Many people don’t realise that there is a difference between health and social care, including that the former is free and the latter is means tested.  For example, health care relates to needs which have to be administered by a registered nurse and it’s free, provided and funded by the NHS. 

NHS Continuing Healthcare (NHS CHC)

NHS Continuing Healthcare, sometimes referred to as ‘NHS continuing care’ or ‘fully funded NHS care’, is the term used when the NHS is responsible for paying for all the care and support required by an individual with ongoing health care needs (referred to as having a ‘primary health need’) provided outside of hospital and administered by a registered nurse. Such care can be provided to any individual aged 18 or over, to meet needs that have arisen because of disability, accident or illness.

Where an individual qualifies for NHS CHC, the funding of the whole package of assessed care, including accommodation if needed, becomes the responsibility of the relevant Clinical Commissioning Group (CCG) as opposed to the Local Authority’s Social Services department. Eligibility for NHS continuing healthcare places no limits on the settings in which the package of support can be offered or on the type of service delivery.

Local Authority Funding

In contrast, The Local Authority (as opposed to the NHS) is only bound to provide social care services.  For example, an individual who requires support getting dressed in the morning and with transferring from room to room does not require a qualified nurse to administer these tasks.  In this case, it would fall into the Local Authority’s remit and would not be the responsibility of the NHS. 

If you do not qualify for NHS Continuing Health Care, your local authority must carry out an assessment of your ‘social care’ needs if you appear to be someone who may have a right to services. This decision must not be influenced by your financial circumstances.  A representative from your local authority, such as a social worker, usually visits you to discuss your needs and to decide with you what actions should be taken. 

Only once an individual has been assessed as having an eligible care need should a financial assessment be completed to determine who pays for what.  The financial assessment differs depending on whether someone is receiving care in a care home, at their own home, or elsewhere.

Guidance

If you would like clarity of your own situation, what you could be entitled to, and how to prepare for assessments, then My Care Consultant can help.

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