NHS, council, or you — understanding who does what

One of the most confusing parts of the hospital discharge process is working out who is actually responsible for arranging care when your relative leaves. The NHS? The council? You? The answer is: it depends — and this guide untangles it.

Understanding who's responsible upfront saves days of delay, missed calls between departments, and the anxiety of feeling like no one is handling it.

The three pathways — at a glance

SituationWho is responsiblePatient has a primary health need (medical care)NHS — via NHS Continuing Healthcare fundingPatient needs social care support and has low savingsLocal authority (Adult Social Care)Patient is self-funding (savings above £23,250 in England)Family or patient, with support from the hospital discharge team

Most families fall into a combination of these — and in the immediate discharge period, the NHS often steps in with short-term Reablement or Intermediate Care regardless of longer-term funding arrangements.

The hospital discharge team — your first point of contact

Every NHS hospital has a discharge coordination function. Depending on your trust, this may be called the Integrated Discharge Team (IDT), the Discharge Coordination Unit, or simply the discharge team. They typically include:

Discharge coordinators (often nurses or allied health professionals)
Social workers (seconded from or employed in collaboration with the local authority)
Occupational therapists (who assess home safety and equipment needs)

The discharge team is responsible for ensuring a safe plan is in place before a patient leaves. They are the right people to ask about timelines, assessments, and what is being arranged.

Who to ask for: If you're unsure who to contact, ask the ward nurse to put you in touch with the discharge coordinator for your relative's ward.

When the NHS arranges — and pays for — home care

The NHS funds home care in two main circumstances:

1. NHS Continuing Healthcare (CHC)

If a person's primary need is for health care — not just social care — they may qualify for NHS Continuing Healthcare. This is a package of care fully funded by the NHS, including home care, paid for by the local Integrated Care Board (ICB).

CHC is assessed using a Decision Support Tool and a multidisciplinary team meeting. If your relative has complex, unpredictable, or intense health needs — for example following a stroke, a serious fall, or living with a progressive neurological condition — they should be considered for CHC before discharge.

Families often don't know to ask for this. If you believe your relative may qualify and no assessment has been offered, ask the discharge team to initiate a CHC checklist assessment.

2. Short-term NHS-funded support (Reablement or Intermediate Care)

Regardless of longer-term funding, many patients are offered up to six weeks of free, short-term care following hospital discharge. This is called Reablement (focused on regaining independence through supported practice) or Intermediate Care (bridging support while a longer-term plan is put in place).

This short-term support is funded by the NHS and provided either by NHS community services or by contracted home care agencies. The family does not typically choose the provider during this period, though they can raise concerns if the care isn't suitable.

After the Reablement period, the patient is reassessed and a longer-term care package arranged — at which point funding responsibility may shift to the local authority or family.

When the local authority (council) arranges and funds care

If your relative's needs are primarily social — help with personal care, meals, domestic tasks, or getting around at home — and they don't qualify for NHS CHC, the local authority's Adult Social Care team becomes responsible.

They will carry out a Needs Assessment (under the Care Act 2014) and, if eligible, a Financial Assessment (means test). If the patient's savings are below £23,250 in England (this threshold is under ongoing review), the council will fund some or all of the care. Above that threshold, the individual is expected to contribute or fully fund their own care.

The local authority then commissions care from approved providers, or in some cases issues a Direct Payment so the individual can arrange their own care.

Important: there is often a significant wait for local authority assessments and commissioned care to be arranged. If your relative needs care immediately, you may need to bridge this period with privately arranged care — which is where finding a CQC-registered provider yourself becomes important.

When the family arranges and funds care (self-funding)

If your relative's savings and assets are above the local authority threshold, they will be expected to fund their own care. This means the responsibility for finding and arranging a home care provider falls to the family or the individual themselves.

The hospital discharge team can provide general guidance and may have a list of local providers, but they are not resourced to carry out a detailed search on your behalf.

Self-funders have the full market open to them — both registered agencies and (with appropriate checks) individual private carers. The key is to ensure any provider you engage:

Is registered with the CQC (for agencies) — check the CQC website or use Care-AI-UK
Has valid Employers' Liability and Public Liability insurance
Carries out DBS (Disclosure and Barring Service) checks on all carers
Has a written complaints and safeguarding policy

Care-AI-UK's platform includes only CQC-registered agencies and DBS-checked private carers, and shows verified reviews alongside CQC ratings so you can compare with confidence.

What the discharge team can and can't do

Understanding the discharge team's limits helps manage expectations and prompts the right questions:

They can:

Coordinate the discharge timeline across departments
Refer to Adult Social Care for a Needs Assessment
Initiate a CHC checklist screening
Arrange short-term Reablement or Intermediate Care
Advise on equipment and community health follow-up
Provide a list of local home care agencies

They can't:

Choose a care provider for you in the long-term
Guarantee a specific start date for council-commissioned care
Override a family's preference for a specific provider (where self-funding)
Make clinical decisions about whether care is medically necessary

A practical timeline of who does what

Days 1–3: Hospital discharge team coordinates assessment. Social worker allocated if needed. CHC screening initiated if appropriate. Reablement or Intermediate Care arranged.

Day of discharge: Short-term care package starts. Equipment delivered. Discharge summary sent to GP.

Weeks 1–6: Reablement or Intermediate Care provided. Patient assessed for ongoing needs.

Week 6 (approx.): Longer-term funding and care arrangement agreed. If self-funding, family confirms ongoing provider. If council-funded, Adult Social Care commissions ongoing care.

What to do right now if you're waiting for the council

If your relative needs care before the local authority assessment or commissioned care begins, you have three options:

Ask the hospital to arrange short-term Reablement. This is the fastest and most straightforward route and is free.
Arrange a private carer for the short term. This can often start within 24–48 hours through a CQC-registered agency. Care-AI-UK can match you to available providers near you immediately.
Apply for a Direct Payment from the council. This takes time to set up, but may be an option if the council accepts responsibility but you want to choose your own provider.

Next steps

Not sure which pathway applies to your relative? Use Care-AI-UK's free matching service to find CQC-registered providers in your area — or read the next article in this series for a full explanation of NHS Continuing Healthcare and how to apply.

Find verified home care near you →

In this series:

Who Arranges Home Care When Someone Leaves Hospital?