'Post Code Lottery' Continues To Impact Availability Of NHS Funding

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The Law Of… The Role Of The NHS In Funding Care

Throughout England, the elderly are facing unreasonably high care fees due to the 'postcode lottery' which seems to dictate who receives NHS Continuing Healthcare Funding.

Elderly people who suffer from very serious health issues, such as dementia, may be entitled to receive free assistance through the NHS Continuing Healthcare fund. Recent research shows that for residents of certain areas, this may not be the case.


James Urquhart-Burton, Care Homes Claims Partner, explains.

'The Post Code Lottery'

Recently released performance data shows that some areas in England are 25 times less likely to offer access to NHS funding than others. The result of this has seen thousands of elderly people being lumped with unfair health and social care bills. Illnesses such as dementia, diabetes and learning disabilities often give rise to a primary health need which should be covered by the NHS, yet many elderly people have to cover costs themselves.

Statistics show that Clinical Commissioning Groups (CCGs) have regional variation in the amount of care funding they provide. For example, South Reading provided paid care for the lowest proportion of patients with 8.78 people per 50,000 head of population. Salford, however, funded 220.38 patients per 50,000.

These are just two examples; the variance seems to fluctuate wildly from area to area:

  • Wolverhampton - 141.19 people per 50k
  • Luton - 20.49 people per 50k
  • Newbury & District - 19.33 people per 50k
  • Sunderland - 120.29 people per 50k
  • Wokingham - 18.78 people per 50k
  • Thurrock - 146.49 people per 50k

These regional discrepancies see those in the less fortunate areas having to pay the full cost of their own care. There have been promises from ministers to cap the amounts to be paid, though it is unlikely this will be introduced for a few years.

Is There Any Way To Appeal?

In the interim, any elderly person looking to receive free care will have to persuade their local CCG that their needs are severe enough to warrant continuing care funds.

Officials of CCGs are expected to use the National Framework to ensure all patients are treated equally, regardless of which area they live in. This recent data shows that a person's postcode is a huge factor in whether the NHS will cover the cost of a person's care.

James Comments:

"The difficulty with the existing criteria for NHS Continuing Healthcare Funding is that assessors use a very wide-reaching discretion and the assessment is usually very subjective. The result is often very inconsistent decision making. CCGs are individual statutory bodies with their own budgets and internal cultures."

"More is needed at Government level to achieve greater consistency in decision making. Individuals and families should not hesitate to exercise their right of appeal against a decision of ineligibility where they do not feel the decision is fair."

Are You Being Charged Unfairly For Your Care?

If you or your loved one is paying for care and you are unsure whether this is right, then contact a member of our Care Homes Claim Fees Recovery team. Our specialist solicitors will be able to advise you whether you or your loved one is unfairly paying for care.

Call today on our freephone number, or send us a secure E-message using our online enquiry form.



To find out how we could help you please make a no-obligation enquiry or call freephone: 0808 129 3320.




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