Legal Background

​NHS Continuing Healthcare (CHC) is a complex legal area where eligibility often falls between health and social care needs, determining whether the NHS or the local authority funds an individual’s care. While local authorities provide means-tested social care, the Care Act 2014 limits their responsibility for healthcare, reinforcing the NHS’s duty to meet health needs. CHC eligibility is based on legal tests developed through case law and must be interpreted alongside health and social care legislation that defines the boundaries of care provision.

Key Legal Cases Shaping NHS Continuing Healthcare

Two landmark legal cases have established the foundations for NHS Continuing Healthcare (CHC) funding decisions. These cases guide assessors in applying the National Framework and Practice Guidance to determine whether an individual has a primary health need.

The Coughlan Case (1999)

The Court of Appeal’s ruling in Pamela Coughlan’s case clarified the boundary between NHS and local authority care responsibilities.

Pamela Coughlan, left quadriplegic after a 1971 road traffic accident, required full-time care but had no significant additional health needs. In 1999, the NHS attempted to transfer responsibility for her care to Social Services. She successfully challenged this decision in court.

The court ruled that her needs exceeded what a local authority could lawfully provide, establishing that individuals with similar or greater needs should be eligible for CHC. This became known as the Coughlan Test, which states:
    •    If an individual’s health needs are “incidental and ancillary” to their social care needs, the local authority can provide for them.
    •    If a person’s primary need is for healthcare, then responsibility lies with the NHS, regardless of their living arrangements.

This principle remains central in CHC eligibility assessments and is reinforced by Section 22 of the Care Act 2014, which limits local authority responsibility for healthcare.

The Grogan Case (2006)

The case of Maureen Grogan further strengthened the legal framework for CHC assessments.

At 65, Mrs. Grogan, who had multiple sclerosis, was a wheelchair user requiring assistance from two people for transfers. She suffered from dependent oedema (posing a risk of ulcers), was doubly incontinent, and had cognitive impairments. Despite her significant health needs, Bexley NHS Trust assessed her as ineligible for CHC on three occasions, providing only Funded Nursing Care (FNC). She had already sold her home to pay for care.

Mrs. Grogan’s family successfully challenged the decision in the High Court, which found that Bexley NHS Trust had used flawed criteria and had raised the bar for eligibility beyond what the Coughlan ruling permitted. The judge ruled that:
    •    The Coughlan Test had not been properly applied in the assessment process.
    •    The NHS had a legal duty to fully fund her care.


This ruling reinforced the importance of correctly applying the CHC eligibility criteria and provided further legal grounds for individuals and families seeking NHS-funded care.

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