Care Act & NHS CHC

What is the difference between social care and a primary health need?

A plain-English explanation of the boundary between Local Authority social care and NHS Continuing Healthcare, including nature, intensity, complexity and unpredictability.

Updated 26 August 2026

Scope: General information for England. This guide does not determine eligibility, replace the relevant NHS or Local Authority process, or provide individual legal or clinical advice.

Why the distinction matters

A 'primary health need' is the concept used in NHS Continuing Healthcare to help decide whether the NHS, rather than the Local Authority, is responsible for arranging and funding the person's overall package of assessed health and associated social-care needs.

It is not a simple test of whether the person has a medical diagnosis. The assessment looks at the totality of relevant needs and the quantity and quality of care required to meet them.

The four characteristics used in CHC

  • Nature — the type and characteristics of the needs and the interventions required.
  • Intensity — the severity and quantity of the needs and the support required.
  • Complexity — how needs interact and the skill required to manage them.
  • Unpredictability — how much needs fluctuate and the risks created if timely care is not available.

Where the Care Act fits

Local Authorities have duties under the Care Act to assess adults who appear to have needs for care and support. If a person is not eligible for NHS Continuing Healthcare, that does not remove the Local Authority's duty to consider care and support needs under the Care Act where the statutory assessment duty applies.

If it appears during a Care Act assessment that NHS Continuing Healthcare may be relevant, the statutory guidance says the Local Authority should notify the relevant NHS body.

A practical way to prepare

Instead of arguing only about labels, organise evidence around what care is actually required: frequency, duration, risk, skilled interventions, interactions between needs and what happens when support is delayed or unavailable. That gives the professionals a clearer factual picture to assess against the correct legal and policy framework.