Defining a 'Primary Health Need'

​An individual has a 'primary health need' if their care focuses on managing significant, complex, and ongoing health needs beyond what a local authority provides. Eligibility isn’t based on diagnosis or care setting—it applies whether care is given at home, in a nursing home, or a residential facility. If eligible, the NHS covers the full cost of care in any setting.
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Understanding Primary Health Need and NHS Continuing Healthcare​

A primary health need determines whether a person’s care should be NHS-funded or provided by local authorities under the Care Act 2014. If eligible, they receive NHS Continuing Healthcare (CHC), covering all assessed health and social care needs, including accommodation if necessary.

Assessing Primary Health Need

Eligibility is based on care needs, not diagnosis or care setting. The Decision Support Tool (DST), used by a multidisciplinary team (MDT), assesses whether an individual’s care primarily addresses health needs.

Four key characteristics determine eligibility:
    •    Nature – The type and impact of physical, mental, or psychological needs.
    •    Intensity – The severity and level of sustained care required.
    •    Complexity – The interaction of multiple conditions increasing care challenges.
    •    Unpredictability – Fluctuations in needs requiring adaptable, urgent care.
These factors, individually and together, establish whether care exceeds what a local authority provides under the Care Act 2014.

NHS vs. Local Authority Responsibilities

A person is ineligible for CHC only if their healthcare:
    1.    Is incidental or secondary to local authority-provided accommodation.
    2.    Falls within local authority responsibilities under the Care Act 2014.

Integrated Care Boards (ICBs) must apply this test in all settings, ensuring no gaps in care provision between the NHS and local authorities.

Key Considerations for Eligibility
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    •    CHC eligibility is based on need, not diagnosis, location, or care provider.
    •    Well-managed needs still count toward eligibility.
    •    Eligibility is reviewed over time if care needs change.


The primary health need test ensures NHS-funded care when health needs are the main concern. By assessing nature, intensity, complexity, and unpredictability, CHC funding is allocated fairly, ensuring individuals receive the necessary care at home, in a care home, or any other setting.

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