What the quarter shows

NHS England recorded 2,229 incomplete standard NHS Continuing Healthcare referrals that had exceeded 28 days at the end of quarter 1 of 2026 to 2027. The period covers April to June 2026 and the files were released on 13 August. At the same point a year earlier, the corresponding total was 1,076. The backlog measure therefore rose by 1,153 referrals, or about 107.2 per cent. It is a snapshot of unresolved standard referrals beyond the time measure, not a count of everyone waiting for any form of health or social care assessment.1

The age profile shows that delay was not confined to referrals just outside the period. Of the 2,229 incomplete cases, 531 were up to two weeks beyond 28 days, 392 were more than two and up to four weeks beyond, and 1,075 were more than four and up to 12 weeks beyond. A further 144 were more than 12 and up to 26 weeks beyond, while 87 had exceeded 28 days by more than 26 weeks. These categories total the published England figure and describe elapsed delay after the first 28 days.1

During the quarter, organisations reported 17,972 new standard referrals and 30,039 fast track referrals, giving 48,011 new referrals in total. They completed 16,954 standard and 29,424 fast track referrals, or 46,378 altogether. Those flows do not show that the backlog increased by the difference between 48,011 and 46,378. Completed work can include referrals received in an earlier quarter, and not every unresolved referral has passed 28 days. The specific incomplete referral measure is the appropriate published count for the reported delay.1

Of the 16,954 standard referrals completed in the quarter, 11,435 were completed within 28 days. NHS England reports the resulting proportion as 67.447 per cent, which is reasonably expressed as 67.4 per cent. The equivalent proportion in quarter 1 of 2025 to 2026 was 75.5 per cent. Timeliness therefore deteriorated on both published measures. Fewer completed standard referrals met the period, while the stock of incomplete referrals beyond it more than doubled.1

What Continuing Healthcare funds

NHS Continuing Healthcare is an arranged package of ongoing care funded solely by the NHS for an adult assessed as having a primary health need. It can be provided in a person’s own home or another setting outside hospital. Eligibility does not depend on a particular diagnosis, care location or the ability to pay. The assessment considers the nature, intensity, complexity and unpredictability of needs and the totality of the evidence. A high level of social care need does not automatically establish a primary health need, while a familiar diagnosis does not rule one in or out.3, 4

The standard pathway commonly begins with the NHS Continuing Healthcare Checklist, a screening tool used to decide whether a full assessment may be required. A positive Checklist does not establish eligibility. It should lead to the fuller multidisciplinary process, usually documented through the Decision Support Tool, followed by a recommendation and a decision from the responsible integrated care board. The national framework says the tool supports professional judgement rather than replacing it. Evidence should describe actual needs, including how they interact, rather than assign scores to reach a preferred funding result.3, 4

NHS funded Nursing Care is a separate arrangement for eligible nursing home residents who do not qualify for Continuing Healthcare but require care from a registered nurse. The NHS pays a contribution directly to the home for the registered nursing component. The quarter end snapshot recorded 78,974 people eligible for funded nursing care, compared with 79,162 a year earlier. That small change cannot explain the Continuing Healthcare delay. The two arrangements have different eligibility questions and the snapshot counts people receiving support, not referrals awaiting a decision.3, 4

At the end of June, 33,972 people were recorded as eligible for standard Continuing Healthcare and 18,169 through the fast track route, giving a total snapshot of 52,141. The prior year total was 50,638. These figures show the number eligible at a point in time, not how many were newly approved during the quarter or how long a package lasted. Comparing 52,141 eligible people with 2,229 delayed referrals would mix a caseload snapshot with an incomplete process measure. The publication supplies each for a different planning question.3, 4

What the 28 day period means

The National Framework says the time between an integrated care board receiving a positive Checklist, or another notice that a full assessment is required, and the eligibility decision should normally not exceed 28 calendar days. The expectation covers assessment and decision, not the delivery of every element of a final care package. A decision made within 28 days can still require prompt implementation work, while a referral counted beyond 28 days has not necessarily been inactive throughout. The measure cannot reveal the quality or completeness of the assessment by itself.3, 1

The framework recognises that there can be valid and unavoidable reasons for a longer process. Relevant evidence may be temporarily unavailable, a person may need recovery before needs can be assessed reliably, or an assessment may be paused for a documented reason. Those circumstances do not make delay invisible. The board should record the reason, keep the person and representatives informed and complete the process as soon as practicable. A national count cannot separate avoidable administrative delay from a justified extension without additional local information.3, 1

The quarter end categories measure how far each incomplete standard referral has travelled beyond the initial period. A case in the more than 26 week category has waited over 28 days plus a further 26 weeks, not 26 weeks in total. Similarly, a case recorded as up to two weeks beyond has crossed 28 days but may have done so recently. Clear language matters because collapsing the categories into total waiting time understates each delay. The data do not publish the individual start date or reason for any case.3, 1

The 67.4 per cent completion measure uses completed standard referrals as its denominator. It is not the proportion of all new referrals completed within the same quarter, and it does not include fast track work. A service can complete older delayed cases and improve the backlog while reducing its within 28 day percentage, depending on the mix. Conversely, it can complete recent cases quickly while very old referrals remain. Boards need both the completion rate and the age profile, together with local case review, to understand performance.3, 1

Why fast track is different

The fast track pathway is for a person with a rapidly deteriorating condition who may be entering a terminal phase. An appropriate clinician completes the Fast Track Pathway Tool so that a suitable package can be arranged urgently. The full standard assessment and Decision Support Tool are not prerequisites to that immediate support. The route is based on the clinical condition and need for urgency, not a prediction that someone has only a specified number of days or weeks to live. Applying an arbitrary life expectancy test would conflict with the framework.3, 4, 1

That distinction explains why the published 28 day indicators concern standard referrals. Combining standard and fast track completions to calculate one timeliness percentage would produce a figure with no equivalent pathway meaning. Fast track made up 30,039 of 48,011 new referrals in the quarter and 29,424 of 46,378 completions, so it is the larger flow. Its volume is important for planning, but it should not be used to dilute or inflate the standard pathway measure.3, 4, 1

A person supported through fast track may later have their needs reviewed. The framework requires reviews to consider continuing eligibility while avoiding unsupported assumptions about recovery or prognosis. Any proposed change should follow the relevant process and preserve support until a lawful decision is implemented. The quarterly data show 18,169 people eligible through fast track at the snapshot date. They do not reveal individual diagnoses, prognosis, package intensity or whether a review was clinically appropriate.3, 4, 1

Nurses may contribute to either route in different roles. They can identify the need for screening, provide evidence about day and night needs, coordinate a multidisciplinary assessment, complete a fast track tool where authorised or deliver care after eligibility. Professional evidence should be specific about frequency, severity, intervention and risk. It should not be altered to fit funding language, and responsibility for the integrated care board decision should remain clear. A delayed funding process should not obscure immediate clinical escalation where a person’s condition changes.3, 4, 1

What the figures cannot establish

The release is management information. Although the GOV.UK announcement page uses an official statistics label, NHS England states that from 14 May 2026 the Continuing Healthcare statistical release and report were discontinued and the existing data artefacts would continue quarterly as management information. That status affects how confidently the numbers should be used. They are an operational return with published metadata, not a patient level study of why delay occurred or the consequences for each person.1, 2, 3

The files are submitted by sub integrated care board locations and mapped to current organisational structures. Reorganisations, local validation and later revision can affect comparisons. Counts also need population and workload context before organisations are ranked. A large area may hold more delayed referrals because it receives more referrals, while a smaller count can coexist with a poor completion rate. The national rise is clear within the published series, but it does not by itself identify the cause or allocate responsibility to one professional group.1, 2, 3

A referral delay does not reveal the eventual eligibility decision. Some people will be found eligible and others will not. Nor does the data show who paid for interim support, whether a person remained in hospital, whether care was delayed, or whether local authorities and families faced disputed costs. Those are important possible consequences, but they need separate evidence. Reporting them as outcomes of all 2,229 cases would convert a process measure into an unsupported account of harm.1, 2, 3

The data also cannot judge the quality of a decision completed inside 28 days. A timely assessment can still omit evidence or communicate poorly, while a longer assessment can be careful and justified. Timeliness remains important because unresolved funding responsibility creates uncertainty and the national framework establishes a clear expectation. It should be read alongside decision quality, review outcomes, complaints, package implementation and the experience of people and carers rather than treated as a complete quality score.1, 2, 3

What local systems should examine next

Integrated care boards should reconcile the national return with a case level age profile. Each referral beyond 28 days needs an identifiable stage, documented reason, responsible person and next action. Reviews should separate cases awaiting evidence, multidisciplinary assessment, board decision or communication because each blockage requires a different response. The 1,075 cases more than four and up to 12 weeks beyond the period form the largest national category, while the 231 cases beyond an additional 12 weeks warrant particular oversight because delay has become prolonged.1, 3, 4

Capacity analysis should follow the work. A shortage of coordinators may slow information gathering, but delays can also arise from unavailable clinical evidence, difficulty arranging multidisciplinary input, disputes about responsibility or repeated requests for clarification. Moving staff to clear one queue can create another if the pathway is not understood. Boards should measure referral arrival, work in progress, completions, age and rework, then ask front line teams where decisions stop. A recovery plan should protect assessment quality and not reward closing cases without adequate evidence.1, 3, 4

People and their representatives need dated information about the process. They should know whether a Checklist was positive, when the integrated care board received it, who is coordinating the assessment, what evidence is outstanding and how to raise a concern. Communication cannot resolve workforce capacity, but it can prevent avoidable uncertainty and identify factual errors before a decision. Accessible records also support a local resolution or independent review where eligibility is disputed. Confidential clinical material should be shared through appropriate routes rather than ordinary email chains.1, 3, 4

Nursing leaders can test whether staff understand the boundary between care delivery and funding assessment. Necessary care and safeguarding action should not wait for a Continuing Healthcare decision. At the same time, detailed nursing evidence often determines whether the multidisciplinary team understands the intensity, complexity and unpredictability of need. Organisations should allow time for that evidence and avoid reducing it to a list of diagnoses or tasks. Delays caused by repeated incomplete submissions indicate a system design issue as well as an individual training need.1, 3, 4

The next quarterly release should show whether the 2,229 backlog falls, whether the oldest categories reduce and whether the standard completion proportion recovers from 67.4 per cent. Like for like comparison requires the same definitions, organisational mapping and reference period. Revision notes should be checked before claiming a trend. One improved quarter would not prove that the process is stable, but persistent deterioration would strengthen the case for regional and national intervention. Publishing the management information promptly allows boards, nurses and the public to test those claims against the same evidence.1, 3, 4

The current conclusion is limited but consequential. England recorded 52,141 people eligible for Continuing Healthcare at the end of June and processed tens of thousands of new referrals, yet standard pathway timeliness worsened. Incomplete referrals beyond 28 days more than doubled from 1,076 to 2,229 in a year, and only 67.4 per cent of completed standard referrals met the period. Those figures do not show why every case was delayed or what decision followed. They do establish a larger and older unresolved workload that local systems should explain and reduce without weakening the assessment itself.1, 3, 4