Health and care planning in later life

Health in later life is not a single question with a single answer. In England, the Care Act 2014, its statutory guidance and the NHS continuing healthcare framework each cover different parts of it, and a care plan is the document where those parts are brought together for one person. The practical task is to record what a person needs, who is responsible for meeting it, and what happens when health changes.

What does health mean in a care and support plan?

A care and support plan under the Care Act 2014 must cover the person's needs and how they will be met, the outcomes the person wants to achieve, and the personal budget available. The statutory guidance issued with the Act (Department of Health and Social Care, Care and Support Statutory Guidance, updated 2024) treats health as one strand among several, alongside daily living, safety, social contact and work or learning. A plan that lists only medical conditions is incomplete, because it leaves out the routine that keeps a person well: meals, movement, sleep, medication, and the people around them.

Health needs also sit with the NHS. Where a person's primary need is a health need, NHS continuing healthcare may fund the whole package, and the decision rests on a multidisciplinary assessment rather than on any single diagnosis. A local authority plan and an NHS continuing healthcare package can run side by side, but they are separate legal routes with separate decision makers. Recording which route applies, and on what date the decision was made, prevents confusion later.

Health is not only a clinical matter. In France, the same questions are handled through a different structure, and a French care home site describes how daily life, admission and costs are organised for residents and families, including care home health routines such as meals, activities, fall prevention and personalised support. The comparison is useful because it shows that the underlying tasks, recording needs, naming responsibilities and reviewing decisions, are similar even where the law differs.

How should a plan record changing health needs?

A plan is a living document. The Care Act 2014, section 25, requires the local authority to keep the plan under review, and the statutory guidance says reviews should take place at least annually, or sooner if circumstances change. A change of health is a trigger for review, not a reason to wait for the next scheduled date.

In practice, a reviewable record has four parts. First, the current need, described in plain terms: for example, help with washing and dressing because of reduced grip. Second, the outcome the person wants: to wash without pain, or to keep a weekly bath. Third, who will provide what, with a name and an organisation rather than a job title alone. Fourth, the date of the last review and the date of the next one.

Medication is a common gap. The plan should state who orders repeat prescriptions, who collects them, who checks that the dose matches the label, and what happens if a dose is missed. Where a person manages their own medication, the plan should say so, and say what support is available if that changes.

Falls are another common gap. A plan can record whether a falls assessment has been carried out, what changes were recommended, and whether they have been made. The National Institute for Health and Care Excellence (NICE) publishes guidance on falls in older people (NICE guideline NG249, published 2022), which sets out assessment and prevention measures. A plan that names the assessment and its date is easier to review than one that says only that the person is at risk.

Who decides when health and social care overlap?

Where a person has both health and social care needs, more than one organisation is involved, and the plan should say who leads. The Care Act 2014, section 6, allows the local authority to delegate functions, and section 75 allows partnership arrangements with the NHS. The statutory guidance describes how a lead professional can be agreed so that the person and their family have one point of contact.

A lead professional is not the same as a decision maker for every question. The local authority decides eligibility for care and support under the Care Act. The NHS decides continuing healthcare eligibility. A GP decides clinical treatment. A plan that blurs these lines creates disputes that are hard to resolve, because no one can say who was responsible for what.

For families, the practical step is to ask for the decision in writing, with the date and the name of the body that made it. A short letter or email confirming the outcome is enough. Where a decision is disputed, the statutory guidance sets out the local authority's complaints procedure, and the NHS has a separate complaints route. Keeping the two routes distinct saves time.

What can families do before health needs increase?

Preparation is mostly about information. Under the Care Act 2014, a person has a right to an assessment of their needs, and a carer has a right to an assessment of their own needs. These are legal rights, not discretionary favours, and they can be requested at any point.

Three documents are worth preparing in advance. A record of current medication, including doses and who prescribes them. A record of who to contact in an emergency, with names and telephone numbers. A note of the person's preferences about daily routine, food, sleep and religious observance, because these are the details that are hardest to reconstruct in a crisis.

Advance decisions about treatment are governed by the Mental Capacity Act 2005, and a valid and applicable advance decision to refuse treatment is legally binding. The plan should record whether such a decision exists, where the document is kept, and who holds a copy. This is not the same as a general statement of wishes, and the difference matters when a decision has to be made quickly.

How is a plan reviewed and kept up to date?

A review should produce a dated record, not a conversation. The statutory guidance expects the local authority to consider whether the person's needs have changed, whether the outcomes are being met, and whether the personal budget is still sufficient. The person, and anyone they ask to be involved, should receive a copy.

A simple review note can be short. It can state the date, who took part, what has changed, what will change in the plan, and the date of the next review. Where nothing has changed, the note should say so, because a record of no change is still a record.

Where a person lacks capacity to take part in the review, the Mental Capacity Act 2005 requires a decision to be made in their best interests, and the plan should name the person who made that decision and how they reached it. An independent mental capacity advocate may be appointed in certain cases, and the plan should record whether one was involved.

What records should be kept, and for how long?

Records belong to the person as much as to the organisation. A family can keep copies of assessments, plans, review notes and decision letters. There is no legal limit on how long a family keeps their own copies, and having them to hand shortens later discussions.

Organisations keep records under their own retention rules, and a request for a copy can be made under the Data Protection Act 2018 and the UK General Data Protection Regulation. The Information Commissioner's Office publishes guidance on subject access requests, including the one month time limit for a response. A request does not need a reason, and it does not need a particular form.

A short set of records, kept together and dated, is the most useful thing a family can hold. It turns a series of conversations into a history that can be checked, and it makes the next review faster for everyone involved.

Sources read for this page: legislation.gov.uk, gov.uk, nice.org.uk, legislation.gov.uk, read on 15 September 2026.