/ Health

NHS funding is a postcode lottery – have you been affected?

Patients around the UK are facing a postcode lottery when it comes to continuing care on the NHS, our health investigators uncovered today. Have you been affected by the NHS postcode lottery like Gill and Carol?

Gill Jarvis was shocked to find herself footing a £96k per year care home bill at short notice. Her mum Jean – who has severe dementia – had lived in her care home for nine years and the NHS had been paying her care bills but all that suddenly stopped with little explanation when Jean’s local health board (Clinical Commissioning Group) reviewed her needs.

In another part of the country, Carol Rumens found herself in a similar situation when her husband Geoffrey’s continuing healthcare funding was stopped after eight years. Geoffrey has long-standing mental health problems and is physically very disabled and unable to care for himself.

Both Gill and Carol are clear that the person they love’s health has deteriorated, making the withdrawal of this funding even more hard to understand, and they’re not alone in feeling that they are victims of a continuing healthcare postcode lottery.

Care costs

The NHS funds people who have the highest healthcare needs. Those assessed and deemed eligible have their full healthcare costs funded by the NHS – whether they live in their own home or in a care home, and whatever their financial situation. At a possible £1,000 plus a week, it’s a life-changing sum of money.

But despite a national framework for assessments, vulnerable people with complex conditions can be up to 25 times more likely to get their care costs covered depending on where they live, according to NHS continuing healthcare funding data.

South Reading, the Clinical Commissioning Group (CCG) area with the lowest level of people funded, paid care costs for 8.78 patients per 50K of the population, while Salford funded 220.38 people per 50K. Although different areas have different populations, these differences can’t be easily explained by demographic differences.

The inconsistencies affect people living in the same region too. In Stockport (31.76 per 50K), patients are almost seven times less likely to get the funding than those 10 miles away in Salford.

Emotional impact

And it’s not just the funding that hits hard. Carol – herself an ex-nurse and health visitor – describes the emotional impact of fighting her husband’s case for funding. She said:

“This has nearly broken me. I go to meetings but it’s a foregone conclusion. This is not justice. CHC is meant to be based on need but his need has got worse. They ask my opinion but it’s not of interest to them even though I’m the one who knows him, and what triggers his mental health, best.”

A new national framework has now been published with implementation due on 1 October 2018. It will not change eligibility criteria, but aims to provide greater clarity, including for staff. But will it make the changes that are needed?

Arthur Hall says:
21 April 2018

If there is to be any distinction with NHS services it should not be by postcode, but by the patient’s contributions to the scheme. How can we have reached a situation where UK citizens who, like their parents, have contributed all their working lives, are in need of care or medical services. Is it any wonder that the NHS staggers from one crisis to the next, or that our elderly are often cared for at the expense of the homes they have worked for all their lives?

[Sorry, your comment has been edited to align with our community guidelines. We do not allow comments which others may find offensive. https://conversation.which.co.uk/commenting-guidelines/. Thanks, mods.]

The post code lottery is actually a crime. We need a government who listens to our concerns and does something about it.
Where is that government ?

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I love that sentence “The truth is always unacceptable to those not willing to accept it“. The trouble with Trump is that he struggles with the truth most of the time and we have difficulty recognising it when he occasionally comes up with it.

Incidentally, why do we say “Donald” but not “Vladimir” when referring to the respective big beasts? My mind turns to water fowl when I hear the word Donald, and if it quacks, waddles and continuously preens itself I guess I am right.

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Putins sends his undercover agents instead armed with toxic Novichok Duncan.

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Do you think British agents in Moscow and Syria are also capable of gassing Syrian women and children?

Your allegiance is at times very questionable Duncan, and what action would you take if you were governed by a cruel dictator who is capable of gassing his own citizens. Would that also make you a terrorist if a military uprising was the only solution to establish a fairer and a more democratic constitution?

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Phil says:
22 April 2018

Wildly off topic but t sounds like you’ve been taken in by the Putin propaganda machine. Let’s wait until OPCW have done their investigation, not question why permission was delayed and hope they aren’t harassed too much by Syria’s secret police.

The pipeline through Syria would’ve earned the country billions in transit fees but Assad turned it down because it would disadvantage Russia. Obvious who’s calling the shots there.

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Phil says:
22 April 2018

[Sorry, your comment has been removed for being off-topic, please remember to align with our community guidelines https://conversation.which.co.uk/commenting-guidelines/. Thanks, mods.]

This convo is about the NHS. If we want a Convo on the relative merits of Putin and Trump we should perhaps ask Patrick for one. Personally I get a bit tired of Trump/USA and Putin/Russia being introduced into any Convo on the slightest pretext. Sorry 🙂

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Correct and to the point! What on earth have we come to when where you live determines whether you are treated like a human being? (or NOT!) we should all be treated universally without exception with humanity, respect and dignity. Obviously at present this is quite patently not the case – you may well ask where the Government is – at the beck and call of big business methinks! and not the democratic majority who clamour for the right to be treated with respect and fairness!

The people of West Cumbria know only to we’ll about the cuts to their services West Cumbria is mostly rural and lives were put at risk

I cannot recall a time when the NHS didn’t need more money, and I was born before the NHS. There is no doubt that clinical advances have prolonged the lives of most of the population – which is a tribute to its success – but its resources have not grown proportionately. I think the areas sadly lacking are continuing care and domiciliary care which are people-intensive needs rather than administered through drug prescriptions or physical procedures or other interventions. During the Cold War we spent 4% of our GDP on defence and other military action; now it is barely 2%. How and where have we managed to fritter away the other 2% with so little to show for it? Perhaps much has gone to the NHS and it hasn’t been spent wisely. Inefficiency and managerial inadequacy remain major challenges. Is it all too big? Perhaps the economies of scale are eroded by complexity and friction in the mechanism that consume more energy but reduce the output.

My wife has dementia and incontinence. I have been looking after her at home for about 3 years since the dementia began. I asked for a doctor to visit her in October 2017, in writing, but no visit was ever made – my request was totally ignored. (We also asked for help in gaining access to the bath, but are still waiting after 3½ years!) When she had a fall a few days later she was taken by ambulance (after a 7 hour wait) to hospital, although apparently uninjured. For a month there were discussions over her being discharged which then then cancelled, as she had ‘deteriorated’ – she lost a lot of weight, needed oxygen and other treatment which had not been needed at home. I suggest poor care was the cause. Wishing to get her out of the hospital; arrangements were made for a ‘fast track’ move to a care home. No one would discuss costs, except to say there would be no charge initially as it was funded under continuing health care under end of life rules. Now I am told that full care cannot be continued – as she is “better” which I interpret as recovered from poor treatment in hospital, but not “better” than she was at home. I am disabled and in receipt of DLA and Industrial Injuries Benefit (that is another story of ‘management incompetence) and so looking after her at home is really not possible. I am now having to declare all sorts of financial details, but have not been offered an opportunity to appeal the decision. She gave many years as a NHS worker. Is this fair?

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Too much has probably gone towards interest on the £1.78 trillion UK National Debt – approximately 87.7% of GDP, now renamed the PSNCR (Public Sector Net Cash Requirement).

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Steve Bolter says:
22 April 2018

Why trivialise this very serious matter by describing it as a “postcode lottery”?
What has it to do with one’s postcode?
NHS care depends on which GP you choose.
I live in Essex with an Essex postcode and a Suffolk GP. Some people with exactly the same postcode have an Essex GP.
Some people who live in Essex have a Suffolk Postcode and an Essex GP.

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My mother went into residential care on the advice of her social worker. She had dementia and was becoming a danger to herself. She contributed to her care costs until she died, because she wasn’t considered to be in “medical” need. I made a retrospective claim for a refund of her care costs and her estate was eventually refunded for 50% of the time my mother was in care. It took over four years for the claim to be decided and I had to go to a tribunal which was quite traumatic. I asked for a full breakdown of the charges which I went through with a fine-toothed comb. There were errors but they were quickly resolved. In the end, over £19,000 was paid to my mother’s estate. One of the reasons it took so long was because the claim was transferred to another health authority, but when it was transferred back to Northumberland the claim was resolved within six months.

My main issue was why is dementia not considered to be a condition needing nursing care. But I would advise anyone to persevere and not give up.

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Hi Jay,

When you say tribunal, was it actually a Court of Law? If not, what was the setting? Did you have to fight the Local Authority (the council), or the NHS Clinical Commissioning Group?

I am asking because if you were in an actual Court, your case could be a useful legal case for many to use in their own fight.

Many thanks,


I though the NHS was for all! But now it seems local NHS not country wide Teresa May. We all paid into the health service so should be treated the same. My sympathies to all affected

How can this be considered to be a NATIONAL Health Service – what is the pint of having local MPs if they allow this sort of unfair treatment across the country. What’s the point of having a pension and other savings if we dare not spend the money just in case one or both of us need long term care.
Our biggest concern is that politicians KNOW all about this and just think that it is Ok to hide behind such silly remarks as “we’re spending more than ever before on the NHS”.

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I doubt any one of us would object to the NHS receiving additional funding so it does make you wonder why successive governments give them less than is required. The vast majority of us would probably be happy to pay a little extra each month for good health care. Hell steal a little extra from road tax – ’cause that doesn’t get used on the roads does it!

Janet marshall says:
5 May 2018

The NHS is seeing numbers not the person underneath. It is a blot on our country that provision for any type of care is a lottery.Money is needed, but a more proficient way of managing. There have been too many chiefs and not enough Indians. more pressure leads to mistakes and omissions in care.I was a nurse for forty years and it is sad that change has been so devastating.

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I’m glad your operation went well, Duncan!

You’re very right, medical costs in the USA can be excruciatingly expensive.

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Are you having difficulties getting your mind around what has happened at Gosport? I am not surprised. Do you really think that your comment does any good what so ever ? Why can we not concentrate on what is to be done to stop this sort of atrocity happening again, it appears no one learnt anything from Mid Staffs Hospital deaths, all brushed under the carpet it is irrelevant if the system is Public or Private ,if it goes wrong it should be sorted and fixed not go into endless debates .

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Those comments by the two professors were not the truth, Duncan, only their opinions. There will be no charges to patients in the UK for the use of the NHS and our doctors, surgeons, nurses, etc. will make certain sure of that I assure you. The only ‘privatisation’ that is going on is the outsourcing of most non-clinical activities and the use of capacity in the private sector to advance some waiting lists – both of which I approve of. For an organisation that is accused of privatising itself, it’s odd that its payroll keeps growing and the number of its hospitals and beds goes up every year.

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The “truth according to Duncan” .
surely you really don’t believe this when all around you the opposite is happening. Why can’t you just stick to constructive and real situations in a balanced way ,the Private Care Homes present no threat to the NHS whatsoever .No one is advocating that the NHS be closed all most critics (including myself) are advocating better management and more cost efficiency with any savings being plowed back into the NHS system.

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I think it would be good to see more constructive debate here and less mudslinging.

I agree with John that our British capitalist society has managed to accept the principle of there being universally available medical care and that no-one should be attempting to dismantle that system.

Hi both. Let’s be careful this difference of opinion doesn’t stray into personal criticism, and let’s also be very careful about the language being used. We want to see debates and don’t want to request that discussions come to a close, but may not have a choice in some instances.

The community guidelines are here, for ref: https://conversation.which.co.uk/commenting-guidelines/

Thanks both.

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Surely my request for a “balanced” discussion on this or any other subject cannot be misconstrued by you or anyone else Duncan. I would like to believe my contributions to all Which ? conversations have been both helpful and constructive.
It appears you think that only your, obviously politically motivated viewpoints, are worth noting and that others of a differing viewpoint are worthless well Duncan I beg to differ.

All I am trying to do is give a balancing viewpoint, there doesn’t appear to be many people of this frame of mind.

Dear George,

More than happy to comply, getting rather wary though of being the butt of some persons rather extreme political viewpoints.
Surely someone has to stand up for the thousands of individuals who are dedicated in Caring for the elderly in this Country who are at the end of their lives.

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Gerald, I get that.

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Hey Duncan and Gerald,

Please can we leave this here now? This isn’t the space for casting aspersions on people’s political views. As George says, you each have differing viewpoints — but both are relevant.

Let’s leave it now.


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NHS funding will never be sufficient as long as GPs continue to prescribe drugs to treat and alleviate symptoms instead of dealing with the source of a problem.

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Dementia, and all associated disease and chronic disabilities should be treated within the NHS free of charge to those who have paid into the system all their working lives in this country. Dementia does not just affect the brain, it affects the whole body. If I had my way all care homes would be run by the government and not for profit. This would allow fair wages to all properly trained and qualified staff with the same terms of employment as other medical staff. All care homes a should have a designated doctor and matron. People should not have to pay for their end of life care. It is no different to being in hospital.

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Dear Susan,
You are correct , dementia should be treated under the NHS system but unfortunately the people deciding whether or not it should be funded by the NHS are NOT qualified Doctors or Nurses , they are in most cases Occupational Therapist with no medical training whatsoever.All Care Homes do have a designated Doctor and Matron but they are included at the initial assessment process , Doctors could make an objection but are regularly ignored, Matrons of care Home have no say whatsoever. Many years ago nearly all Care Homes where run by the government (Local Authorities) and some still are. Over the years the Public themselves have chosen to place their loved ones with the Private Sector of which I am proud to be part of . We do pay “the going rate” and we do carry out training otherwise we would not be be able to attract the Good ,dedicated staff working for us, which, in the case of Nursing Homes includes numerous Nurses trained by the NHS .We have not been allowed to train our own specialist nurses but we are the largest recruiters of Filipino nurses , the NHS are now copying us in this.

Unfortunately, those assessing and deciding matters of funding eligibility are indeed healthcare professionals, and the majority of these are nurses. In those Clinical Commissioning Groups where NHS Continuing Healthcare funding is difficult to get, these nurses are those who filter people out of the funding system. Or at least they let their bosses overturn their assessments and recommendations.

I am a clinical nurse specialist in palliative care, and educator of community nurses and care home nurses. In my career I have been offered multiple times jobs as assessor for Continuing Healthcare, and as manager of teams of assessors, contracts paying me up to £40-50/hour. I have never accepted such kind of offers. In those positions, money is the only reward, as professional and personal satisfaction go out of the window with that monetary reward. In our ongoing economic state of affairs, those "b******t jobs", as Rutger Bregman defines them in his brilliant and bold "Utopia for Realists", attract high salaries. Though, their usefulness is doubtful, and in fact, they do more harm than good, they destroy more wealth than they create.

A committed care worker in a care home or a hospital ward receives £12/hour, and they make a real difference for their residents. They get close to their residents, they suffer through their sufffering, they cry for them when their residents suffer at the hand of NHS entities. In my teaching sessions emotional moments abound when care workers share their experiences of caring for vulnerable people.

From the inequalities in end of life care that are increasing, where better off people get golden plated services at the time of dying and the poorest get to die undignified in busy hospitals, to care funding that correlates with high income areas rather than poorest ones, we all need to get bold as Rutger suggests and call for radical, utopian change.


Something positive happening
A social care provider has been doing its part in helping local hospitals by reducing the number of ‘bed blocking’ patients over the last year. This work is particularly important as the NHS prepares for a seasonal increase in the number of patients needing treatment often referred to as ‘winter pressures’.

In the year between November 2017 and November 2018 Optalis reduced the level of bedblocking, also known as delayed transfers of care, of patients living in the Royal Borough of Windsor and Maidenhead for whom it is responsible, to zero per cent. A delayed transfer of care is defined as ‘when a patient is medically fit for discharge from acute or non acute care and is still occupying a bed.’

This success has been achieved by Optalis staff teams working in partnership with hospitals and the Clinical Commissioning Group to ensure residents are supported to leave the hospital with the right support in place at home.

Optalis provides a variety of care and support teams and services, including extra care, homecare, assistive technology, supported housing and occupational therapy as well as short-term support and rehabilitation all of which are able to support the smooth transition from hospital to life after discharge.

The Government Statistical Service reported that in June 2018 there were 134,300 total delayed days in England. The main reason for NHS delays in June was patients awaiting further non-acute NHS care but also included patients awaiting assessment, care packages in their own home or community equipment and adaptations.

Martin Farrow, Optalis’ Chief Executive, commented: “This success is something we are all very proud of at Optalis. We have reduced the number of delays to zero, and we have successfully maintained that level over a sustained period. It is down to our talented and committed team that we have been able to deliver quality care and support, and maintain excellent working partnerships with our health partners.

“This reduction in delays not only benefits those in hospital requiring extra support, but also the NHS by alleviating bed space pressures.”

Cllr Stuart Carroll, Cabinet Member for Adult Social Care and Public Health, added: “These statistics prove how positive partnerships within health can lead to better outcomes for those who require care and support. Whatever care pathway is required, this delivery model has shown that it relieves pressures on the NHS and ensures individuals are receiving the best care possible after they have been discharged from hospital.”

Established in June 2011, Optalis was only the second local authority trading company of its kind in the country. Today, it is one of the largest with nearly 700 staff providing care and support services across Wokingham, Windsor, Maidenhead and Oxfordshire.

My worry is about who had to bear the cost of this higher efficiency. Considering NHS East Berkshire NHS Continuing Healthcare funding statistics, which put the CCG in the group of CCGs with the lowest amount of funding granted, I suspect it the patients had to ultimately pay for those early discharges. The news of alleged success does not report on the long term direct costs on people. Various tactics can be employed in the short term by hospital discharge teams to get rid of "bedbocker" (I am sorry, I do not normally use swear words). These tactics range from re-enablement packages at home free for 4 weeks, then the patient pays, as means testing is applied. Or Fast Track Continuing Healthcare funding is granted, and then removed at the three month review, which is often carried out much earlier to recup funding even more.
I am totally for saving money through minimising hospital stay. But good, and free care at home needs to be granted on an equitable and consistent basis.