Near 30% rise in rejections for vital NHS-funded social care support, new King’s Fund research finds

Nearly 30% more people are being denied vital NHS-funded care and support on reassessment despite no change to the rules, new research from The King’s Fund finds.  

The proportion of recipients of Fast Track NHS Continuing Healthcare (CHC) packages, which provide NHS-funded health and social care support for those with a rapidly deteriorating condition which may be entering a terminal phase, found no longer to be eligible upon reassessment has risen by almost 30% since 2017/18 despite the criteria for support having remained unchanged.

It comes as the think-tank is set to publish a new report which sets out recommendations for how the NHS and the social care system interact with each other, including a review into the decline of CHC eligibility rates. The King’s Fund will be discussing the issues in the social care system, including those raised in this report, at its Social Care Summit on 2nd June.

CHC packages cover patients' health and social care costs, meaning any removal or rejection of support can have major financial implications for individuals and their families. Without CHC support, people risk being pushed into the means-tested social care system that could leave them without any funding and facing high personal costs for their care. The loss of support can disrupt care arrangement and increase distress, particularly for people with deteriorating or life limiting conditions.

The King's Fund analysis found that the number of recipients of Fast Track CHC found to be no longer eligible upon reassessment increased by 28.21% between 2017/18 Q1 (earliest data available) and 2025/26 Q4 (latest data available). This is despite the criteria for support not changing. The research also found that the proportion of applicants for Standard CHC assessed as eligible (sometimes referred to as the assessment conversion rate) in April-June 2017 was 31.25%. That compared to an eligibility rate of just 16.65% in January-March 2026. This equates to a fall in eligibility from nearly 1 in 3 nine years ago to less than 1 in 5 today.

There are also significant regional disparities in eligibility rates. Individual ICBs, who commission NHS services by assessing needs, planning and prioritising, purchasing and monitoring health services, are responsible for assessing CHC eligibility. In the Cambridge and Peterborough ICB, 35.37% of people assessed for standard CHC were found eligible in January-March 2026. This compares with just 2.26% in Gloucestershire.

In its upcoming report titled ‘No man’s land’: the experience of patients at the interface between health and social care', The King's Fund calls for a review into the decline in CHC eligibility and the rise in reassessments, with a particular focus on reducing unwarranted variation between areas. It also calls for stronger national oversight and more consistent application of the CHC framework to help ensure fairer access, a simplified and more transparent process with better communication to patients and their loved ones, and for health and social care systems to share responsibility for outcomes, supported by aligned incentives, pooled budgets and better data.

More fundamentally it says that eligibility to publicly funded social care should be widened to reduce reliance on boundary decisions like CHC and ease pressure at the NHS and social care interface, calling on the government-initiated independent Casey Commission into social care reform to put this forward as one of its recommendations in its final report.

Katie Purbrick-Thompson and Niamh Buckingham, co-authors of the report and Policy Advisers at The King’s Fund, said:

‘The drop in CHC eligibility despite no change in the criteria is deeply concerning. It raises questions as to why this is happening and the government should launch a full review into CHC to fully understand this deterioration in eligibility rates.

'Whether it be funding pressures making ICBs more reluctant to put in place support or because of the complex and different structures that the NHS and social care operate within, people who have seen their eligibility revoked, especially those at the end of their life, deserve answers as to why this is happening and why there is such geographical variation.

'This is just one example of the interaction between NHS and the social care system being broken. A lot of the time, the right hand does not know what the left is doing and it leads to people falling through the cracks and suffering as a result.

'As we set out in our report, there is only so far tinkering around the edges will go. If we want a joined-up health and care system that improves both the NHS's performance and people's quality of life, expanding eligibility to publicly funded social care is fundamental.

'It would reduce reliance on these complex boundary decisions like CHC and give a clear line of accountability for who is responsible for this patient’s care. We strongly urge the Casey Commission to pick up this mantle and recommend a widening of social care support in its final report.'

Notes to editors     

The King’s Fund research on CHC eligibility can be found here. Recipients who are no longer eligible includes people who have died, people who were assessed as eligible but turned down a care package or did not start care for any reason, as well as people who no longer meet the criteria.

A copy of the report: The Experience of Patients At The Interface Of Health And Social Care | The King's Fund.

Continuing Healthcare (CHC): Package of health and social care provided outside hospital, often at home or in a care home, that is arranged and funded solely by the NHS. People who are eligible have long-term and complex physical or mental health needs. To qualify, their needs must primarily be for health care rather than social care. Organised into two streams – standard and fast-track, the latter for people whose condition is rapidly deteriorating, many of whom may be approaching the end of life.

The Fast Track tool is used where an appropriate clinician considers that a person should be fast tracked for NHS CHC because that person has a rapidly deteriorating condition which may be entering a terminal phase. The person may need NHS CHC funding to enable their needs to be urgently met (e.g. to enable them to go home to die or to provide appropriate end of life support to be put in place either in their own home or in a care setting).

Over 50,000 people in England are eligible for CHC across Standard and Fast Track CHC streams. Care is delivered by MDTs including NHS staff and social care workers, in residential care homes, people’s own homes, and hospices. NHS funded via ICBs but high level of variation of provision and access. Adults in receipt of CHC also have a legal right to a personal health budget. NHS expenditure on CHC is around £6.5bn annually.