What is a Primary Health Need?
NHS Continuing Healthcare funding is a package of care funded by the NHS if an individual is deemed to have a ‘Primary Health Need’. But what is a Primary Health Need? What is the alternative category of care needs? And what can you do if you believe the wrong decision has been made?
For legal advice get in touch with our Care Home Solicitors.
Primary Health Needs vs Social Care Needs
The concept of a Primary Health Need was developed to assist in categorising an individual’s needs and to work out who’s responsible for meeting and/or funding their care requirements.
There is a distinction between a Primary Health Need and ‘social care needs’. Whilst those with a Primary Health Need are funded by the NHS, social care needs are the responsibility of the Local Authority and are means-tested. As a result, many people are responsible for paying for some or all of their own care.
Getting the right decision can therefore be vital, as establishing who’s responsible for providing care can have huge financial consequences for the person being assessed.
The National Framework for NHS Continuing Healthcare Funding tries to clarify the definition of these two types of care, but - importantly - it acknowledges that there’s no legal definition of either.
Social care needs are often described as being focused on dealing with daily living activities, such as eating, dressing, mobilising and meeting hygiene needs. However, this category also covers assistance with maintaining independence, social interaction, maintaining complex relationships and protection from vulnerable situations.
A dependency on others to assist with activities the individual can no longer do independently is therefore not in itself sufficient to be a Primary Health Need, as this falls under the definition of social care.
The National Framework outlines that, in general terms, a Healthcare need is one related to the treatment, control or prevention of disease, illness, injury or disability; and the care or aftercare of a person with those needs. Working out whether someone has a Primary Health Need involves assessing the totality of their relevant needs. Some are clearly health needs and some are clearly social needs. Others can be both.
A Primary Health Need is the situation where the main aspect or majority of the individual’s care is focused on addressing or preventing their Healthcare needs. It is also identifiable as being over and above what a Local Authority can be expected to provide, i.e. social care needs.
The Assessment Process
The National Framework outlines an assessment process, which is used to determine whether someone has a Primary Health Need. The Framework outlines that the ‘Primary Health Need’ test should be applied, so that a decision of ineligibility for NHS Continuing Healthcare is only possible where, taken as a whole, the nursing or other health services required by the individual:
- are no more than incidental or ancillary to the provision of accommodation which local authority social services are, or would be but for a person’s means, under a duty to provide; and
- are not of a nature beyond which a local authority whose primary responsibility it is to provide social services could be expected to provide.
Certain characteristics of need - and their impact on the care required to manage them - may help determine whether the ‘quality’ or ‘quantity’ of care required exceeds the limits of a Local Authority’s responsibilities.
This is a complicated issue and doesn’t look at any diagnosis, reason for the care need, the person providing the care or the setting of the care. But it does look at the overall day-to-day care needs, with the final eligibility decision made in consideration of the nature, complexity, intensity and unpredictability of the care needs.
Whilst the Framework states that families are entitled to, but don’t require, representation at assessments, this clearly isn’t a straightforward process and the financial implications of the incorrect decision can be significant.
Our Care Home Solicitors are experts and can advise families about decisions or represent them at assessments or appeals, both in relation to current assessment of individuals or retrospective reviews of past periods of care.
For a free discussion with no obligation call our Care Home Solicitors
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