In 2005 Maureen Grogan challenged the NHS in the High Court for care funding…
Maureen Grogan’s family challenged her local Primary Care Trust’s (PCT) decision to deny her Funded Nursing Care.
(At the time it was a PCT, whereas now it would be a Clinical Commissioning Group – CCG.)
In January 2006 she won her case.
Like the Coughlan Case, the Grogan Case has given families who are pursuing NHS Continuing Healthcare further clout in their legal argument.
Challenging the NHS can be a hard fight, and it helps enormously to be able to refer to and take courage from people who have already succeeded.
As with Pamela Coughlan, Maureen Grogan and her family also deserve our immense gratitude.
Criteria “fatally flawed”
The judgment in the Grogan Case in the High Court for England and Wales showed that the criteria used by the NHS in their care funding decision had been “fatally flawed” and that Maureen Grogan’s should not have had to pay for her own care.
Clear primary health need
At the time Maureen Grogan, 65, was chronically ill with multiple sclerosis and additional health needs, including dependent oedema and the associated risk of ulcers. She had nil mobility, was totally dependent and also experienced cognitive impairment. She was in a Nursing Home and she had already had to sell her house to pay for care.
Incorrect decisions
The NHS had care assessed her three times as ‘ineligible’ for NHS Continuing Healthcare – even though the care assessments showed she had substantial health needs. She was receiving the (then) top band of Funded Nursing care (FNC) – also known as Registered Nursing Care Contribution (RNCC).
High Court judgment
The Grogan Case came after the landmark Coughlan case and relied heavily on the legal argument that came out of that case. The final judgment in the Grogan Case found that Maureen Grogan’s local NHS Trust (Bexley) had moved the goalposts in terms of defining her level of need – with the result that Maureen Grogan had repeatedly been found ‘ineligible’ for NHS care. The judge found the PCT had not followed the Coughlan Test in it’s decision-making process and set aside their decision to refuse her funding. The Judge recommended that the PCT reconsider her entitlement to NHS funding, in compliance with the Coughlan case.
Since the Grogan case, new national guidelines about NHS Continuing Healthcare funding have been drawn up in an attempt to make things clearer. However, despite this, tens of thousands of elderly people with health care needs as their primary need are still being forced to pay for their own care.
Find out how Care To Be Different can help.
The Coughlan case and the Grogan case: Your 9-point Checklist for NHS Continuing Care
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My CCG said they didn’t know anything about the Coughlan or Grogan Cases and did not use them. Our CHC funding has been taken away after a complete farce of an MDT meeting filling out a new DST.
we are fighting and son was made eligible 10th March 2019 now not funding care
please say you got that in writing? It is the law they might as well say they have never heard of the NHS Act, both cases are mentioned 10’s of times in the chc framework.
Hi, my nan went into hospital following a fall which broke her hip from there she has rapidly declined, she is no longer mobile nor can she complete any personal hygiene, whether she takes her medication is very dependent upon her that day, she has had a CHC assessment where they have stayed that she is eligible for part funding I think it’s atound £150 a week they have said she needs to sell her house to pay for the rest of her care (nursing home) or one of the grandchildren needs to look after her 24/7 my question is she has been deemed to have a primarily health need however these needs aren’t so great that she requires full funding how is this possible? She has a primary health how are they able to state that she does not qualify for full funding? Also as mentioned above they have stated that she needs to sell her house and we need to go through the court of protection for this could I delay this until I have appealed the decision or will myself/ nan be made to sell her house before I have appealed this to the highest possible rank? Thank you so much for your response
1. What view did LA s worker take ?
2.SAR to LA and CCG for all e mails files sms correspondence etc
3.If they want the house insist they take court action with the defence being Coughlan Grogan etc https://youtu.be/FTEsCg0AnTI https://youtu.be/HrpFLLwGqhs
Hi my mum has ms and is in a nursing home now she has just failed her 3rd continuing Healthcare Assessment witch I can not understand why she is solely dependant on her car needs eg can not walk/feed herself/ wash/ incontinence/ and now starting g to get problems with her vision similar to other cases were she has been forced to sell her house to pay for her own care. I can not understand this and not to sure were to go from here can any body help please
Hi James – Please do not hesitate to call us if you’d like to discuss how we might assist you with this. 0161 979 0430 Kind regards
Also worth referencing https://www.equalityhumanrights.com/en/our-work/news/nhs-u-turns-discriminatory-policies
They must be means testing her which is not legal
At 150 I think this is not part funding but fnc which you only get if found Ineligible for CHC. IMHO fnc is a sop to stop people asking for more in case they loose the little they have.
Back in May 2012 i claimed retrospectively payment for my late mother who passed away in November 2005 She had severe Dementia and had been in a care home since May 2003 and we had to sell her home to pay the £30,000 pounds carehome fees. The most recent response from the CCG is her assessmemt records were destroyed in 2013 nearly a year after i first claimed .I’ve in contact with the ombudsman and still waiting for a result some 5 years of dispute .I suppose the message is don’t let them grind you down.
After 27 years of meeting the criteria for Continuing Healthcare (CHC) our disabled adult son in 2009 was found to be ineligible to receive CHC. In 2011 the same happened. In 2012 he was assessed when we moved by social services and because our sons injuries were caused by medical negligence at birth they sent a legal letter demanding to see his Trust Deed. He was not assessed by the new CCG until 2014 when yet again his health needs were consistently downgraded. I found your book last year and have read every page of it several times. I asked for a CHC assessment April 2016 which was done 11th July 2016 and yet again he was considered ineligible . One of the questions was does your condition affect you emotionally and psychologically they said he was not. The nurse assessor was not qualified to give an opinion on this question and our son has not been assessed as to how his condition affects him. I used your book and raised a complaint in August 2016, after the letter was read out to him again saying he did not meet the criteria he asked me to let him die. I made a complaint to PALS as well as CCG and another assessment was carried out where he met the criteria for a full MDT. This takes place next Tuesday. I have copied your 9 comments on the Couglan and Grogan cases so I can read them if necessary. The Nurse assessor and social worker have both never assessed our son or even met him. It says it should be done by professionals involved in your care. If there is any advice you can add I would be grateful as son cannot do anything for himself having quadriplegic spastic cerebral palsy.
Having just received outcome of MIL’s local appeal (why do the always time these things to arrive at the weekend) guess what…. “because her conditions are stable and predictable and in line with that expected for her illnesses she doesn’t qualify” they go on to use the DST as a decision making tool.
In short either negligence and incompetence to the Nth degree or fraud and collusion.
Ok where next well appeal to NHS England ( how many years !) A formal complaint to CCG about failure to put a legal process in place and a reference to the Serious Fraud Office. about the local and National approach ….. so there goes the rest of the weekend.
After a long battle with CHC and no legal help, the lady I care for has been awarded continuing healthcare again after the local authority has deemed again that it is beyond their legal remit. Now the assessor is trying to reduce the package of care that my client receives. Her issues have barely changed and on one domain went from moderate to high regarding behaviour. She has carers all night for 5 nights a week and 3 sitting services a week in the afternoon as well as carers for pad changes 4 times a day. This has been in place for approximately 3 years. Any ideas how we can fight any changes to the package already in place. We are not asking for any additions. I can only find one answer in the national framework regarding this. Paragraph 167, which isn’t very clear
Christine – Did the reduction in the care package happen after a proper review? Also, if can you include the actual content of paragraph 167 in your reply, others may be able to respond to you and help you more easily. Thanks.
Only just read this but it sounds as though now that ‘ the needs ‘ have been met the assessors have withdrawn funding as the person has been assessed on ‘ met needs ‘ which is unlawful as a need is a need whether the need has been met or not. It is not that the person with needs has made a miraculous recovery.
Hi Angela, your book & advice was invaluable to us in securing CHC funding for my mother who has Alzheimer’s. At the time of the funding being granted she was sectioned in a mental health NHS Hospital & had very complex needs & scored highly in almost every category. Gradually, as she became more severe a lot of her acute symptoms subsided & she was moved to a complex needs nursing home. She has been there for 3 months & her CHC has just been reviewed & removed. She is no longer independently mobile, she’s doubly incontinent, cannot feed / drink herself & has to have all her personal needs met. I wondered if, in your opinion it is worth challenging the ruling to remove CHC, or if indeed, now she only has “social needs”. I have read the coughlan case, but I can’t work out where we stand in relation to this. I would be hugely grateful for any advice you can offer and would like to thank you for helping us through this complicated minefield. Regards, Paula Lusk
Thank you for your kind feedback on the book, Paula – I’m glad it was useful. Many families report CHC being removed without proper regard to the review process and the eligibility criteria. I cannot say whether it’s worth you appealing without knowing your case, but this may help: http://caretobedifferent.co.uk/appealing-a-continuing-care-funding-decision/
Hi – Reading paragraph 90 in the National Framework it’s almost saying don’t take any notice of the Coughlan and Grogan cases:
“CCGs should be aware of cases that have indicated circumstances in which eligibility for NHS continuing healthcare should have been determined, and where such an outcome would be expected if the same facts were considered in an assessment for NHS continuing healthcare under the National Framework (e.g. Coughlan or those cases in the Health Service Ombudsman’s report on NHS funding for the long-term care of older and disabled people). However, they should be wary of trying to draw generalisations about eligibility for NHS continuing healthcare from the limited information they may have about those cases. There is no substitute for a careful and detailed assessment of the needs of the individual whose eligibility is in question.” Am I reading right? I thought the whole Framework thing was about the two cases in question.
Hi Barry – the Coughlan and Grogan cases, and other cases of a similar nature, are just as relevant now as they were when they were fought and won. The National Framework upholds the Coughlan and Grogan cases, as should all CHC assessors. Remember that in all CHC assessments, the local authority legal limit is paramount. This article may help: http://caretobedifferent.co.uk/nhs-continuing-healthcare-assessments-2/
I am trying to obtain continuing health care. I am a C5/6 complete spinal injury and I am facing barriers with my health authority. I live at home in Sutton Surrey. I have autonomic dysreflexia which occurs often. My care needs are similar to the Coughlan case.
Sorry for the late reply, Joe. Follow these steps in the Continuing Healthcare assessment process: http://caretobedifferent.co.uk/what-are-the-different-stages-of-nhs-continuing-care-assessment-and-appeal/