Does the National Framework replace the Coughlan case in Continuing Care?

Published 18/12/2013

Please note: This article was published prior to July 2022, and some information may be outdated.

Are you confused about the Coughlan case?

The Coughlan case - is it still relevant? Have you been told the Coughlan case no longer applies? The Coughlan case, brought to the Court of Appeal by Pamela Coughlan in 1999, was a landmark case in NHS Continuing Healthcare. It followed thousands of complaints to the Ombudsman about the postcode lottery of funding for full time care, and it led to a major change in the way Continuing Care was assessed. Many people today would argue that little has actually changed, and the system is still a mess. However, it’s important to understand where the Coughlan case fits in all this – because the information provided by Continuing Healthcare assessors is often confusing or misleading.

How does the National Framework affect the Coughlan case?

Pamela Coughlan won her case for Continuing Healthcare funding and, in 2007, a National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care was drafted. It was the Coughlan case – and the Grogan case – that helped inform this Framework, and the Coughlan case remains just as relevant today as it always was. And even though the Framework was revised in 2012, the Coughlan case remains just as relevant. However, it seems that families are increasingly (and wrongly) being told the opposite by health and social care funding assessors. Assessors may try to persuade you that the Coughlan case was ‘replaced’ or ‘superseded’ in 2007 by the National Framework, or even that the National Framework ‘set a new precedent’. None of this is true, and it simply highlights a lack of knowledge on the part of assessors. The Framework has never replaced the rulings in the Coughlan case – or the Grogan case for that matter. Every NHS Continuing Healthcare assessment must be ‘Coughlan compliant’. It’s also important to keep in mind that the National Framework does not override the law; the law still says that, in the UK, healthcare and nursing care are free of charge.

Do stable needs count in Continuing Healthcare?

Another aspect of the Coughlan case that seems to cause confusion amongst assessors – or perhaps gives assessors another empty excuse for avoiding funding – is the subject of people with chronic, yet stable, needs. This issue was also raised in the Coughlan case. Chronic yet stable needs could, for example, be those that occur during the course of a progressive and degenerative disease, as opposed to an acute condition that needs immediate and urgent medical attention. Thousands of people are told to pay for their nursing care just because their needs are ‘stable’. It is clear from the Coughlan case, though, that the NHS should indeed address chronic yet stable needs as part of the Continuing Healthcare assessment process. The NHS should not simply assume that because a need is stable it is automatically the responsibility of the local authority. Read more about the Coughlan Case.

Tagged Categories: Case law, CHC funding, Legal and financial matters, NHS Continuing Healthcare

Share this article

8 Comments

Pauline Kruyer September 24, 2018 at 5:30 pm

I am going through precisely this at the moment. Fortunately I have a legal adviser involved with this. I feel I could not do this without his services. Attended a Continuing Healthcare meeting today and surprise surprise we were turned down, even though his scores were higher than in the Coghlan case. My legal adviser is busy preparing an appeal. I guess it is going to be a long haul.

disgusted June 5, 2018 at 7:11 am

I would like to speak to bewildered as the same situation happened to me. I wonder if it is the same social worker and LA.
There was serious corruption between PCT/CCG, LA and nursing home.

Suzanne Morrison August 9, 2018 at 9:55 am

I totally agree with your comment as we never seen a copy of the DST prior to nurse assessor who lied and twisted the infomation so it fitted the non eligible criteria. son met criteria until 2009 from birth and then during another flawed MDT he did not meet the criteria. As his high needs have not changed it must be how the assessment is applied by whatever CCG you are in by the nurse assessor who actually left the 12th domain with nothing in. I had filled mine with all the information you can not fit in the other domains

Angela December 24, 2013 at 9:16 am

Louise and Keith - thanks for your comment. Your situation sounds like a catalogue of incompetence, cover-up and maladministration on the part of the care authorities - and of course hugely distressing for you. You may need to seek some legal advice, and if you need any contact details drop us a line using the 'Contact us' link below. Also, if your father/father-in-law has not actually been properly assessed for Continuing Healthcare, then that needs to be done.

Louise & Keith December 22, 2013 at 5:54 pm

We would desperately like to have lawful advice on continuing care a social worker is making our life hell trying to obtain our father/father in laws income details. They basically forgot about him and we thought he was receiving continuing care. They sent a letter stating he must pay around £200 per week clients contribution after a financial assessment last April but forgot to tell us, they just wrote to the nursing home, in turn the nursing home forgot to tell us until this May. A social worker went to see him and gave us a financial form to complete in August but we havent got around to completing it all as yet. We were under the impression she was reviewing him regarding his health and continuing care, but we have not heard from her regarding her report we are just getting harrassment regarding his finances, she even set up an emergency meeting with a debt team without our knowledge. Our father/in law He has been in a nursing home temp basis for 3 years after a fall and suffering a broken back on a hospital ward in London which left him paralysed, he then had grade four bedsores in the rehab home they sent him to. We instructed a solicitor to undertake his assessment to avoid this social worker at all costs but she is harrassing us for his details and has stirred trouble up with the accounts dept of the nursing home stating we havent been managing his financial affairs. The last straw I telephone one of the senior P/A's who was formally worked for the Head of Healthcare to report this social worker for aggression. The social worker has retaliated by asking their inhouse solicitor to contact us making all sorts of untrue allegations about us and a threat if we dont give our solicitors details or report to a meeting on 6 Jan they will report us to the Office of Public Guardin for mismanaging his affairs. This is like our worse nightmare. Help

Angela December 22, 2013 at 11:33 am

Your questions are echoed by many, Bewildered. I suspect different budgets are used for different battles, i.e. the cost of taking people to court may not touch the budgets of those making the illegal decisions in the first place. If anyone has more insight into that, it would be good to know more. The cost of preventing people access to care must be huge - and, as you say, it is taxpayer's money.

Bewildered December 20, 2013 at 11:37 pm

If this is right how can local authorities take a person to court for unpaid care home fees at the expense of their taxpayers , indeed spend more on legal fees than they can achieve on a successful,outcome.
How can the NHS continually deny the rights of a person to be eligible for chc when's they suffer the degenerative effects of Alzheimer's disease - well managed leading to relatively stable condition in a locked nursing environment. Ten years battling for rights to no avail, leading to estate being insolvent and thousands of pounds having been paid for care that should have been free at point of need. I would dearly love to work with like minded people to force the NHS to abide by the law, would you?

margaret scott July 9, 2018 at 12:15 pm

Please contact me regarding the same I have experienced from LA who spent thousands of pounds to drain private funds to pay for care for someone with end stage Multiple Sclerosis and mental illness.