Paying for complex care at home: the funding routes

Funding and choosing care · October 2026 · 5 minute read

Most complex care at home in England is paid for by the NHS, through NHS continuing healthcare for adults or continuing care for children. Where the NHS doesn't fund it, care may come from the local authority after a needs assessment and a financial assessment, from a personal injury or clinical negligence settlement, or privately. Many families end up with a mix. Here is how each route works, and where to start.

NHS continuing healthcare (adults)

NHS continuing healthcare, often shortened to CHC, is a package of care funded entirely by the NHS for adults whose needs are mainly health needs. It is not means tested, and eligibility depends on what someone needs, not on a particular diagnosis.

The process has two stages:

• The checklist. A nurse, doctor, social worker or other professional completes a short screening checklist. If it suggests you may be eligible, you go on to a full assessment. You should get a signed, dated copy of the checklist with the reasons.
• The full assessment. A team of at least two professionals from different disciplines looks at 12 areas of need, such as breathing, nutrition, mobility and cognition, using the national Decision Support Tool. A decision is usually due within 28 days.

If someone's health is declining quickly and they may be nearing the end of life, the fast track route can put a package in place, usually within 48 hours.

Once a package is agreed, it is normally reviewed within 3 months and then at least once a year. Care can be provided at home, and many people choose to receive their CHC funding as a personal health budget so they can choose their own care provider.

Continuing care for children and young people

Children and young people up to 18 have their own route: a continuing care package, assessed under a separate national framework. It is designed for children whose needs can't be met by the services every child can use, for example a child with a tracheostomy or who needs ventilation at home.

The assessment looks at the whole child and family. Packages often combine NHS-funded care with education and social care support, and they should be planned with the child's transition to adult services in mind from about age 14.

Local authority funding

If the NHS doesn't fund care, the local authority can arrange or pay for it after two assessments:

• A care needs assessment, under the Care Act 2014, to work out what support you need.
• A financial assessment, to work out what you should contribute.

For 2026 to 2027 in England, people with savings and capital above £23,250 usually pay the full cost of their care. Below £14,250, capital is ignored and the contribution is based on income only. For care at home, the value of your own home is not counted.

You can ask for your support as a direct payment, which lets you choose and pay a provider yourself instead of using one the local authority arranges.

Personal health budgets

A personal health budget is an amount of NHS money to meet someone's health needs, planned with the NHS team. People eligible for NHS continuing healthcare have a right to have one. It can be managed by the NHS, by a third party, or paid to the person or their representative as a direct payment. For families who want a particular provider, or more say over who comes into their home, it is often the route that gives the most control.

Personal injury and clinical negligence settlements

If someone needs care because of an injury or clinical negligence, their care may be paid for from an interim payment or a final settlement. In these cases a case manager usually arranges and oversees the care, and where the person can't manage their own finances, a deputy appointed by the Court of Protection looks after the money. Care is typically planned around detailed reports, so providers are often asked to show exactly how staff are trained and assessed for each task.

A mix of routes

Plenty of families combine funding. For example, a person may have local authority-funded visits with extra hours paid privately, or a child's continuing care package may sit alongside support from the family's own budget. It is worth asking each funder what the other is expected to cover, so nothing falls between them.

Where to start

1. Ask for a CHC checklist (adults) or a continuing care assessment (children) if needs are mainly health needs. A hospital discharge team, GP, community nurse or social worker can start it.
2. Ask the local authority for a needs assessment if care is likely to be means tested.
3. Keep copies of every assessment, checklist and decision, with dates.
4. Get independent advice if you disagree with a decision. Every decision can be reviewed.

How Eviqa Complex Care can help

We work with every common funding route, and every package is priced individually after a free clinical assessment. If you're not sure which route applies, talk to us. We'll help you understand the options and what to ask for.

Sources

• NHS: NHS continuing healthcare (opens in a new tab)
• NHS England: NHS continuing healthcare (opens in a new tab)
• GOV.UK: Social care charging for care and support, 2026 to 2027 (opens in a new tab)
• Disability Rights UK: Personal health budgets and NHS continuing healthcare (opens in a new tab)

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