Matthew Hosking — Founder, CareAdvocate

Founder, CareAdvocate

A Different Kind of Expertise

My background is in legal case management — specifically, the review of medical records for litigation and formal public inquiries. That means spending years reading thousands of pages of clinical notes, discharge summaries, care plans, and multidisciplinary assessments, and doing so with a single question in mind: what does this evidence actually prove?

The work is not clinical. It is evidential. The task is to identify the facts that matter, assess the weight of each source, expose the gaps, and construct an argument that will hold up in front of a formal decision-making body. In litigation, the stakes are high, the scrutiny is intense, and "good enough" is not acceptable.

That is the framework I brought to NHS Continuing Healthcare — and it changed how I understood the problem families face.

Why Medical Records Are Evidence, Not Just Records

A clinical document and an evidential document are not the same thing. A care plan is written to direct care. A nursing note is written to record an observation at a point in time. Neither is written with a view to proving eligibility for a legal entitlement.

When a family tries to support a CHC application, they face the task of converting clinical documentation into structured evidence — without any training in how to do it. They know their loved one's condition is severe. They have boxes of records. But they do not know which entries are legally relevant, how to frame severity in terms the assessment framework recognises, or how to identify the silences in the record that work against them.

This is not a medical problem. It is an evidential one. And it is a problem I have spent my career solving.

The Legal Framework Underpins CHC

Primary health need is a legal test, not a clinical one. The NHS National Framework for Continuing Healthcare is statutory guidance — it has the force of law, and ICBs are required to follow it. The four key characteristics used to assess need — nature, intensity, complexity, and unpredictability — are legal constructs defined through case law and refined through decades of judicial review.

Families who approach CHC as a medical question are at an immediate disadvantage. Their loved one may have a serious diagnosis, but the question is not "how ill are they?" It is "does the nature and extent of their needs, assessed against the four characteristics, cross the primary health need threshold?" That framing requires legal literacy, not clinical knowledge.

Applying Evidential Standards to the 12 DST Domains

The Decision Support Tool assesses needs across 12 domains: behaviour, cognition, psychological and emotional needs, communication, mobility, nutrition, continence, skin integrity, breathing, drug therapies and medication, altered states of consciousness, and other significant care needs.

For each domain, the assessors are supposed to score needs against defined descriptors — A, B, C, or No Need — based on the evidence available. In practice, the scoring often reflects the assessors' clinical impressions rather than a systematic review of the documentary evidence. Needs that are well-managed are routinely underweighted, contrary to paragraphs 162–163 of the 2022 National Framework, which explicitly requires needs to be assessed as they would present if the current care package were withdrawn.

The methodology I apply to each domain is the same methodology I applied to medical records in litigation: systematic review, source weighting, gap identification, and a structured argument linked to the specific legal standard being applied. Every significant entry in the record is assessed for what it proves, what it implies, and what it fails to say.

Why I Founded CareAdvocate

I started CareAdvocate because the gap between what families are entitled to and what they actually receive is, in large part, a gap of evidential competence — not of provision or policy.

The system is not designed to be navigated by people who are simultaneously grieving, exhausted, and unfamiliar with statutory guidance. The evidence exists in most cases. What is missing is the framework to use it.

CareAdvocate exists to provide that framework at a price that reflects the reality of what families can afford — not the reality of what legal professionals and social enterprises charge.

About the Platform

CareAdvocate combines AI-assisted evidence analysis with human expert review. The AI identifies and organises relevant evidence across the 12 DST domains. Every output is reviewed before delivery. The AI finds; the human judges.

If you have questions or want to discuss your case, you can reach me through the contact page or at hello@careadvocate.co.uk.