CHC Translator

CHC language, translated simply.

NHS Continuing Healthcare can feel confusing because the language is often technical. This page breaks down the key terms families hear most often and explains what they really mean in plain English.

CHC is not just asking whether someone needs care.

CHC is asking who should be responsible for meeting those needs. Are the person’s needs mainly social care needs, or do they amount to a Primary Health Need that sits with the NHS?

Key phrase

NHS Continuing Healthcare

NHS Continuing Healthcare, often called CHC, is a package of care arranged and funded by the NHS for adults who have a Primary Health Need.

Put simply: CHC is NHS-funded care when the person’s overall needs are mainly health needs.
Key phrase

Local Authority care

Local Authorities are responsible for social care support. This may include help with daily living, personal care, routines, safety and support to maintain independence.

Put simply: Social care supports daily life, but it cannot lawfully meet needs that are beyond its powers because they amount to a Primary Health Need.
Screening step

Checklist

The Checklist is usually the first formal screening tool. It helps decide whether the person should move on to a fuller CHC assessment.

Put simply: A positive Checklist does not award CHC. It opens the door to the fuller assessment.
Fuller assessment

Decision Support Tool

The Decision Support Tool, or DST, is used to organise evidence across different areas of need. These areas are often called domains.

Put simply: The DST is not just a score sheet. It should look at the whole picture of need, risk and care.

How the process filters down

The process starts with the big question of responsibility, then narrows down through the Checklist, the DST, NICU and finally the Primary Health Need decision.

1

CHC or Local Authority?

The starting point is understanding that the NHS and Local Authority have different legal responsibilities.

2

Checklist

The Checklist asks whether the person should have a fuller assessment for NHS Continuing Healthcare.

3

Decision Support Tool

The DST organises evidence across different domains, including cognition, mobility, nutrition, skin, medication, behaviour and other needs.

4

NICU

The evidence is then interpreted using Nature, Intensity, Complexity and Unpredictability.

5

Primary Health Need

The final question is whether the person’s needs, taken as a whole, are mainly health needs rather than social care needs.

NICU explained

The four key characteristics.

N

Nature

What are the needs? Why do they happen? What type of care is required?

I

Intensity

How much care is needed? How often is it needed? How severe are the needs?

C

Complexity

How do the needs interact? Does one need make another harder to manage?

U

Unpredictability

How quickly can things change? Can risks increase suddenly or without warning?

Central test

Primary Health Need

A Primary Health Need exists when a person’s overall care needs are primarily concerned with their health, rather than needs for assistance with daily living that can properly be met by social care.

Put simply: It asks whether health needs are the main issue when looking at the whole picture.
Important point

Not a scoring exercise

The DST levels help organise evidence, but CHC is not awarded by simply adding up scores. The final decision should consider the totality and interaction of the person’s needs.

Put simply: The question is not “what score did they get?” It is “what does the whole picture show?”

Eligible — NHS funded

If the person has a Primary Health Need, they are eligible for NHS Continuing Healthcare.

  • The NHS arranges and funds the full package of care.
  • Care can be provided at home or in a care setting.
  • The package should meet assessed health and associated care needs.
  • Eligibility should be reviewed to make sure needs are still being met.

Not eligible — Local Authority / other routes

If the person does not have a Primary Health Need, their needs may be met through social care, other NHS services, a joint package, self-funding or another route.

  • The Local Authority may assess under the Care Act.
  • There may still be NHS involvement for specific health needs.
  • A joint package may be considered where appropriate.
  • The person may still need care even if CHC is not awarded.

CHC, put simply.

The Checklist asks whether a fuller assessment is needed. The DST organises the evidence. NICU helps interpret the nature, intensity, complexity and unpredictability of the needs. The final question is whether the person has a Primary Health Need. If they do, the NHS is responsible. If they do not, care may sit with the Local Authority, other NHS services, a joint package, self-funding or another route.