Direct Payments for Continuing NHS Healthcare
Direct Payments for Continuing NHS Healthcare are available in Wales from April 2026. Direct Payments enable you to arrange care or support services yourself instead of receiving a package of care or support arranged by the NHS.
You need to have had a Continuing NHS Healthcare assessment and be eligible for Continuing NHS Healthcare in order to receive Direct Payments.
Direct Payments mean you can have more control over the support you need, and make important choices about your Continuing NHS Healthcare. The payments, however, must be used to meet the clinically assessed needs for which your health board and care coordinator have agreed you should have help.
To be eligible for Direct Payments we need to be satisfied that your clinical needs can be met in this way and that you are able to manage the Direct Payments, either alone or with help and support.
Direct Payments are a mechanism through which eligible individuals can receive funds to arrange and manage their own care and support.
They are a way by which people can make choices, have a voice and have control to decide how to meet their needs for care and support and achieve their personal health-related outcomes.
Direct Payments may be made to an eligible individual who is entitled to Continuing NHS Healthcare.
Continuing NHS Healthcare is a complete package of ongoing care and support arranged and funded solely by the NHS.
A Direct Payment for Continuing NHS Healthcare is money paid by a Local Health Board to an individual, or to a representative or nominee on their behalf, to enable them to arrange and manage their own care and support in their own home.
The Direct Payment is based on an agreed care plan which identifies the services and/or support the direct payment must be used for.
Direct Payments are flexible and may be used to:
- Meet ongoing care and support needs under Continuing NHS Healthcare.
- Support a one-off Direct Payment to help a person to achieve specific health-related goals or outcomes.
- Support continuity of care where people move from social care Direct Payments to Continuing NHS Healthcare, recognising that care arrangements may need to expand to meet increased health needs.
You may be able to get a Direct Payment for Continuing NHS Healthcare if:
- You are eligible for Continuing NHS Healthcare.
- A Direct Payment is a safe and good way to meet your needs.
- You have agreed to have a Direct Payment, and have not been forced into accepting it.
- You, or someone you choose, can manage the money (with support if needed).
Yes. You can:
- Choose a nominee to manage the money.
- Have a representative if you do not have capacity.
- Use a managed account service if you want help handling the money.
You can spend your Direct Payment on care and support that helps meet the health needs detailed in your agreed care plan, such as:
- Personal assistants.
- Training for personal assistants so that tasks can be delegated safely.
- Support to help you live independently.
- Services and activities that improve your health, as detailed in your identified care plan.
- One-off purchases agreed in your care plan, including emergency support.
You CANNOT use Direct Payments for things like:
- GP appointments or treatments.
- Vaccinations and health checks.
- Emergency hospital treatment.
- Planned surgery.
- NHS charges (dental, optical, prescriptions).
- Alcohol, tobacco, gambling or debt repayment.
- Anything illegal.
Utility and other household bills.
Yes. You can use your Direct Payment to employ personal assistants who support you at home.
Your budget will include money for:
- Wages.
- Tax and National Insurance.
- Training.
- Insurance.
Holiday and sickness cover.
Sometimes. The NHS may agree if it is the only practical way to meet your needs.
Your care coordinator will discuss this with you.
This will depend on your care plan.
The amount must cover the full cost of everything in your plan and must be enough for you to get the care you need.
Your care plan and Direct Payment will be reviewed:
- Within the first 3 months.
- Then at least once a year.
You can ask for a review at any time if things change.
Tell the Health Board if your needs change.
Your care plan will be updated, and your Direct Payment may be increased, reduced, or changed so it continues to meet your needs safely.
Direct Payments can be stopped if:
- You choose to stop.
- You no longer need the care.
- It is not being used as agreed.
- There are safety concerns, for example the care package is no longer sustainable.
- Fraud has taken place.
You must be given reasons in writing.
Health Boards must consider the ‘sustainability’ of care. The current Continuing NHS Healthcare Framework for Implementation in Wales requires that health and social care professionals have “open conversations with the individual and/or their representative, describing the options to be considered and reflecting the principles and requirements set out in the Sustainable Care Planning Model”.
In terms of arranging service provision, the Framework states that the “MDT recommendations and the individual preferences need to be balanced in accordance with the Sustainable Care Planning Policy”.
The ‘Sustainable Care Planning in Continuing NHS Healthcare Policy’ (“the Sustainability Policy”) has several relevant points.
The starting point is that the CHC package to be provided is “that which the Health Board determines is appropriate for that person’s assessed needs”.[1]
The Sustainability Policy also advises that Health Boards (HB) will “give consideration wherever possible or feasible to the reasonable wishes of the person in terms of the options which are available”. The HB is only required to ‘give consideration’ to the wishes of the individual.
There is no obligation to meet the wishes of the patient / family. In addition, as the policy notes, there is “no statutory requirement for the NHS to offer choice in healthcare in Wales”.
Your Continuing NHS Healthcare Care Co-ordinator can provide more information about Direct Payments.
You can ask your local Health Board to look again at decisions you disagree with. This is called reconsideration.
If you are not happy you can:
- Contact your local Health Board to make a complaint.
- Get free help from Llais, who can help you with concerns about health services.
If you are still unhappy you can contact the Public Services Ombudsman for Wales.