The numbers of pensioners claiming CHC has plummeted to a record low of just 20 per cent applicants. (Image: Getty)
A scandal which sees tens of thousands of sick pensioners forced to pay for NHS treatment is worsening.
The numbers of pensioners and other vulnerable ill people successfully claiming NHS Continuing Healthcare (CHC) funding has plummeted to a record low of just 20 per cent of applicants.
And over the last six years, NHS data shows those deemed eligible for the help has fallen by 39 per cent from 4,230 in Q2 2017/8 to 2,568 for the same quarter in 2023/24.
Experts warn that thousands are now being deprived of NHS treatment they have paid tax for all their lives.
Caroline Abrahams, of Age UK, said: “Older people’s rights are often very weak and difficult to enforce.”
“Sadly, I can’t think of a better example than the scandal that is Continuing Health Care (CHC) – the main recipients of which are older people.”
“More and more people who apply for CHC are being turned down, at the same time as the older population is growing. In theory the CHC budget is without limits but in practice it is severely rationed.”
NHS CHC funding is for very ill people outside of hospital, either in their own home or a nursing home, who have significant healthcare needs, resulting from serious illness, disease or disability.
Unlike social care for the elderly and frail but not ill – which is means tested – NHS CHC funding is free at the point of delivery.
The NHS has a statutory legal duty to provide CHC funding, which is not discretionary or subject to affordability.
But increasingly, over the past few years, the bar for a successful application for funding has been raised higher as local councils and NHS Trusts tighten the eligibility criteria in a bid to save money.
Patients, their families, MPs and health experts have been highly critical of the system, describing it as “dysfunctional, complex and unlawful”.
Public bodies that have joined the chorus of concern are said to include the National Audit Office, the Public Accounts Committee, the Care Quality Commission and the CHC Alliance.
In Q2 23/24, out of the 12,529 people who completed a standard NHS CHC assessment, just 20 per cent or 2,568 people were deemed eligible while 9,961 people were turned down.
This compares to Q2 17/18, when, out of the 15,417 people who completed a standard NHS CHC assessment, 27 per cent or 4,230 people were successful and 11,187 people were not, according to analysis of official figures by retirement specialists Just Group.
Lisa Morgan, a partner in the Nursing Care Fee Recovery team at Hugh James Solicitors, said: “With an ageing population and the increase in care cost, future care is a real concern for thousands of people.”
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“There has been a sharp rise in care across the UK up by almost 10 per cent in the past year, with some care homes reaching £10,000 per month.”
“As a result, many people in care are running out of funds and having to sell their homes to afford the cost.”
“However, what many are unaware of is the availability of full financial support.”
“The NHS must pay 100 per cent of a person’s care fees for those whose needs fall under ‘health’, as opposed to ‘social’.”
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“The lack of awareness of the funding and appeals process coupled with guidelines which are often forgotten or applied too restrictively, means more people could be eligible.”
“CHC can be a vital source of funding by removing a huge financial burden.”
Currently in England, if a person has capital over £23,250 (£50,000 in Wales), they will have to meet the full cost of care.
The number of applications assessed as eligible in 2018/19 (the first full year’s data available) was 15,963 and this has dropped by a third to 10,847 people in 2022/23 (the last full year’s data available).
Stephen Lowe, of Just Group, added: “For those living at home, CHC covers the cost of any care and support needed including personal care such as help with washing and dressing.”
“In a care home, CHC would cover the care home fees.”
“It is not means-tested so all those eligible can benefit from thousands of pounds a year.”
“But assessments can be inconsistent across regions and it’s also a complex process so patients and their families can find it difficult to navigate.”
“The fall in referral numbers and eligibility rates suggest CHC is not reaching the people who could benefit and that eligibility criteria are being tightened.”
“This may save the NHS money, but it shifts the cost on to individuals and families who find themselves paying for care themselves instead of receiving the help and funding they need.”
An NHS spokesperson said: “Eligibility for NHS continuing healthcare funding is determined on an individual basis by health and social care professionals in line with guidance and regulations set by the Department of Health and Social Care, to ensure there is a consistent approach across the country.”
“Eligibility is based on primary health need and not on a specific medical condition, disease or diagnosis.”
