NHS care at the end of life is free: the GP, district nurses, the palliative care team, hospice care and hospital care cost nothing. What may cost money is personal care at home or a place in a care or nursing home, which the council means-tests, unless the person qualifies for NHS continuing healthcare, which pays for everything and which people nearing the end of life can be fast-tracked onto within 48 hours. The rules and thresholds differ between England, Scotland, Wales and Northern Ireland.
If money worries are adding to everything else, Age UK (0800 678 1602) and Beacon (0345 548 0300, free advice on NHS continuing healthcare) will talk it through with you.
Key facts (2026/27)
| Question | Answer |
|---|---|
| NHS care (GP, nurses, hospice, hospital) | Free |
| NHS continuing healthcare | NHS pays all care, at home or in a nursing home; fast track for end of life within 48 hours |
| Care home means test, upper capital limit | England £23,250; Northern Ireland £23,250; Scotland £36,750; Wales £50,000 |
| NHS-funded nursing care (England) | £267.68 a week paid to the nursing home for anyone needing nursing care |
| Typical nursing home fee | About £1,450 a week (Age UK average); residential care about £1,100 |
What is free on the NHS?
Everywhere in the UK, the following are free at the point of use:
- GP care, including home visits.
- District and community nursing.
- The specialist palliative care team.
- Hospice care, inpatient, day and at home. Hospices are charities that receive some NHS funding and raise the rest; they never charge patients.
- Hospital care.
- Medicines (prescription charges do not apply to people with a terminal illness in England who hold a medical exemption certificate; prescriptions are free in Scotland, Wales and Northern Ireland).
- Equipment such as a hospital bed, mattress, commode and hoist, through the NHS or council equipment service.
- Marie Curie nursing where available.
What is not automatically free: care workers for personal care at home, and the cost of living in a care or nursing home. These are “social care” and are means-tested, unless NHS continuing healthcare applies.
NHS continuing healthcare: the NHS pays for everything
NHS continuing healthcare (CHC) is a package of care arranged and funded entirely by the NHS for adults whose needs are mainly health needs rather than social care needs. It can be provided at home or in a care home, and it is not means-tested: the person’s savings and house are irrelevant.
Eligibility is based on need, not diagnosis. The full assessment looks at twelve areas (breathing, nutrition, continence, skin, mobility, communication, psychological needs, cognition, behaviour, medicines, altered consciousness, other needs) and rates each. A priority need in one area, or severe needs in two, usually means eligibility; combinations of high and moderate needs may too. The assessment is done by a team of at least two professionals and the integrated care board should decide within 28 days.
The fast-track pathway. If the person’s condition is deteriorating rapidly and they may be entering the last phase of life, they should be considered for fast track. A doctor or nurse completes a short fast-track tool instead of the full assessment, and the care package should be in place within 48 hours. There is no checklist stage and no means test. Ask the district nurse, GP, hospital ward or palliative care team to complete it; if you are told the person “is not quite at that stage”, ask what would need to change and when it will be reviewed.
Once CHC is in place, the NHS pays the care agency or the nursing home directly. Top-up fees cannot be added to a CHC package, though a family can pay privately for extra services.
CHC is reviewed at three months and then yearly, and can be withdrawn if needs reduce. For fast-track packages this is rarely an issue.
If refused. Ask for the written decision and reasons, ask for a review, and contact Beacon for free advice. If the person has some health needs but not enough for full CHC, the NHS may fund part of the package (a joint package) or, in a nursing home, pay NHS-funded nursing care.
CHC exists in England and Wales; Scotland has a different system (Hospital Based Complex Clinical Care, which only applies in hospital settings); Northern Ireland has its own arrangements through the health and social care trusts. The fast-track principle, that people nearing the end of life should have care arranged quickly and free, applies across the UK in practice, though the mechanism differs.
NHS-funded nursing care
In England, anyone living in a registered nursing home who has been assessed as needing care from a registered nurse, but who does not qualify for full CHC, gets NHS-funded nursing care: a flat contribution of £267.68 a week (from 1 April 2026; the previous rate was £254.06), paid by the NHS straight to the home. It is not means-tested. The home should deduct it from the fee. Wales and Northern Ireland have equivalent payments at different rates; in Scotland, free nursing care is part of the free personal and nursing care scheme below.
Paying for a care or nursing home: the means test
If CHC does not apply, the council assesses the person’s capital (savings, investments and, in some cases, their home) and income.
| Nation | Upper capital limit (self-fund above this) | Lower capital limit | What happens between |
|---|---|---|---|
| England | £23,250 | £14,250 | Council contributes; person pays income plus £1 a week per £250 of capital above £14,250 |
| Northern Ireland | £23,250 | £14,250 | As England |
| Scotland | £36,750 (from 6 April 2026) | £22,750 | Council contributes on a sliding scale; free personal and nursing care paid regardless |
| Wales | £50,000 | None | Capital at or below £50,000 is disregarded entirely |
The home. The person’s own home is counted as capital unless a spouse or partner, a relative aged 60 or over, a relative who is incapacitated, or a child under 18 lives there, and is disregarded for the first twelve weeks of a permanent care home stay. Where the home is counted, councils in all four nations must offer a deferred payment agreement, so the fees are secured against the house and paid after death rather than forcing a sale. For a person at the end of life, a twelve-week disregard plus a deferred payment usually means the house is never sold in their lifetime.
Scotland’s free personal and nursing care. Everyone in Scotland assessed as needing personal care receives £260.30 a week towards it, and £117.10 a week towards nursing care, from 1 April 2026, paid to the care home whether or not they are self-funding. Self-funders still pay the accommodation element.
Personal expenses allowance. A person in council-funded care in England keeps at least £30.15 a week of their income for personal spending.
Typical fees. Age UK’s UK averages are about £1,100 a week for a residential care home and £1,450 for a nursing home, with London and the south-east often higher. Homes that provide end of life care may charge more for the extra nursing. Endoflifecare.uk lists 4,707 nursing homes; a few publish fees, and the listing shows the figure with its source where they do.
Paying for care at home
Council-arranged home care is means-tested on the same capital limits (the home is not counted while the person lives in it). Each nation sets rules on how much income can be taken; in England, the person must be left with a minimum income guarantee. Private home care typically costs £25 to £35 an hour for visits and £1,200 to £2,000 a week for live-in care, varying widely by area. For someone in the last weeks of life, the fast-track CHC route is usually the right one and should be asked for first.
Benefits that help
- Attendance Allowance (over State Pension age) or Personal Independence Payment (under): people with a terminal illness can claim under special rules, with a form (SR1) from the doctor or nurse, and are paid at the higher rate without a waiting period, usually within days. The rules now cover people thought to have twelve months or less to live.
- Carer’s Allowance for the person caring, subject to earnings rules.
- Council tax reductions where someone is severely mentally impaired or where a property is empty because the person has moved into care.
- Funeral Expenses Payment and bereavement support after death for those on qualifying benefits.
Macmillan’s benefits advisers (0808 808 00 00) and Marie Curie’s support line (0800 090 2309) help with claims.
A practical order of steps
- Ask the district nurse, GP or ward to complete the fast-track CHC tool.
- While waiting, ask the council for an urgent care needs assessment so that care can start.
- Apply for Attendance Allowance or PIP under the special rules; ask the nurse for the SR1 form.
- If a care home is likely, ask the council about the twelve-week disregard and a deferred payment agreement before agreeing fees.
- Get the home’s fee breakdown in writing, showing any NHS-funded nursing care deduction.
- If CHC is refused, ask for the written reasons and call Beacon.
Are next of kin responsible for care home fees?
No. Care home fees are the responsibility of the person receiving the care, paid from their own income and assets after a means test, with the local authority or the NHS paying where the rules say so. A relative is not liable for the fees because they are next of kin, hold power of attorney or signed as a contact on the admission form. The one exception is a relative who signs the care home contract as a guarantor or as the ‘responsible party’ paying the fees, which some homes ask for; read what you sign, and ask the home to remove that clause if you are not agreeing to pay. A top-up fee, where a family chooses a more expensive home than the council will fund, is a voluntary agreement and can be stopped, although the person may then have to move.
Sources
- NHS: NHS continuing healthcare
- NHS: NHS-funded nursing care; 2026/27 rate reported by Care England via THIIS
- Age UK: Paying for a care home (England limits, average fees, personal expenses allowance; updated April 2026)
- Scottish Government guidance on charging for residential accommodation, 2026/27, as published by Renfrewshire Council (capital limits and free personal and nursing care rates)
- Welsh Government: Paying for a care home (£50,000 capital limit)
- GOV.UK: Attendance Allowance and special rules for end of life
- Beacon: Free NHS continuing healthcare advice