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Who Pays for Care? NHS or Local Authority Funding Explained
When someone needs long-term care - at home, in supported living, or in a care home - one question determines everything:
Who should be paying?
In England and Wales, care may be funded by:
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The NHS (NHS Continuing Healthcare – CHC)
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The Local Authority (under the Care Act 2014)
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The individual (self-funding)
The difficulty is this:
Families are often told they must pay — without being properly informed of their rights.
Understanding the correct funding route can mean the difference between:
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£1,200–£1,800 per week in private fees
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Or fully funded care.
This page explains how care funding works, where errors happen, and how we support families to challenge incorrect decisions.
The Three Possible Funding Routes
NHS Continuing Healthcare (CHC)
If a person’s primary need is a health need, the NHS may be legally responsible for funding their care in full.
CHC is:
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Not means-tested
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Not affected by savings or property
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Based on the “Primary Health Need” test
If CHC applies, the local authority cannot charge.
Local Authority Funding (Care Act 2014)
If CHC does not apply, the local authority may become responsible for meeting eligible needs under the Care Act 2014.
This involves:
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A Care Needs Assessment
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A Financial Assessment (means test)
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Consideration of capital thresholds
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Rules on property, savings and income
However, councils must:
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Assess needs before considering finances
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Apply the law correctly
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Follow strict rules around top-up fees and deprivation of assets
Errors are common.
🔗 Read more about Local Authority Care Funding Advice →
Self-Funding (Private Payment)
If a person’s assets exceed the capital threshold, they may be required to contribute or fully fund care.
But even self-funders have rights.
This includes:
Property disregard rules
Deferred payment schemes
Top-up fee protections
Contract fairness
The right to request CHC reassessment
Paying privately does not remove legal protections.
The Four Key Characteristics
The National Framework explains that certain characteristics of need may help determine whether the care required is beyond the limits of a local authority’s responsibilities
Where Things Go Wrong
We regularly see:
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CHC eligibility wrongly refused
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Financial assessments calculated incorrectly
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Property counted when it should be disregarded
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Top-up fees imposed unlawfully
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Deprivation of assets allegations without evidence
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Families pressured into accepting funding decisions
Many families assume the council or NHS decision must be correct.
It isn’t always.
The Legal Framework
Care funding decisions are governed by:
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The National Framework for NHS Continuing Healthcare
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The Care Act 2014
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Care and Support (Charging and Assessment of Resources) Regulations
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Case law on primary health need
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Ombudsman decisions
These are legal duties - not discretionary guidance.
If those duties are not followed, decisions can be challenged.
How We Support Families
We provide independent care funding advice across England.
Support may include:
✔ Funding Route Analysis
Clarifying whether NHS or local authority responsibility applies.
✔ CHC Eligibility & Appeals
Checklist, DST representation, Local Resolution, IRP and Ombudsman.
✔ Local Authority Funding Advice
Care Act eligibility, needs assessments, advocacy.
✔ Financial Assessment Challenge
Means testing disputes, capital thresholds, property rules.
✔ Top-Up Fee Disputes
Challenging unlawful third-party payment arrangements.
Who This Page Is For
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Families suddenly facing care home fees
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Attorneys and Deputies managing finances
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Self-funders concerned about escalating costs
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Professionals seeking independent review
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Those refused CHC funding
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Those unhappy with a council’s financial assessment
If you are unsure who should be paying, this is the starting point.
A Simple Decision Guide
Step 1: Is the person’s need primarily health-based?
→ Consider NHS Continuing Healthcare.
Step 2: If not, has the local authority completed a lawful needs assessment?
→ Review Care Act eligibility.
Step 3: Has the financial assessment been calculated correctly?
→ Check capital rules and property disregard.
Step 4: Are top-ups being requested?
→ Review legality.
If any step feels unclear, independent review is often justified.
Frequently Asked Questions
Local authority funding is means-tested. NHS Continuing Healthcare is not.
Not automatically. Property may be disregarded in certain circumstances, and deferred payment schemes may apply.
This depends on current regulations. Assets above the upper threshold usually require contribution, but calculations must follow strict statutory rules.
Yes. Incorrect application of charging regulations can be reviewed and formally challenged.
There are structured appeal routes, including Local Resolution and Independent Review Panels.
Care funding decisions shape long-term financial security.
If you are unsure whether the NHS or the council should be paying, or if you believe a decision is wrong:
Book a Care Funding Consultation.
Or explore the relevant pathway:
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NHS Continuing Healthcare Support
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Local Authority Care Funding Advice
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Financial Assessment Challenge
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Care Funding Cap
You do not have to accept a funding decision without understanding your rights.
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