Postcode lottery in NHS funding leaving vulnerable people with huge care bills

Patients including older people with conditions such as dementia and motor neurone disease are being hit with huge care bills because a postcode lottery is denying them access to NHS funding, a watchdog has claimed.

Which? said NHS funding data showed vulnerable people in England with the most expensive medical needs can be up to 25 times more likely to get their costs covered depending on where they live, despite a national framework for assessment.

South Reading, the Clinical Commissioning Group (CCG) area with the lowest level of people funded, paid care costs for just 8.78 patients per 50,000 people in its catchment, while Salford funded 220.38 people per 50,000.

However Which? also found that inconsistencies affected people living in the same region. In Stockport, patients were almost seven times less likely to get the funding than those 10 miles away in Salford.

Similarly, people in the Wolverhampton CCG are more than five times more likely to have their care funded at 141.2 patients per 50,000 than their neighbours in Sandwell and West Birmingham (26.3 per 50,000).

In London, patients in Richmond are more than three times more likely to get the funding based on the NHS figures of 112.1 per 50,000 than those in nearby Ealing (34.4 per 50,000).

The consumer group said that although CCGs have different populations, the regional variations could not be explained by demographic differences between areas.

For example, South Reading benchmarked itself with “the 10 most similar CCGs,” but within this groups such as Leeds North were funding up to nine times as many people.

Which? said it had also found examples of families having funding withdrawn suddenly, with one woman given a £96,000-a-year bill after the needs of her mother, who has severe dementia, were reviewed.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 given a national framework to ensure patients are treated in the same way regardless of where they live.

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.

Alex Hayman, Which? 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.”

A Department of Health and Social Care spokesman said: “We expect NHS England to ensure those with the highest and most complex health and care needs, who are eligible for this type of funding, have easy access wherever they live in the country so people can get the care they need – and deserve.”

“We will publish a Green Paper setting out plans for reform of adult social care this summer – which will look at issues such as quality, a sustainable funding model and the social care workforce.”

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