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Briefing Note | NHS England Review of All-Age Continuing Care Tariff System
An overview of NHS England's exploration of a tariff and currency system for All Age Continuing Healthcare (AACC, also known as CHC).
NHS England is reviewing AACC commissioning and contracting arrangements, including the potential introduction of a tariff-based framework.
The proposed tariff is not intended to standardise payment rates. Instead, it would classify people into groups with similar levels and types of need, with associated resource expectations.
The objective is to reduce the current variation whereby individuals with similar needs can receive significantly different levels of funded support.
Tariff systems are already used across other NHS services, including dentistry, acute care, and mental health.
Commissioners have identified substantial cost variation for people with comparable CHC needs, suggesting inconsistencies in commissioning and purchasing approaches.
The current AACC framework is based on assessment of an individual's complexity, intensity, and unpredictability of need.
There is concern that a tariff approach could shift focus from individual need towards fitting people into predefined categories.
This could create tension with the existing person-centred assessment and eligibility process.
It remains unclear how a AACC tariff would align with NHS financial and payment systems, which are already experiencing payment backlogs and operational challenges across some ICBs.
NHS England has reviewed international tariff models and undertaken initial engagement with providers.
Planned next steps include:
- Design and testing of tariff concepts from September 2026.
- Formal consultation on tariff and currency options in October to November 2026.
- Further modelling between December 2026 and February 2027.
- Pilot implementation in a limited number of ICBs from April to December 2027.
- Design Principles
The review is being developed around key principles, including:
- Maintaining a personalised approach to care.
- Equity and accessibility.
- Sustainability.
- Clinical credibility.
- Implications
While the proposal aims to improve consistency and transparency in AACC commissioning, significant questions remain about how a tariff system can be implemented without compromising the individualised assessment and care planning that underpin Continuing Healthcare eligibility and delivery.
OACP is looking to organise a local opportunity with PA Consulting who are leading this review on behalf of DHSC.
In the meantime, a wider survey on the future development of AACC is now live.
The survey is seeking views from commissioners, providers, people with lived experience and their carers and others with an interest in AACC. It explores current challenges within AACC and asks for feedback on potential approaches to describing, commissioning and funding care more consistently in the future.
Full details, supporting information and the survey can be accessed here
The survey closes on 18 September.
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