Key Facts
- 27% cut in CHC eligibility at one ICB in a single year (HSJ, April 2026)
- 293 people removed from CHC at Staffordshire and Stoke-on-Trent ICB — 53 cases handed to the council
- £2.56m annual cost shifted from NHS to Stoke-on-Trent City Council
- National CHC eligibility fell from 24% (2021) to 17% (2025) (Nuffield Trust, September 2025)
- 73% of council directors link overspends to tightened CHC eligibility (ADASS, July 2025)
- ICBs cannot change CHC eligibility criteria — the National Framework is the legal standard
In 2025, NHS Staffordshire and Stoke-on-Trent ICB cut the number of people receiving CHC funding by 27% — removing 293 people from the programme as part of a £277m savings plan (HSJ, April 2026). An independent review commissioned by Stoke-on-Trent City Council and conducted by the Nuffield Trust formally warned the ICB not to use eligibility tightening as a mechanism to pass costs to local authorities. The warning came too late for the 53 people whose cases had already been handed to the council.
This isn't an isolated story. National CHC eligibility rates fell from 24% to 17% between 2021 and 2025. If your relative is currently receiving CHC — or has just been refused it — the pressure on ICBs to cut budgets is directly relevant to your situation. The April 2026 ICB mergers add another layer of disruption to live cases; see our guide to what the ICB mergers and NHS England abolition mean for your CHC claim.
TL;DR: One ICB cut 293 people from CHC funding in 2025 and was formally warned by the Nuffield Trust not to pass costs to the council. Nationally, CHC eligibility has fallen from 24% to 17% since 2021. ICBs cannot legally tighten CHC criteria to save money — and families can challenge decisions they believe are financially motivated (Nuffield Trust, September 2025).
Why Did the Staffordshire ICB Cut CHC Eligibility?
NHS Staffordshire and Stoke-on-Trent ICB entered 2025/26 facing a £277m savings requirement — one of the largest financial challenges of any ICB in England — with over £40m of that earmarked for CHC cuts, achieved through reduced eligibility and smaller care packages (HSJ, April 2026). In practice, that meant removing 293 people from CHC. For 53 of them, responsibility for their care was handed directly to Stoke-on-Trent City Council — shifting £2.56m annually from the NHS to a council already under severe financial pressure.
Stoke-on-Trent City Council commissioned the Nuffield Trust to review the ICB's savings plans independently. The March 2026 review found the plans risked "narrowing the definition of healthcare to exclude previously covered services like transport, therapy, and household support" (Nuffield Trust, March 2026). The review explicitly warned the ICB against using eligibility tightening to shift costs to the local authority.
The Nuffield Trust's warning matters beyond Staffordshire. It signals that independent experts recognise the mechanism: ICBs under financial pressure apply a narrower interpretation of "primary health need," which technically complies with the law's wording while departing from its intent. The people removed from CHC don't stop having needs — those needs simply become someone else's problem.
Why Are NHS CHC Eligibility Rates Falling Nationally?
National CHC eligibility fell from 24% to 17% between 2021 and 2025 — a 7 percentage-point decline — with total recipients dropping 8.8% over four years and nearly a five-fold variation in rates across ICB areas (Nuffield Trust, "All or Nothing", September 2025). That's a pattern, not a coincidence.
How financial pressure shapes eligibility decisions
The financial pressure on ICBs is real. Many face deficits that require double-digit percentage savings. CHC is one of the largest discretionary spend lines on an ICB's budget — and reducing eligibility doesn't require cutting services outright. It simply requires assessing people as not quite meeting the threshold.
Why the cost doesn't disappear — it shifts
The cost doesn't disappear. Councils pick it up. A record £774m adult social care overspend was recorded across English councils in 2024-25, with 73% of local authority directors explicitly attributing overspends to tightened NHS CHC eligibility (ADASS, July 2025). This is a system deliberately shifting financial risk downward — from NHS budgets to means-tested council provision, and ultimately to families. Read more about how this affects households in our CHC cost-shifting analysis.
Why Staffordshire is the visible case
The Staffordshire case is unusually well-documented. Most ICB eligibility tightening happens without an independent review and without a formal public warning. That's exactly why families need to know what to look for — because the mechanism is the same whether or not the Nuffield Trust is watching. For a full picture of how CHC eligibility rates vary by area, see our CHC postcode lottery analysis. The wider policy story — the Casey Commission's brief to examine the NHS/social care boundary — is covered in our Casey Commission and CHC analysis.
What Does the Law Actually Say About CHC Eligibility?
Under the National Framework for NHS Continuing Healthcare — the single legal standard governing all ICBs in England — eligibility depends entirely on whether a person has a "primary health need," not on local budgets (NHS National Framework, 2022). Yet national eligibility fell 7 percentage points between 2021 and 2025, despite the legal standard remaining unchanged. Something other than clinical change is driving the numbers.
The primary health need test asks whether a person's needs are so substantial that they go beyond what a local authority can lawfully provide under the Care Act 2014. The criteria — nature, intensity, complexity, and unpredictability of need — are set nationally and must be applied consistently. ICBs don't have the authority to set their own eligibility thresholds. They can't decide that transport, therapy, or household support is no longer "healthcare" because it's convenient for their balance sheet.
How "stealth tightening" shows up on the page
In the cases we review, the most common form of improper eligibility tightening isn't an explicit rule change. It's a gradual shift in how assessors describe needs during the MDT process — downgrading the recorded severity of a domain from "severe" to "moderate" without any evidence of clinical improvement. That change isn't visible to families unless they request the full DST documentation and compare it against care home records.
When an ICB applies the framework with one eye on its savings plan rather than the person's actual needs, the decision is potentially unlawful. Several successful judicial reviews have established this principle. Budget pressure is not a defence.
What Should Families Do If CHC Is Refused or Removed?
If you suspect CHC is being refused, reduced, or removed for financial rather than clinical reasons, you have formal rights and a clear process. The first step is always the same: get everything in writing. Families who request the full DST documentation are often better placed to mount a challenge than they initially expect — discrepancies between recorded severity and the care actually being provided are common, and they're your strongest evidence.
Step 1 — Request the full documentation
Ask for the written decision, the completed Decision Support Tool (DST), and the summary of the MDT discussion. You're legally entitled to these. Read them carefully — check whether the recorded needs match what the care home actually provides day-to-day.
Step 2 — Check the DST domain scores
The DST covers 12 domains including behaviour, cognition, mobility, and continence. Each domain is scored A, B, or C. A single "severe" or two or more "high" scores should trigger a CHC recommendation. If the scoring looks inconsistent with your relative's actual condition, that's a ground for challenge. Our guide to how the CHC Checklist and DST work walks through each domain in detail.
Step 3 — Submit a formal dispute
Every ICB has a dispute resolution process for CHC decisions. Submit a formal written dispute, setting out the factual basis for your challenge. Attach supporting evidence: care home daily logs, GP correspondence, hospital discharge summaries, and specialist assessments. The more specific you are about discrepancies between the DST scoring and documented care needs, the stronger the challenge.
Step 4 — Escalate to NHS England
If the ICB's own review doesn't resolve the dispute, you can escalate to NHS England for an independent review. This process takes time, but it has teeth — and ICBs know it. The Nuffield Trust's public warning in the Staffordshire case shows that independent scrutiny of ICB decisions is possible and effective.
start with a free eligibility check
One thing families often miss: if CHC has been removed during an annual review, request evidence of what specifically changed in your relative's condition to justify that decision. A worsening condition cannot be the reason for removal. Deteriorating needs should, if anything, strengthen the case for CHC — not weaken it. If the ICB is removing CHC despite no documented clinical improvement, that inconsistency is your strongest argument. Our guide to the CHC annual review process explains your rights at each stage.
If you're not sure whether your relative should qualify, try the free CHC eligibility screener before committing to a formal challenge — it takes five minutes and gives you a structured starting point.
Citation Capsule — Staffordshire & Stoke-on-Trent ICB: NHS Staffordshire and Stoke-on-Trent ICB reduced CHC eligibility by 27% in 2025, removing 293 people as part of a £277m savings plan. An independent Nuffield Trust review (March 2026) warned the ICB against passing costs to local authorities by narrowing healthcare definitions. The cost shift to Stoke-on-Trent City Council was £2.56m annually (HSJ, April 2026; Nuffield Trust, March 2026).
Citation Capsule — National Decline: NHS Continuing Healthcare eligibility in England fell from 24% in 2021 to 17% in 2025, with total recipients declining 8.8% over four years. A near five-fold variation in ICB eligibility rates — between 20 and 95 per 50,000 adults — suggests inconsistent application of the National Framework rather than genuine differences in local population health (Nuffield Trust, September 2025).
The Staffordshire case won't be the last. ICBs across England are under unprecedented financial pressure, and CHC spending is a large, visible target. The Nuffield Trust's warning shows that scrutiny works — but only when families and councils are paying attention.
If your relative is on CHC, or has recently been refused or removed from it, the time to check the decision is now. The National Framework hasn't changed. The legal test hasn't changed. What's changed is the financial pressure on the people applying it — and that's not your relative's problem to absorb. For a structured first step, use our free CHC eligibility screener or read the full guide to NHS Continuing Healthcare funding.