The Health and Social Care (Wales) Act 2025 Series – Direct Payments for NHS Continuing Healthcare
Will individuals in receipt of NHS Continuing Healthcare soon be able to opt for Direct Payments?
The Health and Social Care (Wales) Act 2025 (“the 2025 Act”) has recently received royal assent on March 24 2025.
This article will focus on the Act’s amendments to introduce direct payment 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.
The changes
The 2025 Act, specifically section 24, 25, 26 and 27 seeks to address the above concerns by amending the 2006 Act to allow the Welsh Ministers to make direct payments to individuals who have been assessed as eligible for CHC in Wales. The Welsh Government contend that such an amendment will:
- enable such individuals to directly secure services to meet their assessed health needs, in lieu of receiving services provided or commissioned by the NHS.
- allow those individuals to have more choice and control about how their care is provided and how their care needs are met.
- ensure fairness and equality for disabled and seriously ill people, ensuring that they do not lose voice and control over their care when receiving CHC.
It is envisaged that this amendment should potentially lead to an increased number of individuals agreeing to undergo CHC assessments, without the fear of losing their direct payments. The Welsh Government believes that this will lead to an increased number of individuals having their complex health needs better managed, as a result of having their full package of healthcare funded by the NHS.
This amendment will align the position in Wales to that which applies in England, where direct payments have been permissible under CHC, via Personal Health Budgets, since 2014. Personal Health Budgets can be used to meet a person’s needs as set out in their care plan and are available for adults’ and children’s CHC.
Implementation timeline
Regarding implementation, section 24 and 25 are not in force as of yet, however, section 26 and 27 came into force on 25 March 2025.
The Act’s progress through the Senedd
The Act has recently received royal assent on 24 March 2025.
The Act 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 Act 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 Act 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.
Consultation on proposals for regulations about direct payment
There is a consultation that provides detailed proposals for regulations and legal framework that will allow local health boards to offer direct payments to individuals who are entitled to CHC.
The proposals that are being consulted address the eligibility criteria, conditions for receiving the direct payments mentioned and the respective responsibilities of individuals and local health boards. The proposals have been developed with the assistance of stakeholders, focusing on the principles of co-production and partnership working.
The consultation also reviews the amendments to direct payments for social care as set out in the Social Services and Well-Being (Wales) Act 2014.
The consultation will run for 12 weeks, closing on 8 October 2015. The link to the consultation is 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) Act 2025 may affect you please contact Eve Piffaretti.
This article was co-written by Luke Williams, Tina Whitman and Eve Piffaretti, first published on 19 February 2025, and updated by Kaya Williams on 25 July 2025.
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