Do You Have a Primary Health Need Which Could Make You Eligible for NHS Continuing Healthcare?

Whether someone has a primary health need is key to deciding if they are eligible for NHS Continuing Healthcare.  The problem is, the term “primary health need” has no legal definition. This causes many problems in eligibility assessments for NHS Continuing Healthcare. After all, most adults who require a package of health and social care support do so for a health-related reason. This could be because they have had an accident or have an illness or disability. However, they do not all qualify for NHS Continuing Healthcare.  It is the level and type of care needs themselves that determine whether they have a primary health need.

So do you have a primary health need?

Just Caring Legal, a solicitors firm specialising in NHS Continuing Healthcare, has produced a free factsheet on “What is a primary health need?” to help you decide. In brief, however, here are five questions you need to ask.

How great is the scale and type of nursing care you require?

Is it so great that it would not be appropriate to regard it as being part of ‘the package of care’ a local authority would normally provide? Local authority care can include some nursing services. The question is whether these services are more than “merely incidental or ancillary” to the provision of the accommodation which a local authority is under a duty to provide, and/or not of a nature that a local authority, whose primary responsibility is to provide social services, can be expected to provide.

What is the nature of the needs?

The CCG should look at an individual’s physical, mental health or psychological needs and the overall impact of those needs on the individual. This will help determine the type of caring interventions that are necessary to manage them successfully.

How intense are the needs?

This relates to the extent (quantity) and severity (degree) of the needs and the support that is necessary to meet them, including the need for continuity of care.

How complex are the needs?

This is concerned with how the needs present and interact with each other. The more complex this picture, the greater the care that is necessary to manage care successfully.

How unpredictable are the needs?

This describes the degree to which needs fluctuate – usually because of an unstable or deteriorating condition – and thereby create greater challenges in managing them successfully. It also relates to the level of risk if carers do not meet unanticipated needs in an adequate and timely way.

To find out more, click here to read our new factsheet entitled “What is a primary health need for the purposes of NHS Continuing Healthcare?” But please bear in mind that this is for general information only. If you need specific advice on your own unique case, click here to fill out our initial questionnaire or call us on 0191 556 1078.