NHS Funding: Who Pays for What?

We are often asked about the confusing area of top up fees. If someone is eligible for continuing health care, fees are funded entirely by the NHS. But where do those financial obligations start and end?

In essence, it is not possible to top up NHS healthcare packages unless it is for additional private services, such as hairdressing, which should be provided by different staff and preferably in an alternative setting. However, if someone wants a bigger room or one with an en-suite and it can be shown that there is a reason why this is needed, it should be funded by the NHS.  

A case brought before the court of appeal (COA) in February this year raised issues over who pays for ‘nursing care’.

The issue related to ‘social care’ tasks carried out by registered nurses. The court ruled that the responsibility for funding such ‘social care’ tasks falls on local authorities, not the NHS. The question here is who should pay for the costs of a registered nurse in the care home when that nurse is not providing healthcare 100% of the time.

The COA considered that the tasks constituting ‘social care’ were the responsibility of the local authority, and the local authority’s argument - that what the nurse does must be a ‘health task’ just because he/she needs to be on the premises - did not make sense. The COA said that the costs could therefore be split. Permission has been sought to appeal to the supreme court but it would appear that what used to be provided free by the NHS can now be seen as a local authority’s financial responsibility. This means that either the local authority or self-funders will be paying for everything that is not considered a health care matter.

This rule may apply in the community as well as in nursing homes.