Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
3. The Care and Support (Charging and Assessment of Resources) Regulations 2014, SI 2014/2672.
4. Department of Health and Social Care. Care and support statutory guidance. Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide compares local authority charging for social care with NHS funding for continuing healthcare in England. It explains the legal basis of each, the means testing that applies to one and not the other, how the boundary between them is determined, the practical consequences for families, and what to do where responsibility is disputed between the two bodies.
Local authority charging versus NHS funding
The same person, with the same needs, can face a bill of many thousands a year or nothing at all, depending on which body is responsible for their care. Understanding the difference between the two routes is the starting point for almost every care funding question.
Two different legal bases
Local authority care and support is provided under the Care Act 2014, which permits charging subject to a financial assessment. NHS Continuing Healthcare arises where a person's needs are primarily health needs, which places responsibility on the NHS, and NHS care is free at the point of use. The difference in cost to the family flows directly from that difference in legal basis rather than from any policy about who deserves support.
Means testing
Local authority support is means tested. Capital above a threshold set by government means the person pays the full cost, and income is also taken into account through a contribution calculation. NHS Continuing Healthcare involves no financial assessment at all. Savings, income and property are irrelevant to eligibility and to the package that follows.
What determines which applies
The boundary is legal rather than discretionary. A local authority cannot lawfully provide services beyond the limits of its social care functions, so where needs exceed what social care can properly meet, responsibility falls to the NHS. That question is answered through the primary health need test, applied via the twelve care domains and the four key characteristics.
The practical consequence
For a self funding family the difference is often the entire cost of care. For someone with limited capital the difference is smaller in cash terms but still significant, since a local authority contribution is calculated from income while NHS funding is not. In both cases the eligibility question deserves to be answered properly rather than assumed.
The middle ground
Not every case falls cleanly on one side. Where someone is not eligible for full NHS Continuing Healthcare, a joint package may be arranged with the NHS funding the health element and the local authority the social care element, with means testing applied only to the latter. Funded Nursing Care is a narrower arrangement, a flat NHS contribution towards registered nursing input in a nursing home.
When the two bodies disagree
Disputes between an Integrated Care Board and a local authority about responsibility are not uncommon, and they can stall a package. Care should not be interrupted while responsibility is resolved, and interim arrangements should be made. If you are caught in the middle, put in writing that provision must continue and ask each body to confirm the interim position.
Order of operations
Establish the NHS Continuing Healthcare position before committing to a funding arrangement, since the routes have very different consequences and it is far easier to resolve before money has been paid. Requesting a Checklist early costs nothing and keeps the question open while other decisions are being made.
Key takeaway
Council care is means tested, NHS Continuing Healthcare is not. Which applies is a legal question about the nature of the needs rather than a discretionary judgement. Establish the position early, and do not accept a means tested route without the eligibility question being answered.
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Frequently asked questions
Can the council charge if CHC has been refused?
Yes. Where the person is not eligible for NHS Continuing Healthcare, local authority support is means tested in the usual way. That is why a refusal has such a large financial consequence and why it is worth testing.
Who decides which body is responsible?
The Integrated Care Board decides eligibility for NHS Continuing Healthcare, applying the primary health need test. Where the person is not eligible, the local authority assesses and may charge under the Care Act.
What happens if they disagree with each other?
Care should not be interrupted while responsibility is resolved and interim arrangements should be made. Put in writing that provision must continue and ask each body to confirm the interim funding position.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.