In the UK, healthcare is free at the point of use. Yet families face bills of over £1,000 per week for standard nursing care. That’s more than £50,000 a year, and many households are unprepared.
QUESTION: Why is this the case if healthcare is free?
ANSWER: Because it’s healthcare that’s free. Social care isn’t.
And though local councils can offer support, it is means-tested, and not everyone qualifies. Without careful planning, families can quickly face financial struggles, all while trying to ensure their loved ones get the care they need.
Contents
- Health Vs Social Care: What’s Free, and What’s Not
- Let’s Break Down the Costs
- Who Pays For Social Care in The UK?
- What Happens if you Run Out of Money?
- Other Situations Where You May Not Have To Pay
- Benefits That Can Help “Offset” Costs
- How To Plan Ahead for Care Costs
- In Summary
DISCLAIMER:
While I am a practising doctor, the information on this site is for educational purposes only. It does not take into account your personal circumstances, which can significantly affect medical decision-making and treatment. This content therefore does not constitute medical advice, and should not be relied upon for diagnosis or treatment. Always consult a qualified healthcare provider regarding any health concerns.
This article was written on the 15/09/2025 using up-to-date sources at that time. Please be aware that medical information and guidelines change often.
Health Vs Social Care: What’s Free, and What’s Not
Healthcare is covered by the NHS and free at the point of use:
- GP appointments
- Emergency care
- Hospital stays and treatments
- Prescriptions if you are exempt from paying
Social care covers personal and practical support for children, young people, and adults. Its main aim is to help people continue daily activities, like washing, dressing, and getting around at home. Examples include:
- Help at home from paid carers
- “Meals on wheels” – meals delivered to your door
- Home adaptations e.g. a stair lift
- Personal alarms and monitoring systems
- Assisted living, residential homes, and nursing homes
Quick fact: Many people assume home carers or care home fees are free – they are not.
Unlike healthcare, social care is usually not free. Local councils can offer financial support, but it is means-tested. This means they look at your savings, income, and sometimes property to decide how much you must pay. Not everyone qualifies for help.
Let’s Break Down the Costs
How Much Do Carers Cost?
The cost of home care varies depending on the type of care, location, and individual needs. In general:
- Hourly home care: Around £25 per hour for one carer
- Live-in care: Typically £800–£1,600 per week for one person
- Specialist care: Dementia or complex medical care can cost more
Quick Tip: Agency vs private carers.
A care agency employs carers and sends them to your home. It generally costs more as the agency handles recruitment, training, payroll, insurance, and compliance.
Pros:
- If a carer is sick or unavailable, the agency provides a replacement
- The agency ensures carers are qualified, trained, and checked
- You don’t have to handle payroll, taxes, or legal responsibilities
By employing a carer yourself (privately), you avoid agency fees, so it is generally cheaper. However, you become the legal employer. This means you must handle:
- Contracts and employment terms
- Tax, National Insurance, and payroll
- Insurance and liability
- Holiday and sick pay
How Much Does a Residential Home Cost?
Residential homes offer support with everyday tasks, such as washing, dressing, and getting around. They also provide all meals and help with daily routines.
Residential homes are suitable for people who need help with personal care but do not require 24-hour medical supervision.
How Much Does a Nursing Home Cost?
Nursing homes provide 24-hour nursing care from trained nurses. They are designed for people who:
- Need regular medical attention
- Have chronic conditions or disabilities
- Can’t be safely cared for at home but do not need hospital treatment
Nursing homes are more expensive because they provide round-the-clock medical care as well as everyday support and meals.
Who Pays For Social Care in The UK?
If you need care, the council may pay for some or all of your costs. Otherwise, you will generally be expected to self-fund (with a few exceptions – more later). Here’s how it works:
Care Needs Assessment
The council starts by looking at your care needs. You can arrange this by contacting your local adult social services.
If they agree you need help, they perform a financial assessment (a means test). It determines how much you can afford to pay.
The Means Test
This looks at:
- Your income (from pensions, any earnings). Certain types of income are ignored, such as disability benefits.
- Your capital (money in savings, investments, assets etc).
Quick Tip: If you need long-term care in a residential or nursing home, the value of your house will be included in this assessment UNLESS certain people are still living in it:
- Your partner
- A close relative who is 60 or older, or under 60 with a disability
- You have a child who is under 16
If you need care at home, the value of your house WON’T be included in this assessment.
Quick Tip 2: Some people give their house or assets away before the financial assessment. The council may see this as a deliberate “deprivation of assets” to avoid paying more. If this is the case, they may still include the value of assets you no longer have in this assessment.
How Your Savings Affect What You Pay
| Capital (savings, investments, assets) | How Much You Pay |
|---|---|
| Over £23,250 | You pay for all of your care (“self-funder”) |
| £14,250 – £23,250 | You get some help from the council. You pay: 1) a contribution from your income, plus: 2) a “tariff income” based on your savings |
| Less than £14,250 | You get help and may pay a contribution from your income. No tariff income is added. |
What Is a “Tariff Income”?
This is where the council assumes you earn a little from your savings.
For every £250 (or part of £250) you have between £14,250 and £23,250, the council adds £1 per week to your income. This is used in the financial assessment (means test). For every £250 over £14,250, the higher your presumed income, and the more you will have to contribute.
Example:
- Savings = £16,000
- £16,000 – £14,250 = £1,750 above the lower threshold
- £1,750 ÷ £250 = 7 → £7 per week added as “tariff income”
- You are treated as having an extra £7 a week income
Minimum Income Guarantee (MIG)
If you pay a contribution towards your care, the council can’t leave you with too little money each week. You have a guaranteed minimum income, so you have enough money for basic living costs, like food, heating, and other essentials:
- Single person above State Pension age MIG: £232.60/week
- Part of a couple where one or both of you is above State Pension age MIG: £175.55/week
Quick Tip: If you are a self-funder, the MIG does not apply. The MIG only protects people who are receiving council-funded support.
What Happens if you Run Out of Money?
If you are a self-funding your care, it’s possible over time that your money may run low. Here’s what happens:
- Council support may kick in
- Contact your council 3 months before you think your savings will drop below £23,250 and they will reassess
- Deferred payment scheme
- Useful if your savings are less than £23,250, and all your money is tied up in property
- The council will pay for your care home temporarily. You pay it back later, often from the value of your home (which can be after you pass away)
- 12-week property disregard
- If you move to a care home permanently, the council will not include the value of your home in the financial assessment initially. This lasts for the first 12 weeks. This gives you breathing space to either sell your home or arrange a deferred payment agreement
Quick fact: If council support doesn’t cover your care home fees, you may need:
- A top-up payment – families or friends can pay this to cover the difference.
- To move to a different home.
Other Situations Where You May Not Have To Pay
In some cases, your care may be covered by the NHS instead of the council. These situations are much less common, but they are important to know about.
Quick tip: If you live in Scotland, personal and nursing care costs are free if your local council deems you to need it.
NHS Continuing Healthcare (CHC)
This is a package of care paid for entirely by the NHS. It can be provided at home or in a care home.
It is for people with serious, complex, and ongoing medical needs. Examples include advanced dementia, a severe disability, or a terminal illness. To qualify, your care must mainly be about managing health problems, not just everyday support like washing, eating, or dressing.
If your health is getting worse quickly, you may qualify for a fast-track assessment. This applies, for example, if you have a terminal illness. With this pathway, care can be arranged within days rather than weeks.
If you are awarded CHC, your package will be reviewed after 3 months. It will then be reviewed at least once a year. If your needs change, you may unfortunately lose eligibility. f you think you may be eligible, speak to your healthcare provider or social worker.
Help After Hospital Discharge
If you have been in hospital, you may be entitled to free care for a short period after discharge. This support is designed to help you recover and get back on your feet.
It is usually for around 1-2 weeks, but can be up to 6. You need to be assessed by a MDT to see if you’re eligible. The plan will be put in place prior to discharge.
NHS-Funded Nursing Care
This is where the NHS pays for the nursing care part of the nursing home fee. You will still pay for the accommodation and personal care. The NHS pay the care home directly (and you will pay less overall). Unlike Continuing Healthcare, this is easier to qualify for.
Your local Integrated Care Board (ICB) can arrange the assessment. You can contact your local ICB directly (find yours here), or speak to your social worker or healthcare provider.
Section 117 Aftercare (Mental Health Act)
If you have been detained under certain sections of the Mental Health Act (e.g. section 3), you are entitled to free aftercare. This applies when you leave hospital, and can include things like supported accommodation and social care.
Benefits That Can Help “Offset” Costs
Certain disability benefits like Attendance Allowance, Personal Independence Payment (PIP), or Disability Living Allowance (DLA) can help pay for care.
These are not means-tested and can be used however you need – including to contribute toward care costs.
- Attendance Allowance (or Pension Age Disability Allowance in Scotland):
- If you’re state pension age (66) and have a disability or health condition that means you need someone to help look after you.
- Either £73.90 and £110.40 a week.
- Personal Independence Payment (PIP)
- If you’re under state pension age and need help due to a disability or long-term health condition.
- Between £29.20 and £187.45 a week.
- Disability Living Allowance (DLA)
- This is being replaced by PIP. If you were born before the 8th April 1948 and you’re already claiming DLA, you can keep doing so.
How To Plan Ahead for Care Costs
Care is expensive, and many families are caught off guard. While no one can predict the future, there are steps you can take now to reduce stress later.
- Understand the costs of care
- Home care: around £25 per hour
- Residential home: around £1,300 per week
- Nursing home: around £1,500 per week
- Consider family or friends
- Some people choose to rely on unpaid carers, like partners, children, or close friends.
- This can ease costs, but may not be practical. It’s worth exploring this with your loved ones, though.
- Check what benefits you’re entitled to
- Ask for a care needs assessment early
- Contact your local council as soon as you think you may need support.
- Consider your property
- For many people, their home is their biggest asset.
- Options include downsizing to release cash, or using equity release.
- Equity release is a type of mortgage that lets you unlock money tied up in your home without moving. Read more here.
- Explore care fee annuities
- An immediate needs annuity is a type of insurance product.
- You pay a lump sum up front. In return, you get a guaranteed income for life. This income helps cover care costs.
- These products are complex – always seek advice before committing. Read more here.
- An immediate needs annuity is a type of insurance product.
- Get specialist advice
- From a financial advisor who specialises in later-life planning to help make sense of your options.
- Charities like Age UK offer free and trustworthy advice.
In Summary
There’s a lot to take in here, but I felt it was important to cover. We don’t talk about the reality of care costs enough.
This article was inspired by a talk last week from my colleague, GP Dr Olivia Ward, who spoke about the realities of adult social care in the UK. This talk was eye-opening; though we know that care is complex and can be expensive, these costs are often much higher than we realise.
Here’s the bottom line: while healthcare is free at the point of use, social care isn’t.
With the average UK house price sitting at £291,000, selling your home would cover around 3.5 years in a nursing home. But according to the Office for National Statistics, women aged 65-69 who enter nursing homes live on average 7 years, and men 6.3 years. At older ages, the average is still 2-3 years. For many families, the maths simply doesn’t work – savings can run out very quickly.
So if people can’t afford to pay, who does?
If you learnt something from this article, spread the word. Start the conversation with those you care about. The sooner you start, the better prepared you and your loved ones will be to get the care you need, when you need it.
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