The Health and Social Care (Wales) Bill Series – Direct Payments for NHS Continuing Healthcare

NHS Continuing Healthcare

NHS Continuing Healthcare (“CHC”) is a healthcare package provided to individuals who are assessed as having a ‘primary health need’, which outweighs their needs for other care and support. CHC is fully funded by the NHS and can be provided in any setting including in the individual’s own home or in a care home.

An individual’s eligibility for CHC is assessed by a range of professionals, by reference to four key considerations, namely the nature, intensity, complexity and unpredictability of an individual’s needs. Eligibility for CHC is also subject to regular reassessment.

If an individual is deemed to be eligible for CHC, the NHS fund a care package to meet their needs. The NHS may do this by arranging services to be provided in the home or by arranging for needs to be met via residential care with ancillary support.

Such needs are paid for wholly by the NHS in accordance with duties under the NHS (Wales) Act 2006 (“the 2006 Act”), without any charge for the person receiving the care as, subject to limited exceptions, healthcare must be provided free at the point of delivery.

Unlike within social care, direct payments to the individual in receipt of CHC are not possible under the 2006 Act. Over time, this has caused concerns that some individuals with complex health conditions are refusing CHC assessments. The Welsh Government state that this can be for a number of reasons, which include:

• not wanting to lose the voice and control they have through local authority direct payments and the further feeling of loss of independence;
• a concern that there may be fluctuation in CHC eligibility that could interrupt their stable package of care; and
• a concern that they may have to let one or more trusted and familiar Personal Assistants go because traditionally commissioned CHC offers less flexibility and choice in terms of the care provider.

Personal Assistants, in the healthcare setting, work directly with individuals to assist them with various aspects of their day to day lives to help them live as independently as possible.

If a person is assessed as being eligible for, but refuses a, CHC package, it will not automatically mean that the local authority will retain responsibility for meeting their care and support needs. A local authority is not under a duty to meet needs for care and supported by other means, such as the NHS.

In addition to this, section 47 of the Social Services and Well-being (Wales) Act 2014 prevents a local authority from providing services which are required to be provided under a health enactment.

Implementation timeline

It is the Welsh Government’s intention for these provisions to be implemented in Spring 2026.

The Bill’s progress through the Senedd

The Bill has recently passed the final stage of the legislative process in Senedd Cymru.

The Bill previously passed legislative stage 1 on 22 October 2024, stage 2 on 28 November 2024 and stage 3 on 28 January 2025.

Stage 4 proceedings took place in plenary on 4 February 2025. During this session a motion to approve the Bill was passed, with 42 of members of the Senedd voting for such a motion.

During the legislative process, a number of different committees prepared their own reports upon the Bill as originally drafted. These reports can be found below:

• The Health and Social Care Committee’s report – dated 11 October 2024
• The Legislation, Justice and Constitution Committee’s report – dated 11 October 2024
• The Finance Committee’s report – dated 11 October 2024

If you would like to view the Welsh Government’s response to any of the above reports, you can find these here.

Blake Morgan has significant experience in advising upon health and social care matters. Should you require advice upon how the Health and Social Care (Wales) Bill may affect you please contract Eve Piffaretti.

This article was co-written by Luke Williams, Tina Whitman and Eve Piffaretti.