Inequalities remain in NHS continuing care access

Nuffield Trust report echoes Beacon findings relating to inequalities in NHS continuing healthcare access

A report issued by the Nuffield Trust think tank has found that NHS Continuing Healthcare (CHC) is failing to reach some of those in England who need it most.

The report also finds that there are ‘notable gaps’ in data being collected by Integrated Care Boards (ICBs), which is affecting understanding of who is accessing CHC – a a package of free health and social care provided outside of hospital which the NHS pays for.

These findings echo a research project concluded by Beacon in March this year, which found similar concerning gaps in data being collected.

The principle recommendations of this project were the commitment to the effective and extant capture of equalities monitoring data by ICBs and a general improvement in cultural competency in CHC for health professionals.

We continue to call for national, mandatory training in CHC as well as a much-more-robust system of assurance which identifies persistent failure and enables genuine accountability

The Nuffield Trust report includes new research exploring data on CHC eligibility, assessments, and spending, alongside the views of people working in health and social care.

And it 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 2017-2023,the total number of people found eligible has fallen over time and varies significantly across the country.

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 key reasons for poor access.

Key findings of the report 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.

One of the key recommendations to improve current practice is to be able to understand who is, and who is not, accessing CHC by pro-actively capturing and analysing information about where referrals are coming from, CHC assessments, and eligibility by demographics, in order to monitor and address potential inequalities in access.

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.

These recommendations are directly in line with those issued by Beacon at the close of its own research project in this area.

Dan Harbour, managing director of Beacon CHC, says: “The research carried out by the Nuffield Trust met with the same frustrations we encountered during our own research project in not being able to identify enough sources of reliable data to draw substantiated conclusions about equality issues.

“We do know, however, that pro-active initiatives to be able to understand the cultural barriers some people face when attempting to find out about or access CHC are fundamental, as is the commitment to addressing them, in consultation with those affected.

“The report’s conclusions into significant variation in eligibility rates nationally chime with those made seven years ago by the National Audit Office, and Beacon’s own data and experiences of attending assessments across the country.

Pro-active initiatives to be able to understand the cultural barriers some people face when attempting to find out about or access CHC are fundamental, as is the commitment to addressing them, in consultation with those affected

“This continues to reveal a deeply-concerning lack of understanding of the key principles of CHC and the eligibility criteria themselves.

“We therefore continue to call for national, mandatory training in CHC as well as a much-more-robust system of assurance which identifies persistent failure and enables genuine accountability.

“We and our partners have been calling for these two measures for a number of years. We also call for proper funding and resourcing of assessment teams to give ICBs a fighting chance to deliver CHC well, in a policy-compliant way, rather than expecting them to meet growing demand with ever-dwindling resources.”