“Under “continuing healthcare” (CHC) rules, those with complicated medical conditions can apply for full funding from the health service. Families are not means tested and the decision is supposed to be made solely on the person’s medical situation.
But, despite the criteria being clearly set out in a national framework, differing interpretations of the rules mean your chances of being deemed eligible depend on where you live.
Telegraph Money is aware of hundreds of cases where regional health authorities have applied the rules differently – including some where patients have been approved by one authority and rejected by another just days later.
Ron Laycock, 87, was admitted to Cheltenham General Hospital earlier this year with a vascular condition. Despite living in Wiltshire, he was taken to a specialist unit in Cheltenham, in neighbouring Gloucestershire.
After he was deemed to be “rapidly deteriorating”, medical staff at the hospital approved him for “fast-track” funding under CHC, meaning his care at a nursing home would be paid for.
However, upon arriving at a home in Wiltshire, the county’s clinical commissioning group (CCG) – the NHS body responsible for determining eligibility – refused to recognise the hospital’s decision and rejected his application. This left Mr Laycock’s family having to find the £1,450 weekly cost of the nursing home themselves.
His daughter Becky Nicholls, 44, who works in human resources, said: “My father had Alzheimer’s as well as this condition and then caught pneumonia as well. He stopped eating and taking on fluids. A specialist at the hospital said he was clearly rapidly declining as he had stopped eating but Wiltshire flatly refused to accept that.”
She was refused an explanation from the CCG and said an administrator was rude over the phone. “I was just shocked after that phone call,” she said. “I hadn’t slept for weeks and that night I lay there just hearing her words in my head. My father couldn’t have been released without a care home to go to, so how can he not be eligible?”
She added: “I felt my dad was going to pass away before they took the time to respond.”
The family paid around £5,800 to the care home and Mr Laycock lived there for two weeks before he died. Further to this newspaper’s involvement, Wiltshire CCG acknowledged it had made a mistake and agreed to refund the money backdated to when Mr Laycock was discharged from hospital.
A spokesman said: “Wiltshire CCG takes all patient complaints and concerns seriously and can confirm that appropriate funding is being put in place for the care Mr Laycock received.
“We acknowledge the upset that Mr Laycock’s daughter has experienced and the director of nursing has spoken to her directly to apologise for any distress caused, as well as offering to meet with her in person in order to better understand the issues raised and ensure we learn from this.”
Andrew Farley, from Farley Dwek Solicitors, a firm specialising in CHC disputes, said his company is dealing with around 500 such disputes, many of which are related to cross-border discrepancies. “It’s clear from the national framework that if fast-track is granted, it should only be withdrawn in exceptional circumstances,” he said.
“The decisions should be the same wherever you are in the country, but they aren’t. There appears to be a postcode lottery as to whether you’ll get funding or not.”
CHC funding is available to anyone with “unpredictable” healthcare needs that go “over and above” what a local authority would be expected to provide, Mr Farley said. It is available for everyone, regardless of wealth.
He said families are often bamboozled by the complex nature of the system and suggested that the cash-strapped NHS may be encouraging assessors to deny funding.
“I think there is possibly a hidden agenda; that’s the impression I get having spoken to many families who have been through this process,” he added.
A spokesman for NHS England said: “Spending on CHC is going up as ever more people are being supported, but it’s CCGs that undertake eligibility assessments, using the national framework, based on each individual person’s specific circumstances.
“While recent improvements in practice mean variation in access to CHC has reduced, there is potential to make the process more efficient and effective for patients as the majority of people put through a CHC assessment turn out not to need it.”