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What is a primary health need in NHS Continuing Healthcare?

A primary health need is the central eligibility test for NHS Continuing Healthcare (CHC). It is not decided by diagnosis, savings, age or the care setting. The assessment must consider the totality of the person's needs and whether their nature, intensity, complexity or unpredictability show that the NHS should take responsibility for the package of care.

Written and reviewed by Paris Theodorou, Solicitor & Principal. Christodoulos Ltd is authorised and regulated by the Solicitors Regulation Authority (SRA 809508). Updated 16 September 2026.

What does primary health need mean?

The concept identifies the boundary between care for which the NHS is responsible and care that a local authority may lawfully provide. If an adult is assessed as having a primary health need, they are eligible for NHS Continuing Healthcare and the NHS becomes responsible for arranging and funding the assessed package.

That package can be provided in a care home or in the person's own home. Eligibility is based on needs, not on a particular disease or diagnosis and not on who happens to deliver the care.

The four key characteristics

Nature

Nature concerns the characteristics of the needs and the interventions required to meet them: what the need involves, what happens if it is not met promptly and whether particular knowledge or skill is required to anticipate and manage it.

Intensity

Intensity concerns the quantity, severity and continuity of the needs. Frequency matters, but so can duration, severity, the amount of intervention required and whether support has to be sustained over long periods.

Complexity

Complexity is often found in the interaction between needs. Cognition may increase mobility risk; behaviour may complicate medication; swallowing difficulty may interact with nutrition and respiratory risk. Looking at each domain in isolation can therefore miss the actual care burden.

Unpredictability

Unpredictability concerns fluctuation and the difficulty of anticipating changes, including the risks if the right intervention is not available at the right time. A need does not have to be constantly at its worst to be significant.

One characteristic can be enough

The National Framework explains that nature, intensity, complexity and unpredictability can demonstrate a primary health need alone or in combination. There is no rule requiring all four characteristics to be present.

Why the diagnosis is not the answer

Two people with the same diagnosis can have very different care needs. Dementia is a common example: one person may need prompting and routine supervision, while another may have severe cognitive impairment, distressed behaviour, high falls risk, resistance to care, medication issues and round-the-clock intervention. The assessment should describe the needs and the care required rather than treating the diagnostic label as the conclusion.

How the Decision Support Tool fits in

The multidisciplinary team uses the Decision Support Tool (DST) to build a comprehensive picture across 12 domains. The descriptors are important evidence, but the DST itself says that professional judgement must be used and that the primary health need analysis must consider the totality of needs.

That is why a case should not be reduced to statements such as “there are no Priority scores” or “there is only one Severe”. The recorded levels need to be accurate, but the final reasoning should also explain how needs interact and what quality and quantity of care is required.

What evidence usually matters?

Good evidence does more than name a condition. It shows what intervention is required, how often, by whom, what skill is needed and what happens when care is delayed or unsuccessful.

What if the ICB says the needs are social care?

The distinction is not simply whether carers rather than nurses perform the tasks. NHS guidance says eligibility is not determined by the provider or setting. The analysis should address the nature and extent of the needs and the overall care required to meet them.

If the reasoning does not engage with the four key characteristics, ignores interactions between needs or relies on inaccurate domain descriptions, those are matters to examine when deciding whether to seek local resolution.

Primary sources

We use the national CHC framework and official NHS tools rather than unofficial scoring rules.

National Framework for NHS Continuing Healthcare — GOV.UKDecision Support Tool guidance — GOV.UKNHS Continuing Healthcare — NHS

Related CHC guides

Decision Support Tool and 12 care domains · Well-managed needs · Appealing a CHC refusal · Who qualifies for CHC?

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