A recent Which? survey has revealed that a postcode lottery is in place as far as care fees are concerned.

Information submitted to Which? through Freedom of Information requests showed that, whilst 48,000 received continuing healthcare funding in 2009/10, there was a widespread variation throughout the country with 14 people out of every 50,000 receiving the funding in Mid Essex PCT compared with 109 per 50,000 in Plymouth Teaching PCT. The figures mean that people in the Plymouth area are eight times more likely to receive the funding than those living in Mid Essex.

It also appears that some PCT's are seeing their funding increase while others are declining. Sheffield has seen an increase from 39 in 2008 to 112 today while Oxfordshire has declined from paying for 46 to now just 25.

It seems that explanations for the wide variations throughout the country vary almost as much. Luke Clements, a professor of health and social care law, said that some PCT's had an ingrained culture against paying out, with a default position being that the patient is not entitled. However NHS London said that the reasons were far simpler with the average age of the local population being the prime reason for the changes.

Which? delved further and found that almost a third of older people, who were initially rejected and then took their cases to an independent review panel, were then successful in getting funding. However, again there were major differences according to where the people lived, with the proportion of older people getting funding varying from 26% in some areas to 95% in others.

The Elderly Forum, lawyers who specialise in the rights of the elderly, believes that information provision is the main reason for the changes with some regions putting the information out so it is freely available and is read by many of the people likely to be affected by it, while other regions seem to be affected by a complete lack of available information. The Elderly Forum said its research suggested that very few who asked about the issue were told that it concerned the "huge financial implications of the outcome and how they can appeal".

Many have said that they have come upon continuing care funding by chance with the suggestion being made that more local PCTs should produce pamphlets giving advice to families in need. Which? tested 10 PCT and health board websites for information regarding the matter and found that just two out of the 10 were described as satisfactory or good in getting information out for potential patients to read. Six out of the 10 were described as very poor, with no information at all on the whole issue of continuing care funding and how to apply for it.

Four years ago a national framework was introduced to try and eradicate any suggestions of a postcode lottery and re-state exactly who would be eligible for NHS funding. However it is clear that the problems have not disappeared, with some responding to the need for clearer guidance on the issue while others are still refusing to co-operate and deny funding to many who, in other areas, would be granted it.

One area of particular concern is where homes may not be assisting their residents who are able to apply for continuing care as their needs increase and they become eligible. Although, in this situation, homes should be helping them to get the help they are entitled to, too often they are not doing so. One possible explanation is that it is not in the care home's best interests to do so as individuals usually pay higher fees than PCT's, so the home concerned could lose money if continuing care is granted.

Residents who don't apply at the first opportunity can make a "retrospective application" which could see the PCT pay backdated fees as well as interest. The 88 PCT's who responded to the Which? Freedom of Information request, said that between them there had been 1,644 retrospective applications, so the figure across the country is likely to be nearer to 3,000.

For those unclear on the whole issue, there is help at hand with PCTs having a co-ordinator for NHS continuing care, which could be a first point of contact for those wondering if they may have a claim for funding. Even if it has already been determined that a person is not entitled to continuing healthcare funding, they may nevertheless be eligible for NHS-funded nursing care, which currently stands at £108.70 a week in England, though rates differ throughout the UK.

Those who fail to get the funding have the right to appeal and ask for a review, whilst two other sources of advice are Charities First Stop and Counsel and Care, both of which provide factsheets and advice on the subject.

Which? says that it is concerned that the proposed changes to the NHS and the way it is funded with £80billion going towards GPs commissioning healthcare services and PCTs being disbanded, could lead to wider variations at local levels and a loss of the specialist skills which are currently found within the PCTs. The Department of Health has said that it is currently working on the arrangements and detail.