Understanding the care system: a family guide
The care system involves multiple organisations, assessments, and processes that can feel overwhelming when you're already under pressure. This guide gives you a plain-English overview of how it works and what your family is entitled to.
Why the care system feels so complicated
The care system in England is not a single, joined-up service. It involves local authorities, the NHS, private providers, and a range of voluntary organisations — each with different responsibilities, funding rules, and processes. Understanding who does what, and when, is the first step to navigating it with confidence.
The key organisations involved
Your local authority (council) is responsible for assessing social care needs and arranging or funding care for eligible people. The NHS is responsible for healthcare — including GP services, hospital care, community nursing, and NHS Continuing Healthcare funding for those with complex health needs. Care Quality Commission (CQC) is the independent regulator that inspects and rates care homes, home care agencies, and other care services in England. Their inspection reports are publicly available and a useful starting point when researching providers. Private care providers — care homes and home care agencies — deliver the majority of day-to-day care, whether funded by the local authority, the NHS, or the individual themselves.
The care needs assessment
Anyone who appears to need care and support has a legal right to a care needs assessment from their local authority — regardless of their financial situation. The assessment looks at what a person can and cannot do, how this affects their wellbeing, and what outcomes they want to achieve. It is carried out by a social worker or care assessor and should involve the person themselves, and ideally a family member or advocate. The assessment determines whether the person is eligible for local authority support under the Care Act 2014. Eligibility is based on whether their needs meet the national threshold — not simply on age or diagnosis.
Financial assessment and means testing
If a person is found eligible for care, the local authority will carry out a financial assessment (means test) to determine how much — if anything — they will contribute towards the cost. In England, if a person has savings and assets above £23,250 (including property, in most cases), they are expected to fund their own care. Between £14,250 and £23,250, they receive some local authority support. Below £14,250, the local authority funds care in full (though a contribution from income may still be required). These thresholds apply to residential care. Home care is assessed differently, and the family home is generally not counted if a spouse or dependent still lives there.
NHS Continuing Healthcare
NHS Continuing Healthcare (CHC) is a package of ongoing care arranged and fully funded by the NHS — meaning there is no means test and no charge to the individual. It is available to adults who have a 'primary health need': where their overall care needs are driven primarily by their health condition rather than social care needs. CHC is often misunderstood and frequently under-assessed. Many families are not told about it, or are wrongly told their relative does not qualify. If your relative has complex health needs — including advanced dementia, neurological conditions, or requires significant nursing care — it is worth requesting a CHC assessment explicitly.
Your rights throughout the process
The Care Act 2014 gives individuals and families a number of important rights. You have the right to a care needs assessment — the local authority cannot refuse this. You have the right to be involved in the assessment and care planning process. You have the right to request a review of the assessment if you disagree with the outcome. You have the right to choose your care provider, within the local authority's usual cost limits. You have the right to a personal budget — a clear statement of the funds available for your care. And you have the right to an independent advocate if you have difficulty being involved in the process.
When things go wrong
Assessments are sometimes carried out poorly, eligibility decisions are sometimes wrong, and families are sometimes not told about options they are entitled to. If you disagree with an assessment outcome or a funding decision, you can ask for a review, make a formal complaint to the local authority, or escalate to the Local Government and Social Care Ombudsman. For NHS CHC decisions, there is a separate appeals process through the Integrated Care Board. Navigating these processes is easier with support — an independent care advocate can help you understand your options, gather evidence, and represent your family's interests.
Need help navigating the system?
Understanding your rights is one thing — putting them into practice is another. We help families across Devon get the assessments, funding, and care they're entitled to. A free 30-minute consultation is a good place to start.