CHC, put simply.
Primary Health Need
The single most important concept in NHS Continuing Healthcare.
Who is responsible for meeting these needs?
This is the question at the heart of NHS Continuing Healthcare.
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Social Care Needs
Support with everyday living.
Usually the responsibility of the Local Authority, following a Care Act assessment.
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Health Needs
Complex health and clinical needs.
May indicate a Primary Health Need and NHS Continuing Healthcare eligibility.
A Primary Health Need is not decided by a diagnosis.
It is decided by looking at the whole picture and asking:
Are these needs mainly health needs?
CHC Clarity · CHC, put simply.
What is a Primary Health Need?
A Primary Health Need means that a person's main needs are health needs rather than social care needs.
If this is the case:
The NHS is responsible for arranging and funding care.
If not:
The Local Authority may be responsible for meeting eligible social care needs.
There is NO legal definition of a Primary Health Need.
- No diagnosis that guarantees eligibility.
- No pass mark.
- No automatic score.
- No single domain that automatically qualifies.
Instead: Professionals must look at the whole picture.
How is a Primary Health Need decided?
Professionals look at four key characteristics of a person's needs.
Nature
- What are the needs?
- How serious are they?
- What interventions are needed?
Intensity
- How much care is required?
- How often?
- How much skill or supervision is needed?
Complexity
- How do different needs interact?
- Do they make each other harder to manage?
Unpredictability
- Can needs change suddenly?
- Could there be unexpected deterioration?
- Are there significant risks?
Often called
NICU
Nature · Intensity · Complexity · Unpredictability
These four characteristics are at the centre of every CHC decision.
It is not about a diagnosis
A diagnosis matters — but the needs matter more.
Dementia
Does not automatically mean CHC.
Stroke
Does not automatically mean CHC.
Cancer
Does not automatically mean CHC.
Parkinson's
Does not automatically mean CHC.
The diagnosis matters. But the needs matter more.
It is not a points system
Many families are told:
"You need a Priority."
"You need two Severes."
This is misleading.
The National Framework explains:
- Scores may indicate eligibility.
- But there is NO automatic eligibility.
- Every decision must consider the totality of needs.
- Professional judgement applies.
- And whether the person has a Primary Health Need.
Legal Principle
"The law does not allow Local Authorities to provide services that are more than incidental or ancillary where the person's needs are, in substance, healthcare needs."
In simple terms:
If the person's main needs are health needs, the NHS is responsible.
Everything in CHC comes back to one question:
Who is responsible for meeting these needs?
The answer to that question is called:
A Primary Health Need.
And that is what determines NHS Continuing Healthcare eligibility.
Next: DST Explained