Key Facts
- Councils overspent adult social care budgets by a record £774m in 2024-25, with CHC cost-shifting identified as a key driver (Community Care, July 2025)
- 73% of local authority directors attributed their council overspends directly to tightened CHC eligibility (ADASS summer survey, 2025)
- Three-quarters of directors reported rising care requests from people previously eligible for CHC (ADASS, 2025)
- Councils face a £600m projected overspend in 2025/26 due to NHS-to-council cost transfer (ADASS, November 2025)
- NHS Staffordshire and Stoke-on-Trent ICB cut CHC eligibility by 27% and handed 53 cases to the council — a £2.56m annual cost shift (HSJ, April 2026)
- CHC spending rose 17% from 2017 to 2023 while eligible recipients fell 9% — money goes to fewer, more expensive cases (Nuffield Trust, September 2025)
- When CHC is withdrawn, the £23,250 means-test threshold kicks in and families with assets above that level must self-fund
- The legal test for CHC has not changed — what's changing is how ICBs apply it under budget pressure
TL;DR: ICBs across England are cutting CHC caseloads to balance their books. When they do, care costs don't disappear — they transfer to councils and, ultimately, to families. Councils overspent adult social care by £774m in 2024-25, with 73% of directors blaming tightened CHC eligibility directly (ADASS, July 2025). The legal test for CHC eligibility hasn't changed. Families have the right to challenge every withdrawal decision.
When the NHS stops funding your relative's care, the bill doesn't vanish. It lands somewhere else — first at the council, then often in your family's bank account. That's the mechanism behind a crisis that's been building for years but has now reached a scale that's hard to ignore.
The NHS Continuing Healthcare framework exists because some people's needs are so complex, so intense, or so unpredictable that only the NHS — not social care, not families — should be responsible for funding them. NHS Continuing Healthcare is not means-tested. It covers 100% of care costs. It is the difference between care bills of £50,000+ a year and care bills of zero.
But in 2025 and 2026, ICBs facing catastrophic financial deficits have turned CHC into a savings lever. The eligibility test hasn't changed. The way it's being applied has. The 1 April 2026 ICB mergers and the planned April 2027 abolition of NHS England add operational disruption to that financial pressure — see our guide to the ICB mergers and NHS England abolition for what families with live cases should do this week.
How Does CHC Cost-Shifting Actually Work?
CHC spending rose 17% between 2017 and 2023 while eligible recipients fell 9% (Nuffield Trust, September 2025). That gap tells the story: ICBs are spending more but funding fewer people. The mechanism is straightforward — when an ICB scores someone out of eligibility, the NHS stops paying and the local authority takes over with a means test attached.
When an ICB reviews someone's CHC eligibility and decides they no longer meet the standard, the NHS stops paying. From that point, responsibility for funding care transfers to the local authority — which then applies a means test your relative was previously protected from.
This transfer doesn't require a change in the person's actual needs. It requires only that the ICB's reassessment team scores the Decision Support Tool (DST) differently — often by rating domains as "Severe" rather than "Priority," or "High" rather than "Severe." Small scoring adjustments on paper translate into enormous financial consequences in practice. For the wider picture on where this tightening is happening, see our ICB CHC eligibility cuts explainer, and for the data-transparency reforms that may finally surface what's being changed, our analysis of the May 2026 NHS CHC data publication.
That's not a paradox — it means ICBs are concentrating funding on the most severe cases while removing it from the borderline ones. Families caught on that borderline are paying the price. The money follows the least challengeable cases, not the neediest.
The Staffordshire Example
The Staffordshire case illustrates how blunt this instrument can be. NHS Staffordshire and Stoke-on-Trent ICB cut CHC eligibility by 27% in 2025 as part of a wider £277m savings programme — of which CHC cuts accounted for £40m or more (HSJ, April 2026). Fifty-three CHC cases were handed back to Stoke-on-Trent City Council. That's a £2.56m annual cost shift to a council already under severe financial pressure.
The ICB was explicitly warned — by a Nuffield Trust-commissioned review — not to shift those costs to the council. It proceeded anyway. The council now carries the cost. Some of the people in those 53 cases have needs that haven't changed at all.
| NHS Continuing Healthcare | Council-Funded Care | |
|---|---|---|
| Means-tested? | No — 100% NHS-funded | Yes — £23,250 capital threshold |
| Who pays? | NHS in full | Council (up to its rate) + family top-ups |
| Trigger | Person meets primary health need | CHC withdrawn at reassessment |
What Is the Scale of the Problem?
The ADASS summer survey of 151 adult social care directors found three-quarters reported rising care requests from people previously eligible for CHC (Community Care, July 2025). The same survey found that 73% of directors directly attributed their council overspends to tightened CHC eligibility.
These figures matter because they're not advocacy claims — they're from the people running adult social care services. Directors of adult social care are not making a political argument. They're describing what's landing in their budgets.
Councils overspent adult social care by a record £774m in 2024-25. CHC cost-shifting was identified as a key driver. By the autumn, ADASS was projecting a £600m overspend in 2025/26, with 100% of directors surveyed saying NHS pressure would increase social care pressure the following year (Community Care, November 2025).
There's a geographic dimension that makes this worse. The Nuffield Trust found that the most deprived areas receive £47,300 per year per CHC recipient, compared with £95,085 in the least deprived areas (Nuffield Trust, September 2025). Families in poorer areas are both more likely to have relatives with complex needs and less likely to have the savings to absorb the cost when CHC is removed — our deep-dive on the CHC postcode lottery covers the regional variation in detail.
| Area deprivation level | CHC funding per recipient per year |
|---|---|
| Most deprived areas | £47,300 |
| Least deprived areas | £95,085 |
Source: Nuffield Trust, September 2025. The gap — £47,785 per person per year — reflects both case mix and variation in how ICBs apply the eligibility standard across different regions.
What Does This Mean in Practice for Families?
The means-test threshold for council-funded care sits at £23,250. Care home fees average over £1,100 per week (Laing Buisson, 2024) — meaning assets of £100,000 are exhausted in under two years once CHC is withdrawn. Two immediate, concrete changes hit every family when that transition happens.
The Means Test Reappears
NHS Continuing Healthcare is not means-tested. Full stop. The moment your relative moves to council-funded social care, the council applies a financial assessment. Anyone with capital assets above £23,250 — savings, property, investments — is expected to fund their own care in full until their assets fall below that threshold.
Care home fees in England now average more than £1,100 per week for residential care and over £1,400 per week for nursing care (Laing Buisson, 2024). At those rates, assets of £100,000 disappear in under two years. That's not a theoretical risk. It's the situation thousands of families face after a CHC withdrawal.
The Package Changes Too
Council-commissioned care packages are typically smaller and less flexible than NHS CHC packages. An NHS package might include one-to-one nursing support, specialist equipment, regular therapy input, and a designated case coordinator. Council packages are built around the council's contracted rates and its own assessment of "eligible needs" under the Care Act 2014.
We've seen families where the person's physical care needs were identical before and after withdrawal — same condition, same severity — but the package shrank because the council applies different criteria. Challenging the package size is possible, but it's a separate process from challenging the CHC withdrawal itself.
Has the Legal Test for CHC Changed?
No — and that matters more than anything else in this article. The "primary health need" standard is set by statute and hasn't been amended. Yet with 100% of adult social care directors expecting NHS pressure to increase social care pressure in 2026 (ADASS, November 2025), families need to know what ICBs can and cannot lawfully do.
The legal test — whether a person has a "primary health need" — is set by the National Framework for NHS Continuing Healthcare, which has statutory force. ICBs cannot rewrite the eligibility standard for financial reasons. What they can do, and what the evidence suggests some are doing, is apply greater scrutiny to borderline cases when their budgets are under pressure.
Three-quarters of adult social care directors in England reported rising care requests from people previously eligible for CHC, and 73% attributed their council overspends directly to tightened CHC eligibility (ADASS summer survey, 151 directors, Community Care, 16 July 2025). NHS Staffordshire and Stoke-on-Trent ICB cut CHC eligibility by 27% and transferred 53 cases to the council at a cost of £2.56m per year (HSJ, 9 April 2026).
The National Framework is unambiguous: assessors must base decisions on individual need, not budget position. An ICB that withdraws CHC funding because of financial pressure — rather than because the person's needs have genuinely changed — is acting outside the framework. The wider question of whether the framework itself should change is now squarely in front of the Casey Commission — see our Casey Commission and CHC analysis for what reform could mean.
The practical implication: if your relative's care needs haven't materially changed, the outcome of a reassessment shouldn't change either. If it does, that outcome is challengeable. The reassessment should reflect actual needs on the day of assessment, not a target reduction in CHC caseload.
Use our CHC eligibility screener to get a baseline view of how your relative's needs map to the 12 assessment domains before any formal reassessment.
What Are Your Rights If CHC Is Withdrawn?
Families with professional support achieve 70–75% eligibility rates at local review, compared with 13–25% without it (Beacon CHC / Nuffield Trust, 2024). Your rights at reassessment are the same as they were at the original assessment — you can attend, contribute evidence, and challenge the outcome through a structured appeals route. See our NHS Continuing Healthcare guide for the full step-by-step process.
If your relative's CHC funding is being reviewed or has been withdrawn, take these steps:
- Request a copy of the Decision Support Tool from the most recent assessment. You're entitled to this. Review how each domain was scored against the actual care needs you observe day to day.
- Put your challenge in writing within 28 days. State which domain scores you dispute, and why, with reference to specific care records, nursing notes, or GP assessments.
- Gather clinical evidence before the review. Letters from the GP or consultant documenting the severity, unpredictability, or complexity of your relative's needs carry significant weight.
- Attend any reassessment meeting. You have the right to be present. Bring written observations covering daily care needs across all 12 domains.
- Escalate if the local review fails. A formal independent review can be requested from NHS England. The Parliamentary and Health Service Ombudsman is the final route if the ICB process fails.
The families who succeed are the ones who treat the reassessment as formally as the original assessment. The ICB is under budget pressure. That's real. But budget pressure doesn't override the legal framework — and a well-documented challenge is harder to dismiss than a verbal one.
This article draws on the ADASS summer survey 2025 (151 directors), the Nuffield Trust's "All or Nothing" report (September 2025), HSJ reporting on the Staffordshire ICB savings programme (April 2026), Community Care, and Laing Buisson care market data. It does not constitute legal advice. If you're facing a CHC withdrawal, consider seeking independent advocacy support. Content was last reviewed in May 2026 and has been reviewed by legal professionals and social care professionals.