When JH suffered a spinal cord injury, his life changed in an instant. The road to recovery was long and arduous. Upon discharge from the hospital, an assessment was conducted to determine if the NHS would cover the cost of his home care. While he received partial funding, it wasn’t enough to cover all his needs, leaving him to self-fund the remainder of his care. This blog shares his journey, the challenges he faced and how he reached out to our nursing care team to make sure he had the fully funded care he was entitled to.
Our client
Mr JH experienced a spinal cord injury following a motorcycle accident in September 2020. Following a period of acute care at University Hospital of Wales, he was transferred to Addenbrookes Hospital and later Stoke Mandeville Hospital for spinal cord injury management and rehabilitation.
Mr JH was originally discharged home in June 2021 with NHS funding to allow a full assessment to take place once his care package was settled. An assessment was completed in early July 2021 by the local Integrated Care Board (“ICB”) with Mr JH being supported by an advocate from the Spinal Injuries Association. The outcome was received in August 2021 and concluded that Mr JH was entitled to a joint funding package, with the NHS only agreeing to be responsible for the cost of his continence care and physiotherapy. Mr JH was to self-fund the remaining cost of his care package at home, which included a live in carer to assist with all aspects of daily living.
JH had extensive nursing needs due to his spinal injury, which caused paralysis of his lower limbs and required a hoist for manual handling. He was at risk of autonomic dysreflexia (AD) and experienced tingling in his left hand, stiffness and pain in his right upper limb and shoulder, and a progressing syrinx on his spine. His reduced respiratory function, due to abdominal muscle paralysis, led to frequent abdominal spasms and breathlessness, requiring manual assistance to cough. His continence care was complex, involving a catheter, daily suppositories, and manual bowel evacuation, with recurrent urinary tract infections and constipation increasing the risk of AD. He also developed pressure sores due to immobility, further heightening the risk of AD. Staff needed to ensure proper positioning in bed and appropriate administration of rescue medication, considering his low blood pressure could mimic AD symptoms.
Therefore, despite the contribution from the NHS for bowel management care and physiotherapy, Mr JH paid the sum of approximately £5000 per month towards his care package at home.
How we helped
Mr JH approached Hugh James Solicitors via the Spinal Injuries Association in 2021. We were instructed to appeal the decision to remove full NHS funding for his care package at home. An appeal was submitted to the ICB, with a local resolution meeting held in January 2023 concluding that Mr JH was not eligible for NHS funded continuing healthcare, and that the joint funding package remained appropriate.
The ICB had also completed a review in 2022, which had concluded there was no significant change in need and so his care package was appropriate. Our team also appealed this decision. The ICB held a further local resolution meeting later in 2023 and again concluded that the package of care and level of funding was appropriate.
An appeal of both the 2021 assessment and 2022 review to NHS England was submitted on behalf of Mr JH by Hugh James Solicitors. We requested an Independent Review Panel be convened. After the panel meeting in 2024, NHS England accepted our submissions, concluding there was specific knowledge and skill required to anticipate and address Mr JH’s needs. They agreed his needs were over and above a social care provision; and the nature, intensity, complexity and unpredictability of his condition amounted to a primary health need.
The local ICB accepted the recommendations of the Independent Review Panel that Mr JH met the eligibility criteria for NHS funded continuing healthcare. The ICB agreed to reimburse him the wrongly paid care fees from July 2021. Mr JH was reimbursed just over £200,000.00 with the ICB also accepting that the full cost of his ongoing care package would be met by the ICB.
Our nursing care team have over 15 years of experience dealing with complex cases and overturning decision for NHS funded care that has been denied. By successfully overturning the initial decision, we ensured that our client received the NHS-funded care at home that he deserved. This case not only highlights the importance of advocacy in healthcare but also reinforces our commitment to providing compassionate and comprehensive support to those in need.
