What is a Primary Health Need
When determining eligibility for NHS Continuing Healthcare funding, the key question is whether a person has what is known as a primary health need.
This concept forms the basis of the NHS Continuing Healthcare eligibility test and helps determine whether responsibility for funding care lies with the NHS or the local authority.
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Why the Primary Health Need Test Matters
Eligibility for NHS Continuing Healthcare is not based on a person’s financial situation.
Instead, the decision focuses on whether the person’s care needs are primarily related to health needs rather than social care needs.
Where a primary health need is identified, the NHS becomes responsible for funding the individual’s care.
The Four Key Characteristics
When considering whether someone has a primary health need, the NHS looks at four key characteristics:
Nature
The type of care required and how it needs to be delivered.
Intensity
The quantity and severity of the care needs.
Complexity
How different care needs interact and increase the difficulty of managing them.
Unpredictability
Whether the person’s condition fluctuates or creates unexpected risks.
How Primary Health Need Is Assessed
These characteristics are considered during the NHS Continuing Healthcare assessment process using the Decision Support Tool (DST).
The multidisciplinary team reviews the individual’s care needs across a number of care domains before making a recommendation about eligibility.
What If NHS Continuing Healthcare Is Refused?
If NHS Continuing Healthcare funding is not awarded following an assessment, families have the right to request a review of the decision.
In some cases it may be possible to challenge the outcome through the NHS Continuing Healthcare appeals process.
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