Nuffield Trust publish ‘All or nothing? Access and variation in NHS Continuing Healthcare’ 

ByJDCteam

The Nuffield Trust has published a report entitled, ‘All or nothing? Access and variation in NHS Continuing Healthcare’. 

In the report, data on NHS Continuing Healthcare (CHC) eligibility, assessments and spending, alongside the views of people working in health and social care, are explored. 

Key findings include: 

  • The number of people eligible for CHC has fallen over time and varies significantly across England. 
  • Population needs explain some of the variation. The research found that sub-ICB locations with higher levels of deprivation, and larger populations aged 75 and over, are more likely to have higher rates of CHC. 
  • CHC spending has increased over time, but the distribution is unequal. Spending per eligible recipient is lower in the north of England, even after adjusting for geographical differences. 
  • There are concerns that financial pressures are playing a key role in the operation of CHC, with all parts of the system facing significant pressure to keep costs down. 

Rachel Hutchings, Nuffield Trust Fellow, says: 

“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.” 

Dementia is mentioned in this report, including by a Focus Group Participant who is quoted as saying: 

“We find in our system and the health and care system that actually dementia completely falls between the cracks… It’s not covered properly within CHC, but yet we’ve got an ageing population… we need to make sure that [the framework] properly accounts for those people living with dementia and what the demography of the future will look like and how we have to support them, because at the moment I don’t think it does.” 

You can read the report here: https://www.nuffieldtrust.org.uk/sites/default/files/2025-09/Nuffield%20Trust%20-%20Continuing%20health%20care_WEB.pdf 

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