A Court of Appeal judgment handed down on 2 November 2015 (Christine Reaney v (1) University Hospital of North Staffordshire NHS Trust (2) Mid Staffordshire NHS Foundation Trust has clarified that a negligent defendant is liable only for the additional care needs of a claimant in the situation where the latter’s needs are essentially of the same kind as the pre-injury needs, albeit that they may be quantitatively greater due to the negligence; however, where the claimant’s needs are qualitatively different due to the negligence, the claimant is able to recover for all of those needs as being caused by that negligence. 

In the instant case, the appeal Court (Lord Dyson MR, Tomlinson LJ and Lewison LJ) found for the defendant on the basis that the trial judge’s findings did not support the conclusion that the claimant’s care needs post-injury were in fact qualitatively different from those needs pre-injury, in which case the defendant was only liable for the claimant’s additional needs.

The brief facts of the case were as follows.  The claimant had been diagnosed with transverse myelitis and (non-negligently) had been left paraplegic.  Her care needs due to her paraplegia would have been met initially by the provision of a few hours care each week, increasing to over 31 hours of care after the age of 75; with such care, she would have led a largely independent life. However, whilst in hospital, and as a consequence of the defendant’s admitted negligence, the claimant developed some deep pressure sores with resultant osteomyelitis, lower limb contractures and spasticity. Consequently, she needed 24 hour a day assistance from 2 carers.

At trial, Foskett J. held that the defendants were liable for all of the consequences resulting from the negligently-caused pressure sores and from all of the resultant care requirements (Reaney v University Hospital of North Staffordshire), on the basis that the post-injury care requirements were “materially different from what she would have required but for the development of the pressure sores and their sequelae”, such that she was entitled to recover damages for of all her care, physiotherapy, accommodation, transport, equipment and holiday costs.  The defendant appealed on the basis that they should only be responsible for the claimant’s additional care needs, over and above those needs that would already have been required due to the existence of the pre-negligence injuries.

The Court of Appeal allowed the appeal.  The Court concluded that the claimant’s post-injury care requirements were qualitatively substantially the same as her pre-injury needs such that only the costs of the claimant’s needs to the extent that they were increased as a result of the negligence were to be met by the defendant (following Performance Cars v AbrahamBaker v Willoughby and Halsey v Milton Keynes General NHS Trust and Steel v Joy.  Although factually not the position in this case, if there was a qualitative difference in the care needs, then the costs of those needs in their entirety could be recovered from the defendant: Sklair v Haycock, upon which the trial judge relied, was explained on this qualitative basis.  The Court also noted that there was no place for the application in this case of Bailey v Ministry of Defence, as upheld in the Court of Appeal, to which the trial judge had also referred, as “there was no doubt about Mrs Reaney’s medical condition before the defendants’ negligence occurred or about the injuries that she suffered as a result of the negligence” such that “the concept of material contribution had no part to play”.

It is, therefore, necessary for a claimant to identify whether their post-negligence care requirements are qualitatively different from their pre-negligence care requirements: if so, they can recover for all of their post-negligence care costs; if not, they will only be able to recover for the additional care costs caused by the negligence, over and above those care requirements existing prior to the negligence.