Summary
This High Court judgement concerned the assessment criteria used when deciding whether someone satisfied the continuing care criteria for NHS funded care.
Background
The claimant was a 65 year old lady who had multiple sclerosis, dependant oedema with the risk of ulcers breaking out, double incontinence and some cognitive impairment.
She had been assessed as not qualifying for NHS continuing health care but argued that the decision to deny her full NHS funding was unlawful, since the eligibility criteria put in place by South East London SHA (Strategic Health Authority) were contrary to the judgment in the Coughlan case.
It was also argued that the level of nursing needs identified in the RNCC (registered nursing care contribution) medium and high bandings indicated a primary need for health care which should be met by the NHS. Mrs Grogan had been placed in the medium band for care needs apart from one assessment which placed her in the high band.
The court decision
It was decided that the Care Trust did not have in place or apply criteria which properly identified the test or approach to be followed in deciding whether her primary need was a health need.
The Trust’s decision that Mrs Grogan did not qualify for NHS Continuing Healthcare was set aside and the question of her entitlement to NHS Continuing Healthcare was remitted to the Trust for further consideration.
More information
- coughlan decision - summary and judgment
- grogan judgment - full text