A scandal which sees tens of thousands of sick pensioners forced to pay for their NHS treatment is worsening, figures show.
The total of older people and others classed as vulnerably ill who are successfully claiming for NHS Continuing Healthcare funding has plummeted to a record low of just one in five applicants.
Over the last six years, those deemed eligible for the help has fallen by 39%, from 4,230 in the second quarter of 2017/8 to 2,568 for the same period in 2023/24.
Experts claim thousands are now being deprived of NHS treatment having paid tax for all their lives.
Caroline Abrahams, Age UK’s charity director, said: “Older people’s rights are often very weak and difficult to enforce. More and more people who apply for CHC are being turned down…as the older population is growing. In theory the CHC budget is without limits but in practice it is severely rationed.”
CHC funding is for people in their own home or a nursing home who have significant healthcare needs.
These are defined as resulting from serious illness, disease or disability.
Unlike means-tested social care for the elderly and frail but not ill, it is free at the point of delivery and the NHS has a statutory legal duty to provide it.
But in recent years, the bar for a successful application has been raised higher as councils and NHS Trusts tighten the eligibility criteria to try and save money.
Patients, their families, MPs and some health experts have branded the system as “dysfunctional, complex and unlawful”.
Public bodies that have joined the chorus of concern at the situation reportedly include the National Audit Office, the Public Accounts Committee, the Care Quality Commission and the CHC Alliance.
In the second quarter of 2023/24, out of the 12,529 people who completed a standard CHC assessment, just 20% were deemed eligible.
During the same time in 2017/18 some 27% were successful, according to analysis by retirement specialists Just Group.
Lisa Morgan, a partner in the nursing care fee recovery team at nationwide firm Hugh James Solicitors, said: “Future care is a real concern for thousands of people.
“There has been a sharp rise in care across the UK, up by almost 10% in the past year, with some care home [charges] reaching £10,000 per month.
“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.”
She added: “The NHS must pay 100% of a person’s care fees for those whose needs fall under ‘health’, as opposed to ‘social’. More people could be eligible. CHC can be a vital source of funding by removing a huge financial burden.”
If a person in England has capital of more than £23,250 (£50,000 in Wales), they have to meet the full costs of care.
The total of eligible applications in 2018/19 – the first full year of available data – was 15,963. This had dropped by a third to 10,847 in 2022/23.
Stephen Lowe, the group communications head at Just Group, said: “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.”
Mr Lowe continued: “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 … instead of receiving the help and funding they need.”
An NHS spokesman said that eligibility for CHC 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.” Meanwhile, a spokesman for the Department of Health and Social Care said: “The total number of people assessed as eligible for NHS Continuing Healthcare has increased since 2017/18.
“These packages of care provide vital support and there is clear guidance to determine who is eligible. All arrangements should place the individual at the centre of the assessment and care-planning process.”
