Complex care funding

Figuring out how you're going to fund your care can be just as important as finding the right provider.

If you need financial help to pay for your care needs, you may be eligible for funding from either the NHS or your local authority.

To determine who may be responsible for funding your care, you will need to go through an assessment. This will divide your care needs into either 'health' care needs or 'social' care needs. Following assessment, if the majority of your care needs are determined as ‘health’ related you should be eligible for NHS continuing healthcare funding. If they are determined as being ‘social’ related you may be eligible for local authority funding.

NHS funding - continuing healthcare (CHC)

NHS continuing healthcare is the name given to a package of care which is arranged and funded solely by the NHS for individuals who have ongoing physical or mental health care requirements and have been assessed as having a "primary health need". You can receive NHS continuing healthcare in any setting, including your own home. The care you receive will be provided free of charge.

For most people considering applying for NHS continuing healthcare, the first place to start is by asking your GP, a hospital discharge team, or someone else closely involved in your healthcare, to arrange for an assessment to be done to determine your eligibility.

To be eligible for NHS continuing healthcare you must be over 18 and have substantial and ongoing care needs. You must have been assessed as having a "primary health need", which means that your main or primary need for care must relate directly to your health.

Eligibility for NHS continuing healthcare does not depend on:

  • A specific health condition, illness or diagnosis;
  • Who provides the care;
  • Where the care is provided.

If you have a disability or have been diagnosed with a long-term illness or condition, this doesn't necessarily mean that you'll be eligible for NHS continuing healthcare.  Your eligibility will be based on the outcome of an assessment. For more information about assessment click here.

Your eligibility for NHS continuing healthcare will be reviewed regularly. If your care needs change, your funding arrangements may also change.

Further information about continuing healthcare can be found on the NHS Choices Website.

Everyone who receives continuing healthcare can ask for a personal health budget (PHB).

A personal health budget is an amount of money to support your identified health and wellbeing needs, planned and agreed between you and your local NHS team. The aim is to give people with long-term conditions and disabilities greater choice, flexibility and control over the healthcare and support they receive.   Personal health budgets work in a similar way to the personal budgets that many people are already using to manage and pay for their social care. 

  • Eligibility

    To be eligible for NHS continuing healthcare you must be over 18 and have substantial and ongoing care needs. You must have been assessed as having a "primary health need", which means that your main or primary need for care must relate directly to your health.

    Eligibility for NHS continuing healthcare does not depend on:

    • A specific health condition, illness or diagnosis;
    • Who provides the care;
    • Where the care is provided.

    If you have a disability or have been diagnosed with a long-term illness or condition, this doesn't necessarily mean that you'll be eligible for NHS continuing healthcare.  Your eligibility will be based on the outcome of an assessment. For more information about assessment click here.

  • Review

    Your eligibility for NHS continuing healthcare will be reviewed regularly. If your care needs change, your funding arrangements may also change.

    Further information about continuing healthcare can be found on the NHS Choices Website.

  • PHBs

    Everyone who receives continuing healthcare can ask for a personal health budget (PHB).

    A personal health budget is an amount of money to support your identified health and wellbeing needs, planned and agreed between you and your local NHS team. The aim is to give people with long-term conditions and disabilities greater choice, flexibility and control over the healthcare and support they receive.   Personal health budgets work in a similar way to the personal budgets that many people are already using to manage and pay for their social care. 

Local authority funding

If you're considering social care funding, the first place to start is by contacting your local authority or social worker to request an assessment of your care and support needs.

Unlike healthcare, social care is not free for everyone. If the local authority considers that you need support, they may also assess your finances. They will use this to determine whether the local authority will meet the full cost of your care, or whether you will need to contribute towards the costs, or meet the full costs yourself.

Click here to find out more information about how the local authority can support you.

If your local authority decides that you need support, they will arrange for you to receive a personal budget. This can be arranged for you in three different ways: personal budget, direct payments, mixed package.

A personal budget is a pot of funding given to people after an assessment which should be enough to meet their assessed needs. You can either take a personal budget as a direct payment (retaining choice around how your care needs are met and by whom), or leave the local authority with the responsibility to appoint and manage a provider on your behalf. Individuals can choose to have a combination of the two.

Local authorities provide personal budgets and direct payments to give you more flexibility over how your care and support is arranged and provided. If you aren’t able or don’t want to manage your own finances, it's possible for another person to manage your personal budget on your behalf. 

Direct payments are payments given to individuals so that they can have greater control and choice over the care services they have been assessed as needing. The payment must be enough to enable the individual to buy services to meet their needs and must only be spent on the services identified in their support plan.

If you would like to receive direct payments and manage your own care, you will need to request and agree this with the local authority funding your care. Direct payments still allow you the flexibility to change your mind at any time; if you no longer want direct payments, contact your local social services and ask them to arrange your services instead.

The direct payment is paid to you by the local authority so that you can decide how you want to meet your care and support needs. Many people choose to employ their own personal care assistants, although there are many other ways direct payments can be used.

Direct payments are available across the UK and can be taken up by individuals, as well as carers, parents of disabled children, and people who lack mental capacity. They cannot however be used to purchase long term residential care or services provided directly by the local authority.

A direct payment gives responsibility to the person receiving it to employ people or buy services for themselves from established care providers. For further support on how to use direct payments, please contact your local authority.

Having full control over care and support, which direct payments enables, is an attractive option for many people. However, some people may be unsure whether they want or could manage a direct payment. In these cases, your local authority can provide you with a mixed package of care.

A mixed package of care may consist of a smaller direct payment, with some care and support arranged by the local authority or a provider. This allows people to try out direct payments before deciding whether to move to "full" direct payment.

  • Personal budget

    A personal budget is a pot of funding given to people after an assessment which should be enough to meet their assessed needs. You can either take a personal budget as a direct payment (retaining choice around how your care needs are met and by whom), or leave the local authority with the responsibility to appoint and manage a provider on your behalf. Individuals can choose to have a combination of the two.

    Local authorities provide personal budgets and direct payments to give you more flexibility over how your care and support is arranged and provided. If you aren’t able or don’t want to manage your own finances, it's possible for another person to manage your personal budget on your behalf. 

  • Direct payments

    Direct payments are payments given to individuals so that they can have greater control and choice over the care services they have been assessed as needing. The payment must be enough to enable the individual to buy services to meet their needs and must only be spent on the services identified in their support plan.

    If you would like to receive direct payments and manage your own care, you will need to request and agree this with the local authority funding your care. Direct payments still allow you the flexibility to change your mind at any time; if you no longer want direct payments, contact your local social services and ask them to arrange your services instead.

    The direct payment is paid to you by the local authority so that you can decide how you want to meet your care and support needs. Many people choose to employ their own personal care assistants, although there are many other ways direct payments can be used.

    Direct payments are available across the UK and can be taken up by individuals, as well as carers, parents of disabled children, and people who lack mental capacity. They cannot however be used to purchase long term residential care or services provided directly by the local authority.

    A direct payment gives responsibility to the person receiving it to employ people or buy services for themselves from established care providers. For further support on how to use direct payments, please contact your local authority.

  • Mixed package

    Having full control over care and support, which direct payments enables, is an attractive option for many people. However, some people may be unsure whether they want or could manage a direct payment. In these cases, your local authority can provide you with a mixed package of care.

    A mixed package of care may consist of a smaller direct payment, with some care and support arranged by the local authority or a provider. This allows people to try out direct payments before deciding whether to move to "full" direct payment.