Thousands of the most vulnerable people with serious health problems are being neglected by our continuing healthcare system. The latest official figures show a further and accelerating rise in the numbers of people eligible for continuing healthcare to 60,000 but with huge regional variations in the setting of the threshold.

Figures published by the Health and Social Care Information Centre recently show that an average of 53.8 people per 50,000 are entitled to NHS continuing healthcare and those people will have the full cost of their care and accommodation funded by the NHS. But some parts of the country, notably the Thames Valley, allow eligibility to just half that number (26.8 per 50,000), with the highest rate (84.2) more than three times the lowest, making the Thames Valley consistently the most difficult part of the country in which to obtain NHS funding. Once again our most vulnerable citizens are subject to a “postcode lottery” in support for their care needs despite supposedly consistent national criteria having been laid down by the government in 2007.

Whilst it is reasonable to anticipate a certain amount of variation between regions due to factors such as differences in age dispersion, the data attempts to account for local demographics by using the ‘weighted’ method of calculation in which an area’s target share of the available resources are based on their share of the population, with the share adjusted to account for their population’s needs for health services relative to those of other areas. One of the NHS’ intended uses of these statistics is to ensure consistency in decision making when it comes to applying eligibility criteria. However, in reality the statistics show huge variances in the number of people who are eligible and therefore highlights differences in the way in which criteria are being applied nationally.

Part of the reason for this postcode lottery comes down to the assessment process itself. Eligibility for continuing healthcare is based upon having a primary health need which is established through an in-depth assessment process in which a multidisciplinary team fully assesses the totality of a person’s care needs. The multidisciplinary team then use their professional judgment to make a recommendation as to whether or not the person has a primary health need. This inevitably means that there is a degree of subjectivity built into the assessment process which can account for variances between area teams in the way in which criteria are understood and applied.

Furthermore, we are aware through our client work that in some parts of the country the multidisciplinary process is being circumvented in favour of the CCG panels acting as ‘recommender and decision-maker’. This approach inevitably has the effect of further distorting the application of criteria with relatively small teams making decisions on eligibility in the absence of clear recommendations from the health and social care professionals who are most familiar with the person’s needs.

Beacon continues to campaign for equality in access to NHS funding for people who have a primary health need. To find out how Beacon can support you with a continuing healthcare assessment or appeal contact us on 0345 548 0300.