CHC Eligibility and Primary Health Need

NHS Continuing Healthcare

What the NHS is actually deciding, how the four key characteristics work, and why no diagnosis qualifies anyone automatically.

01Who 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. This guide covers England.

Plain English

For families and professionals

England

England framework

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.

02The 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

03How 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

04Where 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

05How the domains feed the decision

The DST records needs across twelve care domains, each with its own available descriptors; not every domain has a priority level. A priority level in one of the four relevant domains, or two or more severe levels, would normally be expected to lead to an eligibility recommendation and decision. Other combinations can also indicate a primary health need. The overall reasoning must consider all needs and their interactions.

06Describing the overall needs

Use the person’s views, care plans and representative records to explain needs across relevant domains and how they interact. Ask the team to show its reasoning on each characteristic and the overall conclusion.

07Related pages

NHS Continuing Healthcare ExplainedThe CHC Assessment ProcessChallenging a CHC DecisionNHS Continuing Healthcare services

08Frequently 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?

Successfully managed needs must still be considered. Explain the continuing support and use the relevant descriptors. Do not assess every condition as though routine care or medication had stopped. A lasting reduction in active management can be relevant and should be explained with evidence.

Can savings or property affect CHC eligibility?

No. CHC eligibility and the agreed NHS-funded package are not means tested. The same meeting or wider planning process may involve legitimate financial questions for other services, but wealth must not determine the CHC decision. Ask which process a financial question relates to if it is unclear.

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. Primary guidance: DHSC, NHS continuing healthcare decision support tool guidance. https://www.gov.uk/government/publications/nhs-continuing-healthcare-decision-support-tool/nhs-continuing-healthcare-decision-support-tool-guidance

09Checking the reasons

Request the written eligibility decision, completed DST and MDT recommendation. If you disagree, identify the particular evidence or reasoning at issue and follow the review instructions.

10Primary sources and official guidance

National framework for NHS Continuing Healthcare (England)

Official NHS Continuing Healthcare Decision Support Tool