB Name | CHC – Standard | CHC – Fast Track | FNC – Funded Nurse Care | Adult and Children PHBs | Total |
| NHS Somerset ICB | 17.9 | 4.6 | 17.5 | 13.3 | 53.4 |
| NHS Cornwall & Isles Of Scilly ICB | 23.9 | 6.8 | 8.6 | 17.1 | 56.4 |
| NHS Lincolnshire ICB | 22.6 | 13.4 | 8.5 | 16.5 | 60.9 |
| NHS Gloucestershire ICB | 46.5 | 0.0 | 11.6 | 8.9 | 67.0 |
| NHS Northamptonshire ICB | 46.9 | 11.5 | 11.0 | 11.8 | 81.1 |
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 PHBs saw localised growth, overall every ICB reduced their CHC expenditures.
Overall CHC spending appears to have decreased by 42% in 2023/24 compared to a full-year estimate for 2022/23.
James Urquhart-Burton, at Winston Solicitors, 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.”
