The short answer
- The two are not alternativesA package at home can have NHS nurses doing the clinical part and a carer doing the rest of the day. The question is which task sits where.
- A carer can take on a healthcare task once a nurse has trained and signed them offThat is called a delegated healthcare activity. The nurse who delegates it stays accountable for the decision and keeps the clinical review.
- Some things are never delegatedClinical assessment and care planning stay with the nursing team, along with most injections, medicine given through a line, and wounds that need assessing.
- The nursing is NHS care and is freeHourly carers on PrimeCarers charge £18 to £25 an hour with our fee included, and where the main need is health rather than daily living, the NHS can fund the whole package.
PrimeCarers introduces self-employed carers. It does not employ nurses, provide nursing care, or hold a Care Quality Commission registration, so where this page says a nurse is needed, that nurse comes from the NHS community team, a registered nursing provider, or somebody you engage directly.
The three arrangements
Nurse-led, carer-led, and carer-led with nursing on top
Hospitals, agencies and websites use these words loosely, and a family can come away thinking they must choose between a nurse and a carer for everything. There are three shapes an arrangement can take, and two of them have a carer in the house every day.
Nurse-led care
A registered nurse on the rota
Carer-led care with delegated tasks
A trained carer, with a nurse behind them
Carer-led care with the nursing kept separate
Two teams, one plan
The word complex covers a wide range, from a hoist and a stoma bag through to a ventilator, and what complex care means sets out the ground this pillar covers. Complex care at home lists twelve of the tasks that bring families here and who can do each one. The middle arrangement is the one people have heard least about, and delegated healthcare tasks goes through how a delegation is set up.
Choosing a carer-led arrangement is not settling for less safety. A nurse decides whether a task can be delegated at all, judging the person and the carer in front of them, and can decline. The safety comes from that decision rather than from the job title of whoever is in the room.
Who is responsible for what
Where the line falls between nursing and care
Two rulebooks meet here. One is what the law treats as nursing care. The other is delegation, which is how a nurse can pass a specific task to somebody who is not a nurse. Read together, they tell you who holds each part of your relative's week.
Who holds which part of a complex package at home
The NHS clinical team
Assesses, plans, trains, reviews
- Writes the clinical assessment and the care plan. Neither can be handed to a carer.
- Decides whether a healthcare task can be delegated at all, and to which carer.
- Trains the carer on that one task, watches them do it, and records that they are competent.
- Keeps the tasks that stay with a nurse, including most injections, medicine given through a line, and wounds that need assessing.
- Reviews how it is going and is the number the carer rings when something changes.
District nurses, the GP, and any specialist nurse involved. This part is NHS care and is free.
The carer
The daily care, plus what they are trained and signed off for
- Washing, dressing, toileting, meals, moving and handling, company, and the rest of the day.
- Any healthcare task a nurse has delegated to them, worked to the written plan and no further.
- Writing down what they did and what they noticed, in the shared notes.
- Ringing the nursing team when something is outside the plan, rather than deciding it themselves.
A carer can say no to a delegated task. The guiding principles say they should decline if it cannot be done safely with the training and support they have.
You and your family
Asks, arranges, keeps everyone talking to each other
- Asks for the assessment, and asks for the delegation conversation by name if nobody offers it.
- Chooses the carer, checks their experience with the condition, and agrees hours and rates with them.
- Makes sure the nursing team and the carer have each other’s numbers and the same care plan.
- Says when something has changed, because you see more of the week than anybody else does.
Consent is yours to give and yours to withdraw at any point in the process.
PrimeCarers
Introduces carers, and nothing after that
- Checks identity, right to work and an enhanced DBS on the Update Service, and interviews every carer online.
- Shows you profiles, rates, experience and reviews so you can compare and choose.
- Arranges insurance cover that applies while a carer is working.
PrimeCarers does not train carers, direct or supervise the care, employ nurses or provide nursing. Qualifications and training are for you to check with the carer.
Sources: Delegated healthcare activities, guiding principles (Skills for Care and the Department of Health and Social Care, revised November 2024) for what may and may not be delegated and who stays accountable; CQC scope of registration, Nursing care (January 2025) for what counts as nursing care and the introductory-service exception.
The Care Quality Commission describes nursing care as a service provided by a registered nurse that involves providing care, or planning, supervising or delegating it. Supervising and delegating sit inside that description, which is the formal reason a package can be nurse-led in its planning and carer-led in its delivery on the same day. The same guidance excepts an introductory service that connects a family with a registered nurse, so long as it has no ongoing role in directing the care that follows. That is the category PrimeCarers sits in, and it is why the platform cannot supervise anybody's clinical work.
Delegation has national guiding principles, published by Skills for Care with the Department of Health and Social Care and revised in November 2024. They define a delegated healthcare activity as one a regulated healthcare professional delegates to a paid care worker or personal assistant, and they are clear about the limits. Clinical assessment and care planning must not be delegated. The professional who delegates stays accountable for that decision and for the clinical review, and can be asked to explain it. The care plan has to name the activity, the limits of the delegation, how risk is managed and who to contact out of hours. They are on the Skills for Care delegated healthcare activities pages.
Two parts of those principles are rarely mentioned in a hospital corridor. No care worker has to accept a delegated task, and the principles say one should decline where the activity cannot be done safely with the training and support available. The person receiving care can also decline or withdraw consent at any stage. If a carer says they are not comfortable with a task, that is the system working.
For the tasks that stay on the nursing side whatever training is offered, can you get live-in nurses? sets out what only a registered nurse can lawfully do and how to check a registration. Medicines have their own rules, which can carers give medication? covers.
Which one you need
The questions that decide whether a nurse needs to be on the rota
Work from the tasks rather than the diagnosis. Write down everything that has to happen in a day and a week, then take the list to whichever nurse knows your relative best, on the ward or in the community. This table is a way of ordering that conversation.
| What this points to | Where the nursing sits | What to ask, and who | |
|---|---|---|---|
| The tasks are steady once somebody is shown how: stoma bags, a catheter bag, a feed already set up, oxygen | Carer-led, with tasks delegated | District nurses train the carer, review the site or tube, and deal with problems | Ask which tasks can be delegated, and who signs the carer off |
| A task has to happen several times a day, and waiting for a visit would not work | Carer-led with delegation, or a nurse where it cannot be delegated | The nurse decides whether that task can go to that carer | Ask which tasks can sit with a trained carer |
| Somebody has to judge something during the day: a dose adjusted, a wound assessed, breathing read | Nurse-led for that part of the day | Assessment is never delegated, so a nurse has to do it | Ask the specialist nurse how frequent that judgement needs to be |
| A ventilator, an unstable tracheostomy, or medicine given through a line | Nurse-led, or carers working to a specialist protocol | The specialist team writes the protocol and decides what a trained carer may do | Ask that team what they will sign off, and what they will not |
| The clinical tasks are settled and the worry is nights, falls or being alone | Carer-led | The nursing team carries on visiting as it does now | Ask the carer about waking nights, and the nurses about out-of-hours cover |
The tasks are steady once somebody is shown how: stoma bags, a catheter bag, a feed already set up, oxygen
- What this points to
- Carer-led, with tasks delegated
- Where the nursing sits
- District nurses train the carer, review the site or tube, and deal with problems
- What to ask, and who
- Ask which tasks can be delegated, and who signs the carer off
A task has to happen several times a day, and waiting for a visit would not work
- What this points to
- Carer-led with delegation, or a nurse where it cannot be delegated
- Where the nursing sits
- The nurse decides whether that task can go to that carer
- What to ask, and who
- Ask which tasks can sit with a trained carer
Somebody has to judge something during the day: a dose adjusted, a wound assessed, breathing read
- What this points to
- Nurse-led for that part of the day
- Where the nursing sits
- Assessment is never delegated, so a nurse has to do it
- What to ask, and who
- Ask the specialist nurse how frequent that judgement needs to be
A ventilator, an unstable tracheostomy, or medicine given through a line
- What this points to
- Nurse-led, or carers working to a specialist protocol
- Where the nursing sits
- The specialist team writes the protocol and decides what a trained carer may do
- What to ask, and who
- Ask that team what they will sign off, and what they will not
The clinical tasks are settled and the worry is nights, falls or being alone
- What this points to
- Carer-led
- Where the nursing sits
- The nursing team carries on visiting as it does now
- What to ask, and who
- Ask the carer about waking nights, and the nurses about out-of-hours cover
Clinical assessment and care planning cannot be delegated to a care worker: Delegated healthcare activities, guiding principles, revised November 2024.
If your relative is still on a ward, raise this with the discharge team, and hospital discharge explained covers what that conversation should produce. If they are home already, the care needs assessment is the route back in through the council.
A week with both
One week with a nursing team and carers in it
One worked example, written out so you can see how the parts fit together and where the handovers are. It is a person home from hospital with a catheter, a pressure area being watched, and medicines that changed on the ward.
- Monday
District nurse visit
The nurse checks the catheter and the pressure area, updates the plan, and watches the carer change the bag before recording that they are competent to keep doing it.
- Every day, 8am
Morning call
Getting up, washed and dressed, breakfast and the morning medicines. The carer writes down what the skin looked like, because that is what the nurse asks on Thursday.
- Every day, 1pm
Lunch call
A hot meal, fluids written down, a change of position, and a look at anything the nurse asked to be watched.
- Thursday
Second nurse visit
Dressing changed, skin reviewed, and a decision about whether visits can drop to one a week. That decision stays with the nurse.
- Every evening, 7pm
Tucking-in call
An evening meal, night clothes, evening medicines, the bag emptied for the night, and the doors locked.
- Any time
Something is not right
The carer rings the number in the plan rather than deciding it themselves. Out-of-hours contact belongs in the plan from day one.
A delegation is reviewed as needs change rather than granted once and forgotten, so expect the nursing team to come back to it. That week is three visits a day, around 21 hours, and at about 35 hours a week live-in care starts to cost less than visits, which the cost of live-in care sets out. Nights are their own decision, because a carer who sleeps in the house is a different arrangement and a different price from one awake all night: waking night or sleeping night? explains both. Where a transfer needs two people it needs two every time, which transfers, hoists and two carers covers.
Arranging each part
Who to ring for the nursing, and how to find the carers
The two halves are arranged separately and in either order. The nursing comes through the NHS and is free. The carers you find and agree with yourself, without waiting for the NHS part to settle.
- 1
Ask the GP surgery to refer to the district nursing team
Free, NHSDistrict nursing teams take referrals from GPs, hospitals and social services. If your relative is coming out of hospital, the ward should refer before discharge, so ask whether it has been done. - 2
Ask for the continuing healthcare checklist by name
Free, not means-testedA nurse, doctor or social worker can complete the screening checklist that starts an assessment for NHS Continuing Healthcare, which pays for a whole package at home where the main need is health. Ask for the council's care needs assessment at the same time. - 3
Start the delegation conversation
With the nursing teamName the tasks you would like a carer to take on and ask what the team can train and sign off. Ask for the limits, the escalation route and the review date to be written into the care plan, because that document protects the carer too. - 4
Look at carers near you and ask about experience
Free to searchSearch by postcode and read what each carer says about the conditions and tasks they have worked with. Every carer on PrimeCarers has had an identity check, a right to work check and an enhanced DBS on the Update Service, and has interviewed online, and there is insurance in place while they work. Qualifications and training are not checked, so ask to see certificates yourself. How every carer is vetted sets out what is checked. - 5
Put the two sides in touch and start
Week oneGive the carer the care plan and the nursing team's number, and the nursing team the carer's. Agree hours and rates with the carer directly. The care plan guide covers what a good plan holds.
Who pays
What the NHS pays for, and what you pay for
The nursing and the care are funded through different doors. NHS community nursing is free. Personal care at home is means-tested through the council, unless the package qualifies as NHS care.
Free
NHS community nursing at home
District nurses, specialist nurses and the GP, whoever pays for the rest of the week.
£18-£25
An hour for a carer on PrimeCarers
Our fee included. Agencies charge £28 to £35 for the same visit.
£150-£160
A waking night
A carer awake all night. One who sleeps in the house starts at about £130.
£1,260+
A week for live-in complex care
The band runs to about £1,750 a week.
PrimeCarers rates, September 2026, with our fee included. NHS community nursing is free at the point of use.
Where the main need is health rather than help with daily living, NHS Continuing Healthcare can fund the whole package at home, and it is not means-tested. The NHS describes it as free health and social care for adults with long-term complex health needs, provided in a person's own home as well as in a care home. The screening checklist can be completed by a nurse, doctor, other healthcare professional or social worker, and where care is needed urgently the assessment can be fast-tracked. The route is on the NHS continuing healthcare page, and what the NHS provides free covers the other routes, including up to six weeks of reablement after a hospital stay.
If continuing healthcare is agreed for care at home, NHS England expects the package to be managed as a personal health budget unless there is a reason not to, and that can be taken as a direct payment for healthcare. It is the arrangement that lets a family keep the carer they chose. Personal budgets and personal health budgets explains how the money reaches you.
What carers charge lists current rates, and you can search carers near you for nothing while the NHS side is sorted out.
Questions
Questions families ask about nurse-led and carer-led care
Nurse-led care means a registered nurse delivers the care or directs it, so clinical judgements can be made in the house. Carer-led care means a carer does it, working to a plan written by a clinician, and it can include named healthcare tasks a nurse has trained the carer for and signed off. The difference is who holds the clinical decisions, and those stay with the nurse either way.
It depends on the task and on the delegation. A carer can manage a catheter bag, support a feed and carry out simple wound care where a nurse has trained them, assessed them as competent and written it into the care plan, and insulin can be delegated the same way. Medicine given through a line, most other injections and any wound that needs assessing stay with the nursing team. Delegated healthcare tasks goes through this task by task.
No. PrimeCarers introduces families to self-employed carers. It does not employ nurses, does not provide or manage nursing care, and is not registered with the Care Quality Commission. If your relative needs a registered nurse on the rota, that comes from the NHS community team, a provider registered for nursing care, or a nurse you engage directly. Can you get live-in nurses? sets out those routes and how to check a nurse is on the register.
They are entitled to say no, and the guiding principles ask them to decline where the task cannot be done safely with the training and support they have. Go back to the nursing team: either the training and support need to be stronger, or that task needs to stay with a nurse.
Community nursing at home is NHS care and is free. For a whole package of care and nursing at home, NHS Continuing Healthcare pays in full for adults whose main need is health rather than help with daily living, and it is not means-tested. NHS Continuing Healthcare explains the process.
Not by default. A live-in arrangement is carer-led, with the community nursing team visiting as it would for anybody else and any delegated tasks written into the plan. On PrimeCarers, live-in care that needs more experience starts at about £1,260 a week with our fee included. A live-in registered nurse is a separate arrangement, bought elsewhere.