Understanding the NHS Continuing Healthcare funding process can be no small feat, with complex terminology and multiple stages. At Compass CHC, our goal is to simplify this for you, providing detailed guides breaking the process down and help you navigate from start to finish.
In this guide, we detail the four key criteria for CHC funding, how they work together, and how well-managed needs fit in.
What Is NHS Continuing Healthcare (CHC)?
To start, what is NHS Continuing Healthcare? NHS Continuing Healthcare is free healthcare provided by the NHS to individuals aged 18 or over who have significant and ongoing care needs.
However, not everyone is eligible for NHS Continuing Healthcare, and eligibility requires demonstrating a primary health need. To do that, the four key indicators must be reviewed.
What are the four criteria for CHC funding?
- Nature of needs
- Intensity of needs
- Complexity of needs
- Unpredictability of needs.
1. Nature of Needs
The nature of needs refers to the type of health needs a person has and how they present. This includes consideration of:
- The underlying health conditions involved
- The kind of care required to meet those needs
- Whether the needs are primarily health-related (rather than social care-related)
- The risks associated with those needs if care is not properly provided.
In simple terms, the nature of needs allows decision-makers to understand what is wrong, why care is required, and whether that care requires healthcare input rather than routine support.
The National Framework for NHS Continuing Healthcare includes examples of questions that can help assess the nature of a need, including:
- What types of interventions are required to meet the need?
- Is there particular knowledge/skill/training required to anticipate and address the need? Could anyone do it without specific training?
- Is the individual’s condition deteriorating/improving?
2. Intensity of Needs
The intensity of needs refers to how much care is required and the effort needed to provide that care. This includes consideration of:
- The frequency of care interventions
- The duration of those interventions
- The level of monitoring required
- The impact of multiple needs being managed at once.
Even when a condition is well managed, the level of care required to keep it that way can be significant, and this indicator looks to understand that.
The National Framework for NHS Continuing Healthcare includes examples of questions that can help assess the intensity of a need, including:
- How severe is this need?
- How often is each intervention required?
- For how long is each intervention required?
3. Complexity of Needs
The complexity of needs refers to how care needs interact with one another and how difficult they are to manage. This includes consideration of:
- Multiple conditions affecting different care domains at once
- Symptoms that interact or worsen one another
- The level of knowledge and judgement to manage care safely
- How challenging it is to anticipate changes and respond.
Essentially, complexity seeks to understand whether multiple issues are occurring simultaneously and cannot be considered in isolation.
The National Framework for NHS Continuing Healthcare includes examples of questions that can help assess the complexity of a need, including:
- Are the needs interrelated?
- Do they impact each other to make the needs even more difficult to address?
- How much knowledge is required to address the need(s)?
4. Unpredictability of Needs
The unpredictability of needs refers to how likely needs are to fluctuate and the risks of those fluctuations. This includes consideration of:
- How stable or unstable a condition is
- Whether deterioration can happen rapidly
- How easy changes are to predict
- The consequences of delayed or inappropriate responses.
This indicator aims to assess whether a person’s condition is likely to change quickly and the level of monitoring needed to observe those changes.
The National Framework for NHS Continuing Healthcare includes examples of questions that can help assess the unpredictability of a need, including:
- Does the level of need often change? Does the level of support often have to change at short notice?
- Is the condition unstable?
- What happens if the need isn’t addressed when it arises? How significant are the consequences?
Learn more: What are the 12 Care Domains of Continuing Healthcare?
How the four indicators work together
One of the most vital parts of the assessment for NHS Continuing Healthcare process is reviewing how the four key indicators work together, not just how they appear in isolation. The combined view provides the following:
- Contextualisation: Each need contextualises another – the nature of the need often dictates the intensity, and a need being unpredictable will increase its complexity.
- Evaluation: It’s the combined view of the four needs that determines eligibility, and how they interact is used to justify the final decision on funding.
“A person may not present severe needs in one area, but when you consider how their needs interact day to day, the overall picture can be very different. That’s why the four indicators must always be assessed as a whole.”
Louis Seymour, Legal Services Director, Compass CHC
Where “well-managed need” fits in
A well-managed need is one that is successfully stabilised or controlled with the current package of care. However, a well-managed need is still a need and should be considered and reviewed against the four key indicators.
One issue that we see occur in the CHC review process is well-managed needs being overlooked or not properly assessed. If well-managed, the nature, intensity, complexity or unpredictability of a need might not be properly considered, but this is not right.
The well-managed need principle is in place to ensure it isn’t disregarded during the assessment process.
Learn more: What is a “well-managed need”?
Key takeaways
- Continuing healthcare decisions are about health needs, not diagnosis, care settings, or how well a person appears to be coping.
- The four key indicators – nature, intensity, complexity and unpredictability – must be viewed together.
- Effective care should not disadvantage eligibility.
- Evidence should reflect both what care is provided and what would happen without it.
Understanding nature, intensity, complexity, and unpredictability is central to how NHS Continuing Healthcare decisions are made. These four key criteria are not standalone tests, and are not overridden by how stable a person may appear. Instead, they provide a structured way to assess whether someone’s needs are primarily health-related and require ongoing, skilled management.
If you are going through a CHC assessment, preparing for a review, or trying to understand how eligibility decisions are made, having the right information and the right support matters.
Our dedicated team helps individuals and families navigate the NHS Continuing Healthcare process with clarity and confidence, ensuring needs are properly evidenced and assessed in line with the CHC framework.
Complete our enquiry form to find out how we can support you through your CHC journey.
FAQS about the four key indicators
What are the four key indicators for continuing healthcare?
In the NHS Continuing Healthcare process, the four key indicators of need are: nature, intensity, complexity and unpredictability.
Do all four key indicators have to be present for someone to be eligible for CHC?
No – NHS CHC eligibility is not based on meeting a set number of these indicators. Rather, it’s based on all of the needs viewed together to determine whether their combined impact indicates a primary health need.
How do the care domains relate to the four key indicators?
Care domains describe where the need occurs – including mobility, cognition or behaviour – while the four key indicators explain how those needs present and interact. Eligibility decisions should account for both the domain scores and the broader picture shown by the indicators.
Does the type of care setting affect how the four indicators are applied?
No – eligibility is based on need, not setting. Wherever care is provided, whether in a care home, at home, or elsewhere, the four key indicators should be applied consistently.
Why are the four key indicators sometimes overlooked in CHC decisions?
There are a series of reasons why the four key indicators might be overlooked in CHC decisions:
- Too much emphasis is put on the 12 individual care domains scores, rather than the totality of needs.
- There is inadequate evidence or poor documentation, so the necessary detail to emphasis the needs isn’t there.
- A person has a well-managed need, and the panel decides that the need for intense monitoring is low.
- The key indicators are misinterpreted or missed due to the level of ongoing care in place.
