Thousands of vulnerable patients across England face a "postcode lottery" when trying to access vital NHS care, with new research revealing that your chances of receiving fully-funded continuing healthcare can vary by up to 150% depending on where you live.
The stark disparities, uncovered by the Nuffield Trust in their report 'All or nothing? Access and variation in NHS continuing health care', show that some areas support 2.5 times more people than others through this crucial NHS service—despite using identical national eligibility criteria.
NHS Continuing Healthcare (CHC) provides a lifeline for adults with complex, ongoing health needs arising from disability, accident, or illness. This fully-funded package covers all care costs, whether delivered at home or in a care home, and is designed for those whose primary need is healthcare rather than social care. Eligibility depends on a comprehensive assessment examining the nature, complexity, intensity, and unpredictability of someone's condition.
However, the research reveals troubling inconsistencies in how these national guidelines are applied across England's Integrated Care Boards (ICBs). Patients with virtually identical health conditions may find themselves accepted for CHC in one area whilst being refused in another—a disparity that cannot be explained by local demographics alone.
The consequences extend far beyond administrative inconsistency. When CHC applications are rejected, families often face devastating financial pressure as care costs—which can reach thousands of pounds monthly—fall to local councils or, increasingly, to patients and relatives themselves. This can force impossible choices between adequate care and financial survival, particularly affecting those with long-term neurological conditions, advanced cancer, or severe dementia.
The findings highlight a fundamental challenge facing the NHS: ensuring fair access to complex, expensive services across a health system serving 56 million people. The Nuffield Trust's research calls for urgent review of CHC assessment processes and funding allocation to eliminate these geographical inequalities and guarantee that eligible patients receive their entitled care, regardless of postcode.