NHS Continuing Healthcare Crisis: New Research Exposes’ Postcode Lottery’ Leaving Vulnerable Patients Behind

A newly published report from the Nuffield Trust uncovered alarming disparities in how NHS Continuing Healthcare (CHC) is administered across England, revealing a system critics say is failing the patients it was designed to protect. The comprehensive research, released in early October 2025, exposes a troubling decline in eligibility approvals and a stark postcode lottery that means identical health needs can lead to vastly different outcomes depending solely on geography.

Eligibility Rates Plummet as Demand Rises

NHS Continuing Healthcare provides fully-funded care packages for individuals with complex health needs, yet the Nuffield Trust’s findings indicate that access to this vital support has become increasingly restrictive. According to the research, eligibility for CHC has fallen by 9.1% since 2017, with fewer than one in five applicants now approved through the standard assessment process. This decline comes despite rising demand for complex care across England’s ageing population.

The data reveal a fivefold variation in eligibility rates across different regions, ranging from just 20 to as many as 95 people per 50,000 adults receiving CHC funding. This geographic inconsistency raises fundamental questions about whether decisions are driven by clinical need or budget pressures facing local Integrated Care Boards (ICBs).

The Human Cost of Systemic Failure

For families navigating the CHC system, these statistics translate into devastating real-world consequences. When applications are denied, relatives often face care costs running into thousands of pounds monthly; expenses that can rapidly deplete life savings and place impossible financial burdens on already-stressed families.

James Urquhart-Burton, Head of Continuing Healthcare at Winstons Solicitors, has extensive experience supporting families through CHC appeals and eligibility disputes. He describes the assessment process as “confusing, inconsistent and adversarial” for families already under immense emotional strain.

“The consequences are devastating,” Urquhart-Burton explains. “Denial of CHC can mean facing catastrophic care costs. Many relatives describe a sense of injustice and are forced into lengthy battles simply to secure the care their loved ones are entitled to.”

Regional Inequality and Funding Disparities

Perhaps most concerning is the pattern of spending revealed in the Nuffield Trust analysis. Per-patient expenditure is noticeably lower in the most deprived and northern regions, where health needs are typically greatest. This inverse relationship between need and funding allocation contradicts the foundational principles of the National Health Service.

The research suggests that families in disadvantaged regions face a double burden: they are more likely to be denied CHC funding initially and subsequently must navigate costly, stressful appeals processes to challenge those decisions. This pattern risks widening existing health and social inequalities rather than addressing them.

Legal and Ethical Implications

The systematic variations in CHC eligibility raise significant legal concerns. If Integrated Care Boards apply eligibility criteria more restrictively to manage budget constraints rather than following the National Framework based on individual health needs, such practices could be deemed unlawful and subject to judicial review.

“If ICBs are shaping decisions based on finances rather than genuine application of the National Framework, they place themselves at real risk of legal challenge,” warns Urquhart-Burton. “The fundamental principle is that decisions should be based solely on an individual’s health needs.”

Legal experts like those at Winstons Solicitors have built national practices specifically addressing CHC disputes, retrospective funding reviews, and appeals, reflecting how widespread these issues have become across the healthcare system.

The ‘All or Nothing’ Problem

The Nuffield Trust report highlights what experts describe as an unsustainable “cliff-edge” between health and social care funding. The current binary system, where individuals either receive full NHS funding or must self-fund their care, creates perverse incentives that fuel disputes between health bodies and local authorities while leaving families caught in administrative crossfire.

This rigid structure makes it difficult to accommodate the varying degrees of health needs. Critics argue that a more nuanced, tiered approach to funding could better serve patients while reducing the adversarial nature of the current system.

The Path Forward: Urgent Reform Needed

Healthcare policy experts and legal professionals call for comprehensive CHC system reform. Potential solutions include:

• Integrated budgets that combine health and social care funding to eliminate boundary disputes
• Unified assessment processes that provide consistency across regions
• Tiered funding models that offer flexible support matched to varying levels of need
• Transparent criteria application to ensure decisions are based on clinical assessment rather than financial considerations

The Nuffield Trust’s research clarifies that the problems identified will continue to deepen without significant systemic change. An ageing population combined with increasingly complex care needs means that demand for CHC will only grow in the coming years.

Restoring Public Trust

At its core, the CHC crisis represents a fundamental challenge to public confidence in the National Health Service. When two individuals with identical health needs receive completely different outcomes based solely on their postcode, it undermines the principle of universal healthcare that has defined the NHS since its founding.

As Urquhart-Burton concludes: “We need a system that delivers consistency, fairness and compassion, where funding follows the person’s needs rather than bureaucratic boundaries. Only then will families have confidence that continuing healthcare is being applied in the spirit of the law intended.”

The Nuffield Trust’s findings are a stark reminder that healthcare policy decisions have profound human consequences. Reform cannot come soon enough for the thousands of families currently navigating the CHC system.