CHC Eligibility by ICB: The 2026 League Table

One number per ICB tells you what to expect — and the numbers vary nearly five-fold. This article compiles the ranked league table of NHS Continuing Healthcare eligibility across England, in one place, with every named ICB linked to its local detail page. NHS Digital publishes the underlying data; the Nuffield Trust quotes the range; nobody else lays out the ranking the way families actually need to read it.

For the underlying argument about why this variation exists — and why it shouldn't — see our pillar on the CHC postcode lottery. To look up your own area by postcode, use the Find Your ICB tool.

TL;DR: CHC eligibility ranges from 3.4% to 57.9% across England's ICBs (Nuffield Trust, September 2025). Leicester, Leicestershire and Rutland leads at 42.5%; Gloucestershire sits at the bottom at 7.3%. Rates vary; legal rights don't. Evidence quality is the lever every family can pull.

How CHC Eligibility Varies — The Headline Numbers

Eligibility for NHS Continuing Healthcare varies from 3.4% to 57.9% across England's ICBs — a near five-fold gap that population health alone cannot explain (Nuffield Trust, September 2025). That is the single most important number in any conversation about CHC fairness.

It's worth being precise about which figure you're reading. The 3.4% to 57.9% range is the share of all those assessed who were ultimately found eligible — a whole-population view. A separate Nuffield Trust analysis, focused only on standard CHC assessments completed between January and March 2024, found a tighter but still striking range: 7.3% in Gloucestershire to 42.5% in Leicester, Leicestershire and Rutland. Both gaps describe the same underlying problem from different angles.

Nationally, 51,154 adults were receiving standard CHC in Q3 2025/26 according to NHS Digital's quarterly publication — a number that has fallen even as spending has risen. The National Framework was written explicitly to produce uniform outcomes regardless of postcode. It isn't.

Which ICBs Approve the Most CHC Funding?

The highest CHC eligibility rates in England sit in the Midlands and the East — led by Leicester, Leicestershire and Rutland ICB at 42.5% of standard assessments, and Lincolnshire ICB at 301 recipients per 50,000 population (Nuffield Trust, 2024). Both figures sit at the top end of the dataset by a wide margin.

What does a top-ten ICB look like in practice? It isn't a more generous Framework — the Framework is national and identical everywhere. It is a more consistent practice. ICBs at the top of the league tend to share several features: experienced MDT panels with low turnover, Checklist thresholds that mirror the published guidance rather than a tighter local interpretation, and less appetite for borderline refusals that would otherwise require an immediate appeal anyway. The result is fewer marginal "no" decisions that bounce back as overturned refusals six months later.

In our own casework at CareAdvocate, top-quartile ICBs tend to ask for less duplicate evidence at Checklist stage. Where a bottom-quartile assessor might request the same care home record three times in different formats, a top-quartile assessor reads it once and moves on. That's not a small difference — it shortens the assessment cycle by weeks for some families. The downstream effect on appeal volume is exactly what you would expect.

A high base rate doesn't guarantee an individual approval. It tells you what to expect, not what you will get. A well-prepared evidence pack still matters in a top-ten area — it just clears the bar with less friction. For deeper context on each of these ICBs, the Find Your ICB lookup links through to per-area pages with the latest published rate, rank, and contact detail.

Where to look in the dataset: Lincolnshire's 301 recipients per 50,000 is more than eight times Cornwall's 36.9. That's a population-adjusted figure — it controls for area size — and it is the cleanest single statistic for comparing what a typical adult in each ICB actually receives.

Which ICBs Approve the Least CHC Funding?

The lowest CHC eligibility rates cluster in the South West and parts of the West Midlands — led at the bottom by Gloucestershire ICB at 7.3% standard-assessment conversion and Cornwall and the Isles of Scilly ICB at just 36.9 recipients per 50,000 population (Nuffield Trust, 2024). Staffordshire and Stoke-on-Trent ICB joined the bottom-quartile after a documented 27% cut in eligibility in 2025 (Nuffield Trust review, March 2026).

The named extremes — at a glance

Source: Nuffield Trust analysis of NHS Digital statistics and the March 2026 Staffordshire savings-plan review. The full ranking with current-quarter figures lives on each per-ICB page.

For families in a bottom-ten area, the experience is meaningfully different. Refusal is the modal outcome at the Checklist stage. Dispute cycles are longer. Evidence requests are more aggressive. The emotional cost of pursuing CHC in a low-rate ICB is real and shouldn't be dismissed.

The critical thing to hold onto, though, is that legal rights under the National Framework are unchanged by geography. Low-rate ICBs can and do overturn refusals at appeal — and the rate at which they do so is rising as more families challenge formally. The appeal data isn't published at ICB level, but our own caseload shows that bottom-quartile ICBs are not appreciably less likely to reverse a refusal once the evidence is presented properly.

Look up your area: The Find Your ICB lookup returns your ICB's current eligibility rate, national rank, and recipients per 50,000 — sourced from NHS Digital's published statistics.

Why Does My ICB Rank Where It Does?

Three drivers explain most of the variation: local interpretation of the National Framework, MDT culture and assessor experience, and financial pressure on the ICB budget. Deprivation explains some of the gap — but less than you would expect.

Local interpretation comes first because it's the most visible. The Framework's "primary health need" test asks whether someone's needs are beyond what a local authority can lawfully provide. Two assessors reading the same care home record can reach opposite conclusions if their local panel has settled on a tighter or looser threshold over time. Neither is openly defying the law. They are simply operating in different normative environments.

MDT culture follows. Panels with experienced, long-tenured chairs tend to produce more consistent decisions. Panels with high turnover and frequent locum involvement produce more variable ones. Training cadence matters too — ICBs that refresh assessor training annually drift less from the published guidance than those that don't.

Budget pressure is the third driver, and it's the one that gets the policy attention. Spend per CHC recipient varies from £32,558 to £133,201 across English ICBs — a fourfold gap that mirrors but doesn't perfectly track the eligibility-rate gap (Nuffield Trust, 2024). Where ICBs face the largest savings targets, the temptation to narrow the eligibility interpretation is real, even when leadership formally denies it. The Staffordshire 27% cut is the clearest documented example.

The deprivation correlation is the surprise. You would expect more deprived ICBs to record higher eligibility rates — sicker populations, higher need. The data shows a relationship, but a weaker one than the policy debate assumes. Some of the most deprived areas sit in the middle of the league table; some of the least deprived areas sit at the bottom. That means the postcode lottery is not just a resource-allocation story — it's a practice story. Changing the practice is harder than changing the budget, but it is also possible without legislation.

How to Find Your ICB

Most families don't know which ICB they fall under — and it is not the same as your local council. Use our Find Your ICB by postcode tool, or the official NHS ICB finder for the primary source. Both will return your ICB name; ours additionally returns the current published eligibility rate, the national rank, and recipients per 50,000.

ICB vs Local Authority — quick reference

Your local authority handles means-tested social care under the Care Act 2014. Your ICB handles NHS Continuing Healthcare under the National Framework. The two systems sit alongside each other and sometimes argue over which side of the line a particular care need falls on. When CHC is refused, families often find their council taking over with a financial assessment — and that's where the difference matters most. CHC is free at point of use; council-funded care is means-tested.

What if you move ICBs mid-assessment? Your case continues uninterrupted under the new ICB code. The April 2026 mergers re-assigned twelve ICBs into six new ones, and live cases were ported automatically. For families with an open Checklist or DST in one of the affected areas, see our guide to the April 2026 ICB mergers.

Does a Low Rate Mean I Shouldn't Apply?

No. A low ICB approval rate does not change your legal rights under the National Framework. Low-eligibility ICBs can and do overturn refusals at appeal — and evidence quality is the single biggest predictor of outcome, regardless of where you live.

There's a sharp version of this question that families ask honestly: if my ICB rejects 92% of standard assessments, am I throwing my time away? It's a fair question. The answer is that the rejection rate compresses dramatically once you condition on evidence quality. ICBs at the bottom of the league reject many applications that arrive with thin or unstructured evidence. They reject far fewer applications that arrive with a properly structured evidence pack mapped to the 12 DST domains. The headline rate is the average over all comers — not the rate you face if you prepare properly.

That's the framing shift that matters. Geography is not the variable you can change; evidence is. A Case Strength Report turns the question from "do I live somewhere CHC happens?" into "is this case strong enough to pursue?" — and that's a question with a defensible answer regardless of postcode.

Not sure if your case is worth pursuing? The Case Strength Report tells you in 48 hours, independent of your ICB's headline rate. Free initial review.

How Will the April 2026 ICB Mergers Affect CHC Eligibility?

On 1 April 2026, twelve ICBs were abolished and six new ones replaced them under Phase 1 of NHS England's merger programme (NHS England, April 2026). Some bottom-ten ICBs merged with mid-table or top-ten ICBs — meaning your area's official rate will be re-baselined under the new geography even though the underlying practice gap doesn't vanish overnight.

The mergers were concentrated in London, the East of England, and parts of the South East. The published statistical series will need to be recompiled under the new ICB codes — NHS Digital has announced this will happen across two quarters as the AACC dataset settles into the new structure. For families with live cases, nothing operationally changes: the case ID stays the same, the assessor team transitions across, and the decision letter comes from the successor ICB.

What's worth watching is whether the re-baselining masks previous postcode-lottery patterns. If a bottom-quartile ICB merges with a top-quartile ICB, the combined rate will sit in the middle — useful for headlines, not for the people in the bottom half of the new footprint who still face the same practice culture. The Find Your ICB lookup will be updated to reflect successor geographies as the first post-merger quarter publishes.

Frequently Asked Questions

Which ICB has the highest CHC eligibility rate?

Leicester, Leicestershire and Rutland ICB has the highest recorded standard CHC eligibility rate at 42.5% of those assessed, based on the most recent Nuffield Trust analysis of NHS Digital data (Q1 2024). Lincolnshire ICB has the highest rate of recipients per 50,000 population at 301.

Which ICB has the lowest CHC eligibility rate?

Gloucestershire ICB has the lowest recorded standard CHC eligibility rate at 7.3% of those assessed (Nuffield Trust, 2024). Cornwall and the Isles of Scilly ICB has the lowest rate of recipients per 50,000 population at 36.9 — roughly an eighth of Lincolnshire's rate.

Why does the rate vary so much between ICBs?

Three drivers do most of the work: local interpretation of the National Framework, MDT culture and assessor experience, and budget pressure on the ICB. Deprivation correlates with low eligibility but more weakly than the policy debate assumes — making the postcode lottery a practice problem, not just a resource problem.

Is it harder to get CHC funding in some areas?

In raw approval terms, yes — a near five-fold gap between the top and bottom ICBs is real. But your legal rights under the National Framework do not change with geography. Low-rate ICBs can and do overturn refusals at appeal when the evidence is well-prepared and properly mapped to the 12 DST domains.

Has my ICB changed since April 2026?

Twelve ICBs were abolished on 1 April 2026 and six new ICBs replaced them under Phase 1 of NHS England's merger programme. If you live in one of the affected areas, your CHC case continues uninterrupted under the new ICB — see our guide to the April 2026 ICB mergers.

Where the Data Comes From

This article draws on three publicly available datasets: NHS Digital's quarterly CHC and FNC statistics (most recent Q3 2025/26); the Nuffield Trust's Falling through the gaps analysis and its September 2025 "All or Nothing" briefing; and the upcoming AACC dataset under NHS England's revised reporting structure. Where Sanity stores per-ICB figures internally, we use the 2024/25 approval rate as the canonical value and surface prior-year deltas on each per-ICB page.

Every figure quoted here carries a year-stamp and a date-of-record. The 3.4%–57.9% range is the whole-population view across all ICBs. The 7.3%–42.5% range is the narrower Q1 2024 standard-assessment view. The 51,154-adult national figure is the live count at end of Q3 2025/26. We don't conflate these — they are different cuts of the same problem.

Closing Thought

Rates vary dramatically. Rights do not. Evidence quality is the lever every family can pull — and it's the one the data says matters most, regardless of which ICB stamps the decision. A 3.4%–57.9% gap is not natural variation in a system designed to produce uniform outcomes; it is the consequence of inconsistent practice that the National Framework was supposed to eliminate. Until the practice gap closes, the families who do best are the ones who prepare best.

Start by finding out where you stand — both geographically and evidentially. The Find Your ICB lookup tells you your area's published rate and rank. A Case Strength Report tells you whether your specific case is worth pursuing, free of the headline-rate noise. Together they answer the only two questions that matter at the start of a CHC journey: what's the lay of the land, and is my case strong enough to walk it?

This article was reviewed by legal professionals and social care professionals at CareAdvocate.