
When you or your loved one are living with care and support needs and require help, navigating through the health and social care system can be stressful and overwhelming.
When you have care and support needs, you often require a combination of practical, emotional and financial support to live independently and manage activities of daily living. These needs may be a result of mental health, dementia, ageing, long term physical illness, a learning disability, a stroke or frailty. You may require help with medication, washing, dressing, cleaning, domestic tasks, meal preparation and accessing the community.
An Assessment of Need

Anyone who has care and support needs is entitled to be supported by adult social care or the local authority (the local council who you pay your council tax to) and has a right to an assessment of need regardless of funding status (whether you pay for your own care or it is paid for by adult social care).
The Care Act 2014 requires adult social care to carry out an assessment of need for anyone who has care and support needs.
An assessment of need is completed by a social worker from adult social care. They will visit you at home to complete the assessment. It focuses on the person’s physical health, mental health, ability to carry out activities of daily living and wellbeing.
The process has three stages:
1. identifying needs,
2. assessing eligibility
3. care planning
The assessment may be completed over several visits and the social worker may need to speak to other health and social care professionals involved in your care.
After you have had an assessment of need, the social worker will be able to make recommendations of what care and support you may need e.g. day centre, home care, cleaning support, care home, respite care, also known as a ‘care package’
The social worker can arrange and support you to set up a care package regardless of your funding status (if you pay for your own care or adult social care pay for it).
If you have more than £23,500 in savings in your own right, you are considered self-funding, this means you are responsible for paying for your own care package.
If you have less than £23,500 in savings you may be eligible to have your care package funded by adult social care however this will depend on your income and is means tested.
If you live in your own home, and intend on staying in your own home with a care package, your home is disregarded from any financial assessments.
If you are self-funding, you may be charged a fee by adult social care to arrange and set up your care package, this is called a brokerage fee, but your social worker should inform you of this. You can set up your own care package, ask the social worker for the completed assessment of need and recommendations, this will inform you of what care package you need.
Adult social care has a preferred provider list, which is a list of care services and care providers that have a contract with adult social care. However, you can set up a care package with any care service or care provider if you are self-funding and do not have to use one that is on the list. If you are not self-funding and eligible to have your care package funded, the social worker will arrange and support you to set up your care package. Even though your care package is funded by adult social care, you are still entitled to choose the care provider or care service.
The social worker should give you a copy of the preferred provider list, if you do not want to use a care provider or care service from the preferred provider list you can ask to use an alternative provider, as long as the care provider or care service can meet your needs (assessment of need). When a care provider or a care service is not on the preferred provider list, adult social care can still fund your care, this can be through a direct payment.
Under the Care Act 2014, a direct payment is also known as a personalised budget. Adult social care will make the direct payments to you direct or to an organisation to pay for your care package of choice. Direct payments give you flexibility and choice on how your care package is arranged.
Continuing Health Care Funding

Continuing Health Care (CHC) funding is when your care package is paid for by the NHS because you have long term and complex health and care needs. It is non means tested and free of charge if you meet the eligibility criteria. Eligibility for CHC funding is assessed in 2 stages: Stage 1 CHC Checklist and Stage 2 CHC Assessment
Stage 1 - CHC Checklist
This is a screening tool used to assess eligibility and to help determine if you should proceed to Stage 2 for a full Assessment. The CHC Checklist can only be carried out by a health and social care professional including a nurse, social worker or GP. It is made up of 12 domains including breathing, nutrition, mobility and continence. If the CHC Checklist is mostly positive, it will progress to stage 2 for a full Continuing Health Care assessment.
Stage 2 - CHC Assessment
A full CHC assessment is completed by a CHC Nurse Assessor at a multidisciplinary team meeting with health and social care professionals who are involved in your care. It uses a standardised tool called a ‘decision support tool’ (DST) to help make the decision and determine if you are eligible.
A decision support tool involves a comprehensive assessment and evaluation of your health and social care needs and the reviewing of evidence such as medical records, examinations and assessments.
If you are eligible for CHC funding, the NHS will pay for your care, they should also give you the option of having a personalised budget or direct payment.
If you have rapidly deteriorating health and care needs, your diagnosis is terminal or you are close to the end of life, you can apply for urgent CHC funding via a Fast Track Pathway.
When applying via a Fast Track Pathway there is no requirement to complete a CHC checklist, instead the health and social care professional involved in your care will complete a Fast Track Pathway Tool.
It you are not eligible for CHC funding you may be eligible for Funded Nursing Care which is when the NHS pays for the nursing element of your care home fees if you are in a care home and reside on a nursing unit. The NHS pays a flat rate directly to the care home for the nursing element of your care and adult social care, or you, pay the rest of your care home fees depending on your funding status.
If you have been detained in hospital due to your mental health, you may be eligible for 117 After Care which is free. To be eligible for 117 After Care you must have had treatment placed under section 3, placed under a hospital order, placed under section 37, placed under a transfer from prison under section 47 or 48, placed under a hospital direction under section 45A or placed on a community treatment order. Services funded under 117 after care include, health care, social care, housing, supported living, care home and medication.
Understanding the process of care assessments, funding options, and available support can help with the challenges of managing care and support needs. Whether you are self-funding or eligible for financial assistance through adult social care or NHS funding, it’s important to know your rights, the resources available to you, and the flexibility in choosing the right care providers. By staying informed, you can ensure that you or your loved one receives the care and support needed to live as independently and comfortably as possible
Below is a list of useful resources with further information and guidance.
Resources
Guide to continuing healthcare (CHC) funding - Dementia UK
NHS continuing healthcare (CHC) funding for people with Dementia
Sources of support Dementia UK
https://www.mind.org.uk/information-support/legal-rights/leaving-hospital/section-117-aftercare/