Last Updated on July 28, 2026

NHS Continuing Healthcare (CHC) is failing to reach some of the most unwell patients in England in their time of need, say new research. The findings and accompanying report, published by the Nuffield Trust, express that CHC is also reinforcing deep regional inequalities, with varied eligibility rates and less being spent per person on care in deprived areas and the North of England.

Nuffield Trust's research saw a deep exploration of data on CHC eligibility, assessments and spending, alongside the views of people working in health and social care. The report highlights the paradox that, despite overall demand for health and care services being on the rise and spending on CHC increasing by around 17% between 2017 and 2023, the total number of people found eligible has fallen over time (by 9% between June 2017 and December 2024) and varies significantly across the country.

The authors say that the current ‘all or nothing’ approach to deciding who gets the package of free health and social care provided outside of hospital, which the NHS pays for, is dysfunctional and does not reflect the nature of need. A lack of awareness and understanding of CHC among the public and health and care professionals and a complex and often gruelling application process are also reasons for poor access, the report finds. Despite a National Framework setting standards to improve consistency, there are concerns that decisions about who gets funding are arbitrary and subjective, leaving people potentially missing out on vital support.

Key findings include:

• There is an almost five-fold difference between the Integrated Care Boards (ICBs) with the highest and lowest rates of CHC eligibility. Some of this variation could be explained by differences in population need. Areas with older and more deprived populations were more likely to have higher CHC eligibility rates. But this does not explain the extent of the variation.
• Spending on CHC is not distributed equally and is lower per eligible recipient in the north of England, even after adjusting for geographical differences. In 2022/23 (latest data), a person found eligible for Standard CHC in the North West had on average £22,432 less spent on their care that year compared to the England average which is £65,012 per eligible recipient.
• In 2022/23, the average (median) amount spent per eligible recipient of Standard CHC was £47,300 in the most deprived fifth of local areas compared to £95,085 in the least deprived fifth of areas.
• The research raises concerns about a 'postcode lottery' and unfair and inconsistent practice. Variable relationships between NHS organisations and local authorities and financial pressures are affecting the numbers of people being referred, assessed and found eligible for CHC.
• The average cost per eligible recipient has increased for both Standard and Fast-track care packages, which may reflect a growing number of complex cases requiring more intensive or prolonged care.

In the short term, the authors say NHS and Department of Health and Social Care leaders urgently need to improve consistency and fairness in how CHC operates, through better training, sharing good practice and ensuring assessments are conducted in line with national standards. The funding package is intended to help people live in their communities while dealing with health issues, so ensuring fairness is crucial to the Government’s aim to shift more care from hospital to community.

The research also raises questions about the very existence of CHC and whether it perpetuates an in-built unfairness where some people’s needs are supported but other people’s needs are not. With the flawed and cash-strapped social care sector making it even more difficult for people to get support when they are rejected by CHC, the Nuffield Trust says the Casey Commission into adult social care offers a key opportunity to create a resilient and fair care system which can work alongside the NHS.

Commenting on the new research findings, Nuffield Trust Fellow, Rachel Hutchings, said, 'For people grappling with the bewildering CHC process, the stakes couldn’t be higher. Being eligible can be the difference between having all of your health and social care funded or being faced with catastrophic care costs, often during times of crisis. But our research suggests that access to this vital funding is unfair and inconsistent.

'Not only is the assessment process itself challenging, but the toll it takes on families is long-lasting, part of an ongoing struggle to access good-quality, timely care for their loved ones. CHC is a window into the stark divide in our system between care that is funded by the NHS and care that isn’t, and it exposes yet more flaws with our wider social care system.'

Cllr Dr Wendy Taylor, Chair of the Local Government Association's (LGA's) Health and Wellbeing Committee, said, 'Issues with CHC are not a new problem for councils. Financial pressures on the NHS are making it increasingly difficult for councils to deliver essential services, particularly CHC, but also SEND and complex care.

'Cost-shunting behaviours create local tensions and offer no net benefit to the public purse. Ultimately, they make it harder for people who draw on care and support to access the services they need, and to live the independent and dignified lives they want to lead.

'Efforts to examine how CHC is working in practice and the interface between health and care is something we would encourage the Casey Commission to consider. But ultimately, this must be matched with sustainable funding if we are to improve services for people who draw on care and support.'

Jess McGregor, President of the Association of Directors of Adult Social Services (ADASS), said, 'This report highlights the lack of fairness and consistency in who receives CHC, with deep regional inequalities across the country despite CHC being underpinned by a national framework.

'Our latest survey found 75% of directors of adult social services reported an increase in the number of people no longer eligible for CHC who would have previously qualified for the NHS funded care. We are worried that the NHS, which struggles to move resources away from hospitals, is increasingly balancing its books by taking away care from individual people. This is placing pressure on councils’ adult social care budgets and the frontline adult social care workforce who are increasingly taking on the responsibilities previously delivered by health partners in the NHS, often without associated funding, training, supervision or strategic coordination.

'But perhaps most worryingly, it is placing unimaginable emotional and financial stress on people drawing on care and the people who love them, often at the end of their lives. Too many people, at the times when they need the most support, are finding themselves worried about how they and the people they love will cope. This is unacceptable.

'This is about our rights to free NHS care. Care people are entitled to but are finding it harder and harder to secure. We have to work together to find a different way. We can't expect individual people to go without what they need because our systems can't find ways to get the money to the right place.'

To read the new report, All or nothing? Access and variation in NHS continuing health care, click here.

In other news, a new report is calling for improved support for older disabled people and older people with health conditions to find and stay in work.