Author and Publication
Author: Ben Slater, Registered Social Worker, Founder and Managing Director of Nellie Supports
Reviewed by: Kerry Slater, Director of Operations
Last reviewed: 20 July 2026
Citation
1. Department of Health and Social Care (2022) National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care. Available at: https://www.gov.uk/government/publications/national-framework-for-nhs-continuing-healthcare-and-nhs-funded-nursing-care
2. R v North and East Devon Health Authority, ex parte Coughlan [2000] 2 WLR 622.
3. R (Grogan) v Bexley NHS Care Trust and others [2006] EWHC 44 (Admin).
4. Department of Health and Social Care (2022) NHS Continuing Healthcare Decision Support Tool.
Copywright
Copyright © 2026 Nellie Supports Ltd. All rights reserved.
This article is made available for general information, education and professional reference. It may be downloaded, printed and shared for non-commercial purposes, provided that it is reproduced in full, is not altered in any way, and is properly cited as the work of Nellie Supports Ltd. This material must not be edited, adapted, sold, republished, incorporated into commercial products, or used for commercial training, assessment, report-writing or advisory services without prior written permission from Nellie Supports Ltd.
This article does not constitute legal advice, clinical advice or a substitute for a decision-specific professional assessment. Where legislation, government guidance, court forms or external professional materials are referred to, those materials remain subject to their own copyright, licensing and re-use terms.
Abstract
This guide explains the High Court decision in R (Grogan) v Bexley NHS Care Trust and its significance for NHS Continuing Healthcare. It covers the facts, the court's findings about the criteria applied and the failure to apply a proper primary health need test, the difference between a substantive and a procedural challenge, and how the judgment is used in appeals today.
The Grogan judgment and lawful CHC decision-making
If Coughlan decided where the boundary sits, Grogan decided that decision makers must actually apply it properly. It is the authority to reach for when a decision reaches a conclusion without showing its reasoning.
The facts
Maureen Grogan was severely disabled with multiple sclerosis and living in a nursing home. She had been assessed as not eligible for fully funded NHS continuing care and was receiving a nursing care contribution. She challenged the decision, arguing that the criteria applied and the way the assessment had been conducted were unlawful.
What the court found
The court held that the criteria being applied were flawed and that the decision maker had failed to apply a proper test of primary health need consistent with Coughlan. The assessment had not properly identified whether her needs went beyond what a local authority could lawfully provide, and the decision was accordingly quashed.
The principle it established
Grogan is a decision about process and reasoning rather than about where the boundary lies. It establishes that a decision maker must apply a lawful and properly articulated test, must engage with the Coughlan boundary, and must be able to show how the conclusion follows from the assessed needs. A conclusion without visible reasoning is vulnerable.
Why it matters in practice
Most eligibility disputes are not about the law but about whether the reasoning was done. Where a Decision Support Tool records domain levels and then states a conclusion without any analysis of nature, intensity, complexity and unpredictability, Grogan is the authority for saying that is not a lawful approach to the decision.
Substantive and procedural challenges
Grogan supports the procedural side of an appeal. A substantive ground says the levels or the conclusion were wrong on the evidence. A Grogan-type ground says the decision maker did not apply the test properly or did not show its reasoning. Running the two separately, under clear headings, produces better responses than merging them.
Using it today
Use it briefly and specifically. Where the reasoning is missing, say that the decision does not show how the primary health need test was applied to the assessed needs, and ask for that reasoning. Referring to the requirement for a properly applied test is more effective than extended citation of the judgment itself.
Key takeaway
Grogan requires decision makers to apply a lawful primary health need test and to show their reasoning. Where a decision moves from domain levels to a conclusion without any characteristics analysis, that is the point Grogan supports, and it belongs in the procedural section of a submission.
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Frequently asked questions
What did Grogan decide?
That the criteria applied were flawed and that the decision maker had failed to apply a proper primary health need test consistent with Coughlan. The decision was quashed on that basis.
How does Grogan differ from Coughlan?
Coughlan established where the boundary between NHS and local authority responsibility sits. Grogan established that decision makers must apply that boundary properly and show their reasoning.
When should we rely on it?
Where a decision reaches a conclusion without visible reasoning, particularly where domain levels are recorded but there is no analysis of nature, intensity, complexity and unpredictability.
Related NHS Continuing Healthcare pages
These links take you to the most relevant Nellie Supports service page and to the supporting guides that explain the surrounding process.
Speak to an independent CHC specialist
Nellie Supports prepares independent needs evidence for NHS Continuing Healthcare assessments, reviews and appeals across England and Wales. Our reports are written by registered social workers on a permanent employed team, with internal peer review before release. Call 0333 987 5118 or send an enquiry and we will talk through where you are in the process.