MHA or Care Act?

Dear colleagues,

I am kindly seeking for guidance within the Care Act 2014 if possible please give me the evidence within the act.

P is known to Mental health (MH) services, larger part of his life he has lived in residential care due to high level of MH needs: having said this he has always been on section 2 therefore not eligible for aftercare services and therefore contributes towards his social care needs.

In 2019, he was hospitalised on a medical ward for about 6 months and there after was deemed to have in additional to his MH needs, he needed a nursing care home as he was bed bound. Due to his close relationship with his family a nursing home was identified near the family members which meant it was out of borough therefore placed in borough B and borough A is paying and as well he contributes towards his care.

He has lived in this nursing home for 2yrs however one morning he woke up from his bed and started walking (after not walking since admission in this home… say about 2.4months). It was noted that since he is now mobile he is walking to other people and eating foods that he is not allowed to eat- he was on a pureed diet. He started eating things like biscuits and incidents of chocking were significant. His capacity is compromised around certain areas. The risk management plan agreed by the nursing home was 1:1 support to minimise the risk of getting foods that he is not allowed. A DoLS application was completed.

The nursing home is requesting for extra funding for the 1:1 as the risk to his physical health is high unless he remains on this level of support.


  1. Can this be identified as a new need that has developed in the last year since he started walking?

  2. Would this be assessed under the Care Act 2014?

3.Which borough is responsible to assess this need?

  1. Who is responsible of funding the request made by the nursing home?

Please i will appreciate some quotes from the act.

Kind regards


Social Worker MH services.

Quick question, has a CHC Decision Support Tool been completed? Worth checking as there will be some variations if funding is LA or Health.

From the info given, sounds definitely Care Act responsibility (no s117 aftercare duty). Unless CHC funded. Sounds like review needed in view of changed circumstances and local authority A is responsible through the ‘specified accommodation’ rules which replaced the deeming provisions of the previous legislation.


Thank you for advice.
Not sure CHC checklist or process has been completed: i will inquire.
If not yet who would complete this?
Still borough A?
Any reference to the policy or legislation would be helpful.

Thank you.
Once borough A completes the review and identifies this increase of needs, i envisage they will be due to physical health as opposed to MH: would borough B be responsible to fund it as it would be under the Care Act abd its a new need developed whilst under their “borough “.

From the information give, the resident remains ordinarily resident in local authority A as a result of the “Care and Support (Ordinary Residence) (Specified Accommodation) Regulations 2014”.
Care Act responsibilities remain with the borough of ordinary residence, so management of the placement will remain with local authority A, even if the person’s needs have changed since moving into the care home.
As stated previously, this assumes the person is not eligible for Continuing Healthcare.

1 Like

Thank you Steve, this is now clear and I highly appreciate.

Hello Esther as stated above responsibility will remain with LA A. They will need to take the lead in completing a re-assessment. When I have used the DCT, I am looking for triggers that the care required goes above and beyond what a Local Authority would typically provide. There is quite a substantial body of caselaw that examines at what point care shifts from what has been coined ‘ancillary and incidental’ to health care. You could start here for some information

Then have a look at here NHS continuing healthcare decision support tool guidance - GOV.UK

Basically look at the care domains within the DCT, and consider if the needs cross the threshold into a primary health need. What this would then mean is that the LA is no longer liable for covering the costs of the care, and where the service user has been paying contributions, these would also stop.

Thank you and much appreciated: i will have a read.