Patients including older people with conditions like dementia and motor neurone disease are being hit with huge care bills because a postcode lottery sees them denied access to vital NHS funding, Which? research has found.
Despite a national framework for assessments, vulnerable people in England with the highest medical needs can be up to 25 times more likely to get their care costs covered depending on where they live, according to NHS continuing healthcare funding data.
South Reading, the Clinical Commissioning Group (CCG) area with the lowest level of people funded, paid care costs for 8.78 patients per 50K of the population, while Salford funded 220.38 people per 50K.
The inconsistencies affect people living in the same region. In Stockport (31.76 per 50K), patients are almost seven times less likely to get the funding than those 10 miles away in Salford.
Similarly, people in the Wolverhampton CCG (141.2 per 50K) are more than five times more likely to have their care funded than their neighbours in Sandwell and West Birmingham (26.3 per 50K).
And in London, patients in Richmond (112.1 per 50K) are more than three times more likely to get the funding than those in nearby Ealing (34.4 per 50K).
Although CCGs do have different populations, regional variations can not easily be explained by demographic differences between areas.
For example, South Reading benchmarked itself with “the 10 most similar CCGS,” but within this group CCGs such as Leeds North are funding up to nine times as many people.
Which? also found examples of families having the funding withdrawn suddenly. One woman was saddled with a £96,000-a-year bill after the needs of her mother – who has severe dementia – were reviewed.
The NHS continuing healthcare scheme is administered by local CCGs, whose medics are supposed to use the national framework to ensure patients are treated in the same way wherever they live.
Decisions on the funding often dictate whether families are left to foot the bill for patients with complex care needs – typically costing tens of thousands of pounds a year.
Which? also found that nearly all areas are failing to meet national framework guidance stating that in most cases people should not wait more than 28 days for a decision about whether they are eligible for funding.
In some cases campaigners say these delays mean people have died while waiting to hear if they are eligible, bringing extra heartache for family members who may have to pursue a claim retrospectively while grieving for a lost loved one.
Although the Department of Health insists that there are no quotas or caps on access, NHS England’s efficiency plan includes asking CCGs to make £855m savings on CHC and NHS-funded nursing care by 2020-21 despite a 45% predicted five year growth in costs.
A new national framework has now been published with implementation due on 1 October 2018. It will not change eligibility criteria but aims to provide greater clarity, including for staff.
Which? is calling on the Government to look at the care system as a whole in its forthcoming Green paper, including regional factors that affect whether elderly people and their families can access high-quality, affordable care in later life.
Alex Hayman, Managing Director of Public Markets, said:
“Whether you get funding for care shouldn’t depend on where you live.
“The Government must take these regional factors into account in its forthcoming Green Paper and use it to deliver the fundamental reforms needed to ensure everyone has access to high-quality, affordable care.”
Top five funding CCGs [per 50k of population]
Salford – 220.38
Thurrock – 146.49
Wolverhampton – 141.19
Sutton – 131.96
Sunderland – 120.29
Bottom five funding CCGs [per 50k]
Luton – 20.49
Newbury & District – 19.33
Wokingham – 18.78
North and West Reading – 18.45
South Reading – 8.78
Notes to editors:
Which looked at a snapshot of NHS continuing care data at end of Q3, 2017/18 – Oct/Nov/Dec 2017. Figures include standard and fast-track referrals.
A new national framework for NHS Continuing Healthcare comes into force in October 2018
NHS Berkshire West Clinical Commissioning Group (CCG) was established on 1 April 2018, following the merger of Newbury, Wokingham, North and West Reading and South Reading CCGs.
Interactive maps for people to view and compare the situation in their area are available below:
Which? Elderly Care is a free website offering practical, impartial information and advice about arranging care in the UK. The information on the site is aimed at relatives and friends of people in need of care advice but it can also be used by people arranging care for themselves. It has advice about challenging an NHS decision and applying for CHC.
Which? is campaigning to convince the Government to confront the care crisis and ensure high-quality, affordable elderly care is available to those who need it, now and in the future. Find out more about our campaign at http://which.co.uk/carenow