The Nuffield Trust conducted a mixed-method approach to examine variation and inequalities with NHS Continuing Health Care (CHC) and what it tells us about the key issues facing health and social care.
In February 2025, the Homecare Association participated in the workshops that formed the basis of this research. The Nuffield Trust also spoke to people with lived experience of the CHC process and sent Freedom of Information (FOI) requests to each of the 42 Integrated Care Boards to better understand the data they collect locally.
Key findings include:
- The number of people eligible for CHC has fallen over time and varies significantly across England.
- Population needs explain some of the variation. The research found that sub-ICB locations with higher levels of deprivation, and larger populations aged 75 and over, are more likely to have higher rates of CHC.
- CHC spending has increased over time, but the distribution is unequal. Spending per eligible recipient is lower in the north of England, even after adjusting for geographical differences.
- There are concerns that financial pressures are playing a key role in the operation of CHC, with all parts of the system facing significant pressure to keep costs down.
The variation in the rates that NHS organisations paid is a prominent theme in the research. The report uses our Homecare Deficit 2023 data to highlight not only variation but also a significant deficit in the amount the NHS paid for homecare compared to local authorities.
