Complete guide to NHS social care integration in the UK — hospital and local council coordination, discharge to assess, Continuing Health Care (CHC), social care funding, Better Care Fund, and integration software.
The UK spends £25 billion on adult social care and £9 billion through the Better Care Fund. Integration between NHS and social care is critical for reducing DTOCs and improving patient outcomes.
NHS-Social Care Integration Components
| Component | Description | Funding |
|---|---|---|
| Better Care Fund (BCF) | Pooled NHS + local authority budget | £9B/year |
| Discharge to Assess (D2A) | Assess care needs at home, not hospital | Part of BCF |
| CHC | Fully-funded NHS care for complex needs | £4B/year |
| Social care funding | Means-tested council-funded care | £25B/year |
| Integrated care records | Shared records across health and social care | ICS investment |
| Joint commissioning | ICB + council jointly commission services | ICS level |
| Care Act assessments | Needs and financial assessments | Local authority |
CHC Assessment Process
- Initial screening: NHS CHC checklist completed by hospital or community staff
- Decision Support Tool (DST): Full multi-disciplinary assessment using DST
- Domains assessed: 12 care domains (behaviour, cognition, communication, mobility, nutrition, etc.)
- Eligibility decision: Primary health need determined by MDT
- Personal health budget: If eligible, patient can choose personal health budget
- Review: Annual review of CHC eligibility
- Fast-track: Rapid CHC for end-of-life patients (within 48h)
Hospital-Council Coordination Actions
- Embedded social workers: Social workers based in hospital discharge teams
- Joint discharge planning: NHS + social care plan discharge together from admission
- Shared care records: NHS and social care access same patient record
- Single assessment: Combined NHS and social care assessment (not separate)
- Pooled budgets: Joint funding for complex cases
- Care home register: Shared register of approved care homes with availability
- Discharge funding: BCF funds discharge support and interim care
Frequently Asked Questions
- What is the Better Care Fund (BCF)?
- The BCF is a pooled budget of £9 billion shared between NHS and local authorities to integrate health and social care. It funds: discharge support, community services, prevention, and care coordination. BCF requires joint plans between ICBs and local authorities, with shared outcomes and pooled budgets.
- What is NHS Continuing Health Care (CHC)?
- CHC is fully-funded NHS care for adults with complex, ongoing health needs. Eligibility is determined by a structured assessment of care needs. CHC covers care home fees, home care, and equipment. 60,000 people receive CHC in England, costing £4 billion annually. Delayed CHC assessments are a major cause of DTOCs.
- How much does the UK spend on social care?
- The UK spends £25 billion annually on adult social care. 1.5 million people receive social care support. Social care is means-tested — only those with assets below £23,250 receive full funding. The funding gap between NHS and social care creates discharge delays and bed blocking.