The short answer
- There is no legal definition of complex careThe phrase describes care that takes more skill, more equipment or more hours than ordinary help at home, and it means slightly different things to a hospital team and to a care provider.
- The funding decision is the one that mattersNHS Continuing Healthcare pays for the whole package, at home or in a care home, and there is no means test. Complexity is one of the four things the assessors weigh.
- Four people decide, and each decides something differentThe NHS decides who pays. The council decides whether it will help. The nursing team decides which tasks a carer may do. You decide which carer takes it on.
- Arranged privately, nobody grades the care for youCarers on PrimeCarers charge from £18 an hour for visits, and live-in care with complex needs starts at £1,260 a week.
This page covers England. Wales, Scotland and Northern Ireland run their own continuing healthcare and social care systems, and the tests and the figures differ.
The short answer
Complex care describes what the care involves, not what the diagnosis is
Families usually hear the phrase for the first time from a ward nurse, a discharge co-ordinator or a care provider, and it arrives without an explanation. It is a working description rather than a status your relative has been given.
What people mean when they say complex care
- Care that involves clinical tasks, such as a feeding tube, a tracheostomy, a catheter or rescue medication
- Care where two carers are needed for a transfer, or where a hoist, a profiling bed or a ventilator is in the house
- Care that has to run day and night, or that changes from week to week as a condition moves
- Care where several conditions interact, so managing one of them affects the others
What the phrase does not mean
- A category your relative has been placed in by law. No statute defines complex care
- A guarantee that the NHS will pay. That is a separate decision with its own test
- Something only a registered nurse can provide. Many of these tasks can be delegated to a trained carer
- A reason your relative has to move into a nursing home. Care at this level is provided at home every day
The word that does carry a legal meaning is complexity, and it belongs to the NHS. In the national framework that governs NHS Continuing Healthcare, complexity is one of four characteristics that assessors weigh when they decide whether the NHS should pay for someone's care in full. Everything else in the phrase is shorthand used by hospitals, care providers and families to describe care that takes more skill or more time than help with washing, dressing and meals. The complex care at home guide sets out the tasks carers take on at this level and how experience is shown on a profile.
That leaves families with a practical problem. If the phrase has no single definition, who decides that a need is complex, and what changes when they do? Four separate decisions are made, usually by four different people, and each one changes something different for you.
Who decides
Four decisions, made by four different people
These come in roughly this order, though they can overlap, and a family can be waiting on more than one at a time. Knowing which decision you are waiting for makes it much easier to know who to ring.
The NHS
The integrated care board covering your relative
Is the main reason this person needs care a health need?
- How it is decided
- A screening checklist first, then a full assessment by at least two professionals from different professions, using the decision support tool.
- What it changes for you
- If the answer is yes, the NHS arranges and pays for the whole package, at home or in a care home, whatever your relative has in savings.
The council
Adult social care at the local authority
Do these needs meet the national eligibility criteria, and what can your relative afford to pay?
- How it is decided
- A care and support needs assessment under the Care Act 2014, followed by a financial assessment of capital and income.
- What it changes for you
- If the answer is yes, the council arranges care or pays towards it, and a direct payment lets your family choose the carer instead.
The clinical team
District nurses, a specialist nurse, or the hospital team
Can this particular task be handed to a care worker, and is this care worker trained for it?
- How it is decided
- A written care plan, training given and signed off by the professional who delegates the task, and continuing oversight from that professional.
- What it changes for you
- This is what decides whether the care can happen at home at all, and which tasks a carer may do rather than a nurse.
You and the carer
The family, and the carer you are talking to
Has this carer done this work before, and are they willing to take it on?
- How it is decided
- The experience listed on a carer profile, the questions you ask at interview, and what the clinical team has already put in writing.
- What it changes for you
- When a family arranges care privately, nobody applies the label for you. You check the experience yourself and agree the work with the carer.
The first two decide who pays. The third decides what is possible at home, because a carer cannot carry out a clinical task unless a registered professional has delegated it and trained them for it. The fourth surprises families most: if you are paying privately, no organisation grades the care for you.
The NHS test
What the NHS means by complex, in its own words
NHS Continuing Healthcare is a package of care arranged and paid for by the NHS for adults whose care needs arise mainly from their health. The law calls that a primary health need. Assessors decide it by looking at four characteristics of the needs, and complexity is one of them.
Nature
Intensity
Complexity
Unpredictability
The framework is explicit that any one of these can demonstrate a primary health need on its own, or they can do it in combination. It is equally explicit that a diagnosis never decides it, and neither does the setting the care happens in. Two people with the same condition can get different answers, because the assessment is about the care each of them needs.
Underneath the four characteristics sits the decision support tool, which scores twelve areas of need, from breathing and nutrition through mobility and cognition to behaviour and medication. Each area is scored from no needs through low, moderate and high to severe, and four of them can also be scored as priority. One area at priority level indicates a primary health need, as does severe in two or more areas, though assessors are asked to use judgement rather than apply those thresholds mechanically.
Asking for an assessment
How to ask, who carries it out, and how long it takes
You do not need a consultant's referral and you do not have to wait to be offered one. Ask the GP, the district nurse, the hospital ward or the social worker for a continuing healthcare checklist, using that phrase.
- The ask
Ask for a checklist by name
A nurse, doctor, other healthcare professional or social worker can complete the screening checklist. The person completing it has to record their reasons in writing, then sign and date it. Ask for a copy.
- The screening
The checklist is a screen, not a decision
It only decides whether a full assessment happens. A low score at this stage is not a finding that your relative has no health needs, and you can ask for it to be repeated if their condition changes.
- The assessment
A multidisciplinary team completes the decision support tool
At least two professionals from different healthcare professions take part. Your relative, and you as their representative, should be involved, and you can ask for the evidence each score is based on.
- Within 28 days
The integrated care board makes the decision
The framework expects the whole process, from the board receiving a positive checklist to the eligibility decision, to take no more than 28 calendar days in most cases. In hospital, where someone is otherwise ready to go home, it should be faster.
- If eligible
A care plan, and the option of a personal health budget
The NHS becomes responsible for arranging and funding the care, at home if that is where your relative wants to be. People eligible for continuing healthcare have had a right to have a personal health budget since October 2014, which can be taken as a direct payment.
- Afterwards
Eligibility is reviewed, not permanent
A review can end the funding as well as continue it, so keep your own record of what the care involves week by week.
If the answer is no
The council asks a different question, and its answer comes with a means test
If continuing healthcare is refused, the care sits with the council and the family instead. The council is answering a different question from the NHS, so a no from one is not a no from the other, and it is worth asking both.
- 1
Ask adult social care for a needs assessment
FreeRing the council your relative lives in and ask for a care and support needs assessment under the Care Act 2014. It does not depend on income, and anyone who appears to need care and support can have one. - 2
The eligibility test has three parts
The lawThe needs have to arise from a physical or mental impairment or illness, your relative has to be unable to achieve two or more of ten specified outcomes, such as managing nutrition, personal hygiene, toilet needs or using the home safely, and there has to be a significant impact on their wellbeing. - 3
Then comes the financial assessment
Means testedIn England the upper capital limit is £23,250 and the lower limit is £14,250 for 2026 to 2027. Above the upper limit your relative pays for their own care. Below the lower limit their capital is disregarded and only income is taken into account. - 4
Ask about a joint package
Both budgetsWhere some needs are health needs and some are social care needs, the NHS and the council can fund a package between them. Ask directly whether a joint package has been considered, because it is easy for two organisations to each assume the other is picking it up. - 5
Take a direct payment if you want to choose the carer
Your choiceIf the council is funding some or all of the care, a direct payment sends the money to your relative or to you, so you can arrange the care yourselves rather than take the council contract.
Local authority funding explains how to ask for the assessment, and personal budgets and personal health budgets sets out the council version and the NHS version side by side.
The tasks themselves
Which tasks make care complex, and who has to agree they can happen at home
A healthcare task carried out at home by a care worker is a delegated healthcare activity: something a registered professional has handed over after training that worker and satisfying themselves they are competent, keeping clinical oversight afterwards. This is why the nursing team decides what is possible.
| Who has to agree it | What to get in writing | |
|---|---|---|
| Hoisting and two-person transfers | The occupational therapist or physiotherapist who assessed the equipment | The moving and handling plan, the sling size, and whether each transfer needs one carer or two |
| Feeding through a PEG tube | The community nursing team and the dietitian, who train the carer and sign the training off | The feeding regime, who to ring when the tube blocks, and the chart the carer fills in |
| Tracheostomy care and suction | The respiratory or community nursing team, under a nurse-led plan | Which parts are delegated, which stay with the nurses, and exactly what to do in an emergency |
| Stoma and catheter care | The stoma or continence nurse, who reviews it | The routine, where the supplies come from, and the signs that mean a phone call rather than a note |
| Rescue medication for seizures | The epilepsy nurse or the consultant, with a written protocol kept in the house | The protocol itself, the dose, how long to wait, and when to call an ambulance |
| Insulin and other injections | The prescriber and the community nurses. Most injections and all intravenous care stay with nurses | Whether anything can be delegated at all, and who is coming in to do it if not |
| Pressure care and wound dressings | The tissue viability or district nursing team | The turning schedule, which dressings a carer may change, and when the nurse visits |
Hoisting and two-person transfers
- Who has to agree it
- The occupational therapist or physiotherapist who assessed the equipment
- What to get in writing
- The moving and handling plan, the sling size, and whether each transfer needs one carer or two
Feeding through a PEG tube
- Who has to agree it
- The community nursing team and the dietitian, who train the carer and sign the training off
- What to get in writing
- The feeding regime, who to ring when the tube blocks, and the chart the carer fills in
Tracheostomy care and suction
- Who has to agree it
- The respiratory or community nursing team, under a nurse-led plan
- What to get in writing
- Which parts are delegated, which stay with the nurses, and exactly what to do in an emergency
Stoma and catheter care
- Who has to agree it
- The stoma or continence nurse, who reviews it
- What to get in writing
- The routine, where the supplies come from, and the signs that mean a phone call rather than a note
Rescue medication for seizures
- Who has to agree it
- The epilepsy nurse or the consultant, with a written protocol kept in the house
- What to get in writing
- The protocol itself, the dose, how long to wait, and when to call an ambulance
Insulin and other injections
- Who has to agree it
- The prescriber and the community nurses. Most injections and all intravenous care stay with nurses
- What to get in writing
- Whether anything can be delegated at all, and who is coming in to do it if not
Pressure care and wound dressings
- Who has to agree it
- The tissue viability or district nursing team
- What to get in writing
- The turning schedule, which dressings a carer may change, and when the nurse visits
The guiding principles for delegating healthcare activities to care workers are published by Skills for Care with the Department of Health and Social Care and the Care Quality Commission, and they ask for consent from the person, training matched to the activity, and continuing clinical oversight.
Two things follow for a family. The permission is never a general one, it belongs to that carer and that person, so a carer who was signed off for PEG feeding with one client has to be assessed again for yours. Delegated healthcare tasks covers how the sign-off works and what to keep a copy of. Some packages also need a registered nurse for part of the week and a carer for the rest, so it is worth settling that shape before you start looking. Nurse-led or carer-led complex care sets the two side by side, can you get live-in nurses? answers the question families ask next, and can carers give medication? covers prescriptions more broadly.
What it costs
What complex care costs when the family is paying
If continuing healthcare is refused and your relative is above the savings limit, the cost falls to them. These are the rates carers on PrimeCarers charge, with our fee included, so they are what a family pays.
£18 to £25
an hour for daytime visits
Carers with experience of a particular condition or task sit at the higher end. Agencies charge £28 to £35 for the same visit.
£150 to £160
a waking night
For a carer awake and working through the night, rather than sleeping and available. Turning, suction and repositioning usually mean a waking night.
£1,260 a week
live-in care with complex needs, from
A typical week is £1,340, and the band runs to £1,750 where the care is heaviest or two carers are needed.
£23,250
the savings line for council help in England
Above this your relative pays for their own care. Continuing healthcare has no means test at all, which is why it is worth asking for the checklist first.
PrimeCarers rates, September 2026, with our fee included. Capital limits for 2026 to 2027 from the Department of Health and Social Care charging circular.
Arranging it
What to have in place before a carer starts
Whether the funding came from the NHS, the council or your relative, the practical work is the same: get the clinical plan written down, then find somebody with the experience it needs.
The care plan, in writing
The training sign-off
The questions worth asking at interview
What we check, and what you check
When you are ready to see who is available, you can search for carers near you and compare their rates, filter for the experience your relative needs, and message two or three before you decide. Carers list the conditions and the tasks they have worked with on their profiles, and the interview is free. PrimeCarers is an introductory service rather than a care agency, and holds no registration with the Care Quality Commission, so the arrangement is between your family and the carer.
The terms sit in that contract rather than with us. A visit the client cancels is payable in full, apart from unplanned hospitalisation, illness, or another reason the carer agrees, which matters when a relative with an unstable condition is admitted at short notice. Notice is 48 hours for hourly care, and for live-in care it is 7 days once 168 hours have been worked, with 48 hours before that. Bank holidays are charged at one and a half times the rate and Christmas Day at double. To put a weekly figure on a particular set of hours first, what care costs where you live works it out by postcode.
Questions
Questions families ask about complex care
No. No statute or regulation in England defines complex care, and no organisation issues a decision that says a person now has it. The phrase is used by hospital teams, care providers and families to describe care that takes more skill, more equipment or more hours than help with washing, dressing and meals. The word that does carry a legal meaning is complexity, which is one of the four characteristics assessors weigh when deciding whether someone has a primary health need for NHS Continuing Healthcare.
It depends which decision you mean. The NHS decides whether her needs are mainly health needs, and therefore whether it pays for everything. The council decides whether she meets the national eligibility criteria for care and support, and what she has to contribute. The nursing team decides which clinical tasks can be handed to a carer and who is trained to do them. If you are arranging and paying for care yourselves, nobody applies the label, and you check the experience with the carer directly.
Not on its own. The national framework is clear that the diagnosis of a particular disease or condition does not by itself determine eligibility for continuing healthcare. The assessment looks at what care the person needs and how intense, complex and unpredictable those needs are. Two people with the same diagnosis can get different answers, and a person can become eligible later even if they were not at first.
The national framework expects the assessment and the eligibility decision to take no more than 28 calendar days in most cases, counted from the day the integrated care board receives a positive checklist. Where the assessment is being done in hospital and the person is otherwise ready to go home, it should take considerably less. If you are past that point, ask the board in writing for the reason for the delay.
Yes. Continuing healthcare can be provided in any setting, including a person's own home, and eligibility is not determined by where the care happens or by who delivers it. At home it can cover a live-in carer or a rota of carers. The practical limits are the room for equipment, whether the community nursing team can support the plan, and whether carers with the right training are available locally.
Often yes, but only once a registered professional has delegated that specific task, trained that specific carer and satisfied themselves that they are competent, with continuing clinical oversight afterwards. It is not a general permission: a carer signed off for one person has to be assessed again for another. Delegated healthcare tasks covers how the sign-off works, and nurse-led or carer-led complex care covers the packages that need a registered nurse for part of the week.
Visits from carers on PrimeCarers run from £18 to £25 an hour with our fee included, a waking night is £150 to £160, and live-in care where the needs are complex starts at £1,260 a week and typically runs to £1,340. Agencies charge £28 to £35 an hour for visits. How to privately fund care covers the ways families meet it.
Ask both, in writing, whether a joint package of care has been considered, and ask the integrated care board for the completed decision support tool. Where some needs are health needs and some are social care needs, the two can fund a package between them, and they are expected to agree a division locally rather than leave a family waiting. The different types of care funding sets out which budget covers what.