Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains the nature characteristic in NHS Continuing Healthcare decision making. It covers what nature means, the distinction between the type of need and its quantity, the questions assessors should ask, the significance of the skill required to deliver care, examples across the care domains, and how to evidence nature effectively.
What nature of need means in a CHC assessment
Nature is the characteristic that catches the person whose care is modest in quantity but unmistakably clinical in kind. It asks what type of need is present and what quality of care it demands, not how much of it there is.
What nature means
Nature describes the type and quality of the need and the effect it has on the person. It asks what kind of care is required, what skills are needed to deliver it, and what would happen to the person if that care were not provided. It is a qualitative question, concerned with the character of the need rather than its volume.
Type, not amount
This is the distinction that matters. A person may need a great deal of assistance that remains social in character, such as help with washing, dressing and meals. Another may need a small amount of care that is unmistakably clinical, such as a nursing intervention requiring registered skill. Volume belongs to intensity. Nature belongs here.
The three questions
A proper nature analysis answers three things. What type of care does this person require? What skill is needed to deliver it safely? And what would happen if it were not delivered? The third question is where the well-managed need principle enters, because it forces a description of the underlying need rather than the managed outcome.
Skill as the marker
The clearest indicator of clinical nature is the level of skill required. Care that must be delivered or supervised by a registered nurse, that requires clinical judgement about when and how to act, or that carries serious consequences if performed incorrectly, all point towards a health nature. Care that any competent person could deliver after basic instruction usually does not.
Examples across the domains
Suctioning a tracheostomy, managing a syringe driver, delivering a prescribed bowel programme, administering feed through a gastrostomy, or making the clinical judgement about when to give rescue medication are all clinical in nature. Assistance with dressing, prompting to eat, or accompanying someone to an appointment usually are not, however much of it is required.
How to evidence nature
Describe the intervention precisely rather than generally. State who delivers it, what training they require, what judgement is involved, what monitoring accompanies it, and what the consequence is of doing it wrongly or not at all. Care plans written by clinicians and specialist input describing required competence are strong evidence here.
Key takeaway
Nature concerns the type and quality of care, not the amount. Skill required and consequence of omission are the clearest markers. Describe interventions precisely and always answer the question of what would happen without them.
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Frequently asked questions
Is nature about how much care is needed?
No. Quantity belongs to intensity. Nature concerns the type and quality of the need, the skill required to meet it and what would happen to the person if it were not met.
What makes a need clinical in nature?
The level of skill required is the clearest marker. Care requiring registered nursing delivery or supervision, clinical judgement about when to act, or carrying serious consequences if done wrongly, points towards health nature.
Can a small amount of care indicate eligibility?
Yes. A modest quantity of care that is clinical in nature can carry significant weight, which is exactly the situation the nature characteristic is designed to capture.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.