Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. Care Act 2014, c. 23. Available at: https://www.legislation.gov.uk/ukpga/2014/23/contents
3. Department of Health and Social Care. Care and support statutory guidance. Available at: https://www.gov.uk/government/publications/care-act-statutory-guidance
4. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains the difference between NHS care and local authority care in England for someone encountering the system for the first time. It covers who provides what, the fundamental difference in charging, how to tell which system you are dealing with, who to contact, why the boundary matters, and where NHS Continuing Healthcare sits between them.
NHS care and council care: what is the difference
Two separate systems provide care in England, run by different organisations under different laws with completely different rules about payment. Almost every difficulty families encounter starts with not knowing which one they are in.
Two systems, not one
The NHS provides healthcare, funded from general taxation and free at the point of use. Local authorities provide social care under the Care Act 2014, and they are permitted to charge for it. These are different organisations, with different budgets, different assessment processes and different rules. Nothing about the system announces which one you are dealing with.
The charging difference
This is the difference that matters most. NHS care is free. Council care is means tested, so a person with capital above the threshold set by government pays the full cost, and income is also taken into account. The same person with the same needs can therefore pay everything or nothing depending on which system is responsible.
Who provides what
The NHS provides GP services, hospital care, district nursing, therapy services, mental health services and palliative care. Local authorities arrange care homes, home care, day services, equipment, adaptations and support for carers. In practice the two overlap constantly, particularly for someone with both health and personal care needs.
How to tell which you are in
Ask who is arranging and paying. If you have been asked about savings, income or property, you are in the council system, because the NHS never means tests. If a financial assessment has been carried out, that is local authority charging. If nobody has mentioned money at all, ask, because assumptions get made quickly.
Who to contact
For the NHS side, the GP is the usual starting point, and for continuing healthcare specifically the Integrated Care Board's continuing healthcare team. For the council side, adult social care at the local authority, requesting a needs assessment. You can approach both, and where the position is unclear that is often the sensible course.
Where NHS Continuing Healthcare sits
It sits exactly on the boundary. Where a person's needs are primarily health needs, responsibility falls to the NHS and the care is free, including accommodation in a care home. Where they are not, the council route applies with means testing. That is why the assessment matters so much financially and why it is worth pursuing properly.
Key takeaway
The NHS never means tests and the council does. If you have been asked about savings or property, you are in the council system. Where health needs are substantial, ask about NHS Continuing Healthcare, because the boundary between the two systems is often worth the whole cost of care.
Add a Title
Add paragraph text. Click “Edit Text” to update the font, size and more. To change and reuse text themes, go to Site Styles.
Add a Title
Add paragraph text. Click “Edit Text” to update the font, size and more. To change and reuse text themes, go to Site Styles.
Frequently asked questions
Is all care free on the NHS?
NHS care is free at the point of use, but most long-term care is arranged by local authorities under the Care Act and is means tested. Which system applies depends on the nature of the person's needs.
How do I know which system we are in?
Ask who is arranging and paying. If anyone has asked about savings, income or property, you are in the council system, because the NHS never carries out financial assessments.
Who should I contact first?
The GP for the NHS side and adult social care at the local authority for the council side. Where the position is unclear, approaching both is sensible rather than confusing.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.