When social care pulls out but health care won't step up

Hi all,

I posted the other day asking for some information regarding a situation currently ongoing within my family, but I’m curious about something else…

Does anyone here have any idea what happens if a disabled person falls out of eligibility for social care (due to increased needs) but doesn’t yet meet the criteria for care funding through the NHS/CHC?

Who funds the care that’s been in place if the local authority want to wash their hands of it due to budgeting but the NHS won’t pick up the slack? Are the local authority obligated in any way to maintain funding until the person in question meets the criteria for CHC?

If anyone has any experience or advice on this issue, I would love to hear from you.

Hi Jenne … a very good question.

The clues lies within several threads as to the true state of caring in 2019.

( Care Act , 2014 … obligations to provide care … number of cases referred to the PHSO increasing … restoration of care
packages usually the end result … trouble is , how many cut care packages are referred to the PHSO ??? )

If the LA cutbacks are reducing the level of care … through Direct Payments and Personal Budgets … who is picking up the slack ?
Either we are or the caree goes without … a few may have the resources to pay for extra care themselves.

( Hospital discharge thread … relevant … street name " The Dumpster thread " as you will read : https://www.carersuk.org/forum/support-and-advice/new-to-the-forum/please-tell-us-about-your-experiences-of-hospital-discharge-31980?hilit=chc%20rstioning … many more carers taking on nursing and doctoring duties. )

That’s my simple deduction … born out by both the recent Carers UK State of Caring report and by AGE UK.

( I’ll post links for you to explore if so required. )

No CHC / Continuing Healthcare …is there an alternative … not quite but near to ?

Yes … NHS Nursing Funded Care.

Main CHC / Continuing Healthcare thread :



( Follow the colour. )

I have also added a couple more sections which are relevant here :



I have tried to keep the answer fairly simple … I hope it assists ?


Green Paper thread : https://www.carersuk.org/forum/support-and-advice/all-about-caring/social-care-funding-green-or-red-herring-paper-various-schemes-and-utter-madness-all-together-in-this-thread-32659

Contains the main arguments on the future … our role a recurring theme … as is our way forward.

Only recently , 8.8 MILLION of us … all figures used 6.5 / 7.8 million … that £ 140 BILLION we save the taxpayers … should now
be both HIGHER and INCREASING at a fastest rate !

( 10 MILLION in sight …only question is when … by … March 2021 … cutbacks are STILL increasing ? )

The words BLOOD / STONE / SLAVE … aren’t going away anytime soon.

Hi Jenne,
From the experience of ourselves and friends, it seems social care have to keep funding care until a funding formula is agreed, at one point, S was funded 40% by health 60% by social care.



it seems social care have to keep funding care until a funding formula is agreed,

The Government web site … 2106 … for the full sp on the background :

New research into funding for adult social care published - GOV.UK

Review of Adult Social Care Relative Needs Formulae | PSSRU

Logical question now to ask … " How it is working in practice ? " … especially when the LAs are being starved of cash ?

Enter the post code lottery … and the north / south divide ???

( Back to Jenne’s first posting … health / social care … and … who gets to define which is which ???
Curtain call for that Green Paper thread … again ??? )

Google “Continuing Healthcare Grogan Case” or look at “nhs care info”. The judge made it clear there should be no gap in the middle.
Can I ask what is the matter with the person concerned?

Grogan ?

Main CHC / NHS Continuing Healthcare thread … link posted earlier … again … section colour coded :


Another section if " Grogan " kicks in here :

Coughlan and Grogan cases … how to use them.



it is something for the local authority/social services and continuing healthcare CCG to remedy between themselves,

Recurring theme throughout this thread … and others … health / social care … boundaries … two different systems ?

Dare I mention that Green Paper thread again ???

This is exactly my issue , as their illnesses and disabilitys progress, and of course aging, my carees are getting worse and worse.
They are needing more and more care, but it is just not available, they do not qualify for CHC, but are not entitled to any more care although they need more care.

Who is responsable for ensuring my carees get more help, There should be a CHC test when discharged from hospital, just discharged with no extra help.

The social worker, no help whatsoever, the G.P. should the G.P. be helping?

I can see my carees struggle every day and do the best to help, but they clearly need more care or a CHC package.


If the LA cutbacks are reducing the level of care … through Direct Payments and Personal Budgets … who is picking up the slack ?

Either we are or the caree goes without … a few may have the resources to pay for extra care themselves.

Like a permanent black cloud over this thread ?
( Quite a bit on the running battle between The Government and the LAs in the main LA FINANCIAL MELTDOWN thread : https://www.carersuk.org/forum/news-and-campaigns/latest-caring-news/las-financial-meltdown-nationwide-support-services-cuts-council-tax-rises-arrears-31688?hilit=la%20cutbacks : I doubt if many readers , having read some of the articles ,
would have much sympathy for the Government … the comments of Joe Anderson , Mayor of Liverpool , typically potent , and extremely apt ? )

That is exactly the problem my carees have, the service is cut and they are simply told to pay for it.

The cleaning has been cut, we don’t do that any more, we suggest you get a cleaning company to clean your house- £40 a week.

The specalist disabled transport has been cut, instead of a couple of pound for a journey, it can be 20 pound to go the doctors and back for a taxi.
Shopping used to be provided but has been cut, pay someone to do your shopping, but if you have a limited budget how can you pay someone? you can’t.

And paying for extra care on basic benefits just impossible.

I am by providing free care/help and support saving my carees hundreds of pounds a year. But they just cannot afford the hundreds a year, forget savings to fall back on many have debts.

But it should not be me cleaning the house, its not my house, it should not be me taking disabled to the doctors and back, it should not be me taking and helping my carees with shopping.
It should not be me providing night care, this should all be provided by Social Services.

Sorry if i have hijacked this thread but this is the problem, my carees need more help, instead of providing more help, services are cut making an already difficult life more difficult.

Social services are cutting the lifeline, i like many thousands are rejoining it providing this essential support and it is essential to carees but at the expense of our health.

Yep … a common theme that even Carers Uk have finally discovered for themselves through their annual State of Caring
survey … in essence , a regurgitation of reports / articles posted under several threads constantly since I returned in
September 2016.
( Even then , the results are somewhat watered down due to the limited survey sample , and virtually excluding input from
potentially half the carer army who do not have regular Internet access. )

Your not alone , Londonbound … nor are the problems you are facing detracting from the theme of this thread !

The burden is increasing on us , almost daily !

No wonder so many carers are having to give up whatever work to care … flies directly in the face of anyone out there who
purports to support carers to juggle work with caring !

Even that one strand of the mythical safety net … food banks … is limited !



Yep … basics are spelt out … in plain English … in the bible for hospital discharges :


Being discharged from hospital,

Each hospital has its own discharge policy. You should be able to get a copy from the ward manager or the hospital’s Patient Advice and Liaison Service (PALS).

Once you’re admitted to hospital, your treatment plan, including details for discharge or transfer, will be developed and discussed with you.

A discharge assessment will determine whether you need more care after you leave hospital.

You should be fully involved in the assessment process. With your permission, family or carers will also be kept informed and given the opportunity to contribute.

If you need help putting your views across, an independent advocate may be able to help.


What’s meant by minimal or complex discharge ?
If the discharge assessment shows you’ll need little or no care, it’s called a minimal discharge.

If you need more specialised care after leaving hospital, your discharge or transfer procedure is referred to as a complex discharge.

If you need this type of care, you’ll receive a care plan detailing your health and social care needs.

You should be fully involved in this process.

A care plan should include details of :

the treatment and support you’ll get when discharged.

who will be responsible for providing support and how to contact them.

when and how often support will be provided.

how the support will be monitored and reviewed.

the name of the person co-ordinating the care plan.

who to contact if there’s an emergency or things do not work as they should
information about any charges that will need to be paid (if applicable).

Find out more about care and support plans

You’ll also be given a letter for your GP, providing information about your treatment and future care needs. Give this letter to your GP as soon as possible.

Being discharged from hospital - NHS

Every time I post that link , I add those magic words … BY THE BOOK OR … NO DISCHARGE !


I can honestly say I have never met a discharge team/discharge nurse in my life, I did actually talk to one discharge nurse on the telephone, I also stuck a letter in the Pals box on the main desk.

Completely totally ignored, it was agreed that my caree needed night care, was there anyone who could stay with them NO.
Social Services don’t do night care, sent home anyway.
All the hospital do when discharging is go back to the same care plan.

The hospital think right the care is arranged and that’s that, doesn’t matter that the patients needs aren’t met, we have a clear bed.

Basically I the unpaid carer don’t exist, I was never offered a carers assessment, requirements of the discharge. But I was the one who had to provide the extra care.

Complain, contact PALS, nothing happened, go to the Ombudsman, all takes time and energy which as a clapped out exhausted unpaid carer you don’t have.

I didn’t know about discharge rules until I joined this forum and I am sure a lot of others don’t, you expect the 5 star rated CQC inspected hospital to do the right thing, follow the rules, it is clear they don’t.

I just wish there were more like you out there Londonbound, you clearly show a passion and love what you do.

Mums care agency has become greedy beyond bounds, they keep taking on more clients without the staff to cope. The carers talk to me all the time and are disillusioned, they are often expected to do two calls at the same time. My problem is that without them, Mum will end up back in a nursing home, so we put up with it.

In answer to the question posted, it’s so scary that Local Governments are running out of money for Social Care, will dig there heels in and do everything to not pay out.

I personally think the whole Local Government experiment is a failure, postcode lotteries and corrupt officials, Directors of Local Government earning more than the Prime Minister…High pensions and ridiculous redundancy pay outs…

In my time in Local Authority I witnessed a Chief Executive earning £150,000 a year, then putting himself up for voluntary redundancy and getting a £250,000 pay off for 18 months work. The leech took around 1000 elderly peoples care away without batting an eyelid.

Sorry this is my rant, I have seen Council money wasted in such extreme ways it makes me angry to hear a Council say they can’t afford this!!!

Care Act Statutory Guidance 5.25
“Sections 18 and 20 of the Care Act sets out when a local authority must meet a person’s eligible needs. They place duties on the local authority. If the circumstances described in the sections apply and the neneds are eligible, the local authority must meet the needs in question.”

Yep … plain as day.

Trouble is , those complaints to the PHSO , when LAs breach that bit , are NOT increasing … best guestimate ?

1 in every 10,000 breaches ?

Who knows beyond the clues within reports published under several threads here on this forum ???

( That Should / Would / Could act again … only effective IF it is enforced … and there is no enforcer , on a case by case basis , around ! )

( Enforcer ? That means the individual … everyone else ain’t interested … except for the PHSO !!! )

I don’t think the Care Act has made any difference, my caree/carees are eligible for support and do get support but minimum support.

Many have been disabled since birth and these disabilitys get worse and worse- more care, more help, support needed, but this just isn’t taken into account.
Off the record I was told that many of the services have just been cut and are very difficult to access, you have to have the right criteria, what is the right criteria? don’t know.
So yes you need the service but are not entitled to the service.

The council has contracted out the care to private care companys paying the minimum wage and carers with little or no experience training etc.
You have new carers who know nothing about complex issues cerebral palsy, never heard of it.

It takes time to build up a trusting relationship, then the carer leaves and you have to explain it all again.
The council should be thinking about wellbeing and providing services to prevent and delay needs.

Wellbeing means getting looked after properly, high quality care, good nutrition, being able to go out and about in the community, having extra support when things go wrong, at crisis time, or preventing crisis.

There should be help for unpaid carers, thinking about their health and welfare, access to help and support, regular breaks, respite, advocacy, a life on ones own.

There just isn’t any of that, the care and support is cut and someone has to take up the slack-unpaid carers, but what if there is no unpaid carer.

Carees are literally stuck at home, day after day, unable to live any life, living on simple meals as the carers don’t have time to cook a proper meal, lonely, isolated.

Even the voluntary sector which provides vital support for the disabled/elderly, has been cut, specalist services been cut, specalist disabled transport has been cut, the bus service has been cut.

10 years ago, my carees were receiving good quality services, able to go out and out about, were happy and as healthy as expected.

Now they are heavily dependent on unpaid carers, friends and neighbours for support.

Complaints , my caree put in a complaint, sent recorded, never received any responce, you are expecting someone elderly disabled to fight social services when they can barely make a cup of tea.

And where is the help for complaints, the days of having a support worker to help with issues are long gone again been cut.

Should / Would / Could act … just the last rites needed … that thread for the true diehards left in our ranks : https://www.carersuk.org/forum/news-and-campaigns/latest-caring-news/care-act-2014-should-could-would-act-2014-r-i-p-27850?hilit=care%20act%202014 … 19 short of 15,000 views … anyone disagree with
the conclusion ???

In short , if family / kinship continue to care … and continue to pick up the slack … all parts of the social care system will
be happy … and so will Government … by not having to look to the taxpayers ( Who tend to get each successive Government
elected ) to put their hands in their pockets to provide us with little more than meagre rations for saving everyone else

The usual sticking plaster policies persued by our supporting organisations … for a gaping wound … none of which address the
issue of perceived poverty for low millions just because they care for family members … " It’s your duty ! " … a constant cry
of the ignorant over the decades … conducted not from the front line trenches , but from ivory towers miles away.

A vicious reality that carers , themselves , can only break collectively.

Perhaps , one day , the word HUMANITARIAN be be added to our plight … just as I have added that word to food banks ?