NHS Continuing Healthcare is an NHS-funded package intended to meet an adult’s assessed health and associated social-care needs. When a family prefers a care home costing more than the package the Integrated Care Board considers necessary, the answer is not an ordinary local-authority style top-up. The National Framework distinguishes the funded package from genuinely additional services that fall outside assessed needs. Families should ask the ICB to identify a suitable funded option and describe any proposed extra precisely before agreeing to pay.
Start with the assessed needs and the commissioned package
Obtain the eligibility decision, assessment evidence, care plan and written package offered by the ICB. List every need the NHS has accepted and the service required to meet it. Then ask which care-home placements are actually available and suitable at the commissioned rate, not merely theoretically registered for that category.
Review the broader NHS Continuing Healthcare eligibility and application pathway if the package appears to omit assessed needs. A dispute about whether a need belongs in the package should not be disguised as a request for the family to purchase an “extra.”
Recognise an improper top-up in substance
The NHS cannot ask the individual to contribute to the cost of meeting assessed needs under an agreed CHC package. Calling the payment a supplement, upgrade or family contribution does not change its substance. If the chosen home says the ICB rate is insufficient for essential staffing, accommodation or care, require the commissioner and provider to resolve what the core package covers.
Ask a direct question: would the resident’s assessed needs still be fully met if the family declined this payment? If the answer is no, the charge is unlikely to be a genuinely optional additional service. Request the ICB’s written position and complaint or review route.
Define a genuine additional service without ambiguity
A person may choose to buy services beyond the NHS package, provided they are additional, optional and separable from what the NHS must provide. Examples depend on the facts and could include a clearly premium amenity or service unrelated to assessed provision. The arrangement should not substitute for, subsidise or alter the funded care.
Write down the extra’s content, supplier, price, cancellation terms and what happens if payment stops. Keep its invoice and agreement distinct where possible. A vague charge for “enhanced care” is a warning sign because care required by assessed needs belongs in the commissioned package.
Test whether the preferred home is an available NHS choice
The ICB should consider wishes and the suitability, cost and availability of placements, but CHC does not create an unlimited right to any chosen home at any price. Ask for the reasons the preferred home was or was not approved and the evidence that another offered placement can safely meet the full plan.
Visit the alternative and compare capabilities, location, continuity and risk. Use the care-home selection method that looks beyond regulator ratings. If the alternative cannot perform a required task, document the gap and return it to the ICB rather than treating the preferred-home difference as purely personal taste.
Protect the resident from an unstable private agreement
Before a relative signs, establish who is legally liable, whether the resident has capacity, how prices can rise and what notice applies. Avoid an open-ended promise to pay “whatever the difference is.” A genuine extra should have a defined service and transparent charge, not track an unexplained gap in NHS funding.
- Name the funded provider and core package.
- Describe the optional service in ordinary language.
- Confirm that declining it will not reduce assessed care.
- Record review, cancellation and refund arrangements.
Independent advocacy or specialist advice may help where the parties cannot explain the boundary consistently.
Revisit the division whenever needs or fees change
At each CHC review or provider fee increase, ask whether the care plan, NHS contract or optional service has changed. An extra that was genuinely separate at admission can become entangled if the resident later needs it to meet an assessed need. Conversely, a new personal preference may be separately purchasable without changing the package.
Search the care-home directory for suitable alternatives under the current plan if the preferred arrangement becomes unaffordable. Do not cancel an essential placement or private agreement without understanding notice and continuity consequences.
Use the dispute routes without interrupting essential care
If the ICB and provider disagree about what the package buys, ask them to document the commissioned specification, contract position and interim plan. The resident should not be left without assessed care while organisations debate price. Direct the complaint about NHS commissioning to the appropriate NHS route and a contractual complaint to the provider, keeping the issues distinct.
Where the disagreement is actually about the CHC assessment or a later review, ask for the relevant review or appeal procedure and deadlines. Keep care notes, invoices and correspondence in chronological order. Advocacy and specialist legal advice may be proportionate when a significant payment is demanded as the condition of receiving necessary care.
Ask that every invoice identify the service period and whether it belongs to the NHS package or private agreement. Do not pay an undifferentiated arrears demand merely to preserve goodwill without first seeking an explanation, but continue meeting clearly valid obligations. A transparent audit trail protects the resident and helps commissioners see whether the arrangement follows the Framework. Record any interim agreement with its review date and authorised signatories.
Can a family top up an NHS CHC package?
Not in the ordinary sense of paying toward services required to meet assessed needs. The NHS package must be sufficient for those needs. Separately purchased, genuinely additional services may be possible when they do not replace or subsidise funded provision.
Must the ICB fund any care home the family chooses?
No. Suitability, availability, individual wishes and reasonable cost all matter under the current framework. The ICB should explain its decision and identify a real option capable of delivering the assessed package.
What should be done before signing for an extra?
Ask the ICB and home to define the funded package and additional service separately in writing. Confirm liability, price, cancellation and the effect of declining. Current National Framework rules and individual commissioning decisions should be checked directly.
