NHS Continuing Healthcare
CHC Eligibility and Primary Health Need
What the NHS is actually deciding, how the four key characteristics work, and why no diagnosis qualifies anyone automatically.
Who is eligible for NHS Continuing Healthcare?
A person is eligible for CHC when they have a primary health need. That means the care they require goes beyond what a local authority can lawfully provide, judged on the nature, intensity, complexity and unpredictability of their needs. It is a judgement about the whole picture of need, not a score, a diagnosis or a savings threshold.
Plain English
For families and professionals
England and Wales
National coverage
Registered professionals
Written and reviewed
Eligibility is the part of CHC that families find hardest to pin down, because there is no list of qualifying conditions. The national framework deliberately avoids one. What matters is the quality and quantity of care a person needs, and whether meeting it is properly the responsibility of the NHS rather than social care.
The four key characteristics
Every CHC decision is reasoned against four characteristics. They are considered together, and any one of them can be significant enough on its own to indicate a primary health need.
- Nature: the type of need, and the sort of skill required to meet it
- Intensity: how much care is needed, how often, and for how long
- Complexity: how needs interact, and how difficult they are to manage together
- Unpredictability: how much needs fluctuate, and the risk if they are not managed
- The overall picture: whether the needs taken as a whole are primarily health needs
How to prepare
Eligibility decisions turn on evidence. The stronger the record of what actually happens, the harder it is to understate need.
- Describe a typical week rather than a settled day
- Record every intervention, including the ones done quietly by family
- Evidence night time needs, which are routinely under recorded
- Collect incident logs, medication charts and continence records
- Ask for the reasoning behind each domain level, not just the level itself
Where people often go wrong
- Treating the domain scores as an automatic pass or fail
- Letting well managed needs be recorded as low needs
- Accepting that a need is social care simply because a carer meets it
- Allowing behaviour or cognition to be judged on the day of the meeting
- Not challenging a decision that gives no written reasoning
- Treating the domain scores as an automatic pass or fail
- Letting well managed needs be recorded as low needs
- Accepting that a need is social care simply because a carer meets it
- Allowing behaviour or cognition to be judged on the day of the meeting
- Not challenging a decision that gives no written reasoning
How the domains feed the decision
The Decision Support Tool scores need across twelve care domains, from breathing and nutrition to cognition, behaviour and drug therapies. Each is rated on a scale running from no needs up to priority. One priority level, or two severe levels, usually indicates a primary health need. Scores do not decide the outcome on their own. They inform a reasoned judgement that must be recorded in writing.
A social work led multidisciplinary practice
We evidence need against the four characteristics and the twelve domains before the meeting, so the multidisciplinary team is working from a full picture rather than a snapshot. Where a decision is not reasoned properly, we say so at the time and in writing.
Frequently Asked Questions
What counts as a primary health need?
There is no statutory definition. A primary health need exists where the nature, intensity, complexity or unpredictability of a person's needs means that meeting them is beyond what a local authority can lawfully provide. It is a judgement about the whole picture of need, reached by a multidisciplinary team and recorded with written reasoning.
Do I need a certain score to qualify?
No. There is no pass mark. As a guide, one priority level, or two or more severe levels across the twelve domains, usually indicates a primary health need. A combination of high and moderate levels can also qualify. The scores support the decision rather than making it.
Does well managed care count against eligibility?
It should not. The framework is clear that a need does not become less of a need because it is being managed well. If good care is keeping someone stable, the assessment should record the need that is being managed, not the calm picture that results from managing it.
Can savings or property affect CHC eligibility?
No. CHC is not means tested at any point. Financial circumstances are irrelevant to the eligibility decision and should never be raised during an assessment. If finances are mentioned as a reason for an outcome, that is a clear ground to challenge the decision.
This page explains the eligibility framework for NHS Continuing Healthcare in England. It is general information rather than legal advice, and it does not replace an assessment of an individual's needs.