Uncovering the Truth: How Many People Are Assessed and Eligible for NHS Continuing Healthcare?

I started my second qualified year as a Social Worker in a Local Authority as a consultant social worker back in 2009. Back then, the National Framework was on it's second iteration and there was discontent across Local Authorities who felt that the NHS were placing restrictive criteria for eligibility for NHS Continuing Healthcare. The situation was equally, if not more, challenging for people who were paying privately for their care home fees.

As a consultant social worker, I spent significant hours researching the legal framework, the history of NHS Continuing Healthcare (which has its roots in the 1948 legislation of the National Assistance Act and NHS Act 1946) and 'league tables' across England. Back then, we had Primary Care Trusts (PCT) before the Lansley reforms brought in Clinical Commissioning Groups (CCG). They were responsible for administering and co-ordinating NHS Continuing Healthcare but there was a significant postcode lottery. I remember vividly the stark differences between Luton PCT who were always at the bottom end of the league tables and at the top were Barking PCT.

The Nuffield Trust in 2024 identified that the proportion of people who have undergone assessment and are then found eligible for standard CHC (the ‘assessment conversion rate’) has dropped from 27% to 21% since mid-2017. This means that, by early 2024, only one in five people undergoing assessment were deemed eligible for a standard CHC package. As of March 31, 2024, the total number of individuals in England eligible for Continuing Healthcare (CHC) was 52,096, comprising 34,055 through the standard route and 18,041 through the fast-track process. To qualify for CHC, individuals must undergo an assessment to evaluate the extent and severity of their needs.

From January 1, 2024, to March 31, 2024, slightly over one-fifth (21%) of those assessed for standard CHC were deemed eligible. However, this percentage varied significantly and the postcode lottery is still alive and well, ranging from 7.3% in Gloucestershire ICB to 42.5% in Leicester, Leicestershire, and Rutland ICB.