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
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Abstract
This guide explains care home top-up fees and how they interact with NHS Continuing Healthcare. It covers what a top-up is, the circumstances in which a local authority may lawfully require one, who can pay it, the position where NHS Continuing Healthcare applies, and what to do where a top-up is being requested despite eligibility.
Top-up fees and NHS Continuing Healthcare
Top-up fees are one of the most misunderstood parts of care funding, and one of the areas where families are most often asked to pay something they do not owe. The position under NHS Continuing Healthcare is simpler than most people expect.
What a top-up is
A top-up, properly called an additional cost payment, is a payment made by a third party where a person chooses a care home that costs more than the amount the funding body has determined is sufficient to meet their assessed needs. It bridges the difference between the two. It is not a charge for better care as such, it is the cost of a preference beyond what the assessment requires.
When a local authority may require one
Where a local authority is arranging a placement, it must be able to offer at least one home that meets the person's assessed needs within its usual rate. If a more expensive home is chosen, a top-up may be sought. If no suitable home is available at the usual rate, a top-up should not be required, and that is the point most often overlooked.
Who can pay a top-up
Ordinarily a third party such as a family member, rather than the person themselves, since the person's own resources have already been assessed. There are limited exceptions. The agreement should be in writing, should record what happens if the third party cannot continue paying, and should be entered into with a clear understanding that the commitment may run for years.
The position under NHS Continuing Healthcare
Where a person is eligible, the Board meets the full cost of the placement that meets their assessed needs. There is no financial assessment and no personal contribution, so a top-up for the assessed placement should not arise. If a top-up is being requested while someone is eligible, that requires an explanation from the Board in writing.
Where it becomes less clear
The complication is choice of setting. A Board must meet assessed needs, not fund any preferred home. Where a family wishes to move someone to a more expensive placement not required to meet those needs, the Board may not be obliged to fund the difference. That situation is genuinely more complicated and warrants advice specific to the circumstances.
Continuing a placement after eligibility
A common scenario is someone already living in a home under a private or council arrangement, with a top-up in place, who is then found eligible. The top-up should stop for the assessed placement. In practice families sometimes continue paying because nobody tells them otherwise, so raise it with the Board as soon as eligibility is confirmed.
What to do if asked for one
Ask in writing who is requesting the payment, on what legal basis, and what assessment supports it. Ask whether a placement meeting assessed needs is available without a top-up. Those two questions resolve a large proportion of these situations, because a top-up requested where no suitable alternative exists is not properly payable.
Key takeaway
A top-up covers a preference beyond what the assessment requires. It should not be payable where no suitable placement is available at the usual rate, and it should not arise at all for the assessed placement where NHS Continuing Healthcare applies. Ask for the basis in writing.
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Frequently asked questions
Can we be charged a top-up if CHC applies?
Not for the placement that meets assessed needs. The Board meets the full cost, so a top-up should not arise. If one is being requested, ask the Board in writing to explain the basis for it.
What if no home is available at the usual rate?
A top-up should not be required. The funding body must be able to offer at least one placement meeting assessed needs within its rate, and if it cannot, the additional cost is not properly passed to the family.
Can the person pay their own top-up?
Usually not, since their resources have already been taken into account in the financial assessment. Limited exceptions exist, and any arrangement should be documented in writing.
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.