The Clinical Commissioning Group had refused to fund Ms AA’s treatment but finally withdrew its refusal days before a hearing was due to take place regarding a Judicial Review of the group’s original decision.
Ms AA instructed law firm Leigh Day in May 2015, having spent over two years trying to secure NHS funded specialist mental health treatment for her very serious health condition, severe Dissociative Identity Disorder.
Ms AA, having undergone years of treatment with only limited success, researched treatment options and international guidance and listened to healthcare professionals who recommended treatment at the Clinic for Dissociative Studies, before she and her GP applied for funding for treatment at this specialist clinic.
Despite being supported by healthcare professionals, Ms AA’s requests were refused by her local NHS Clinical Commissioning Group. Appeals, which every patient has the right to, took considerable time or were treated as fresh applications, and the Clinical Commissioning Group repeatedly refused Ms AA’s funding application, instead referring her to a local Mental Health Trust which had already responded to an enquiry from Ms AA confirming that the specialist services she sought were not available. Ms AA had also been told by an expert in the field that receiving inappropriate treatment could be very dangerous for her and result in significant harm.
The reasons provided by the Clinical Commissioning Group for the refusals varied and Ms AA made a successful complaint about the handling of her requests. As a last resort, she contacted Leigh Day, and the firm successfully applied for legal aid to assist Ms AA. They also instructed David Lock QC to assist in the case.
After a gruelling process of successful internal appeals and fresh decisions being taken and then further appealed, a final refusal of funding was upheld in an internal appeal in March 2016. The Clinical Commissioning Group maintained that Ms AA either could receive appropriate treatment from the provider who had previously told Ms AA they did not have the services to help her; or that Ms AA could access treatment on the other side of London from her home, despite her suffering health conditions which would make this journey almost impossible.
A judicial review was brought challenging the lawfulness of the decision-making processes, arguing inter alia that:
- Ms AA had expressed a choice to receive treatment from a specialist provider, which assisted other NHS patients, and she had a legal ‘patient choice right’ that should have been respected;
- The Clinical Commissioning Group was failing to comply with its legal obligation to meet Ms AA’s reasonable requirements as it has offered treatment it knew would not meet Ms AA’s needs or that Ms AA was unable to access.
Permission to bring the judicial review was granted by the Administrative Court in August 2016, who also allowed for the case to be fast-tracked due to Ms AA being without treatment. After permission was granted Leigh Day tried to persuade the Clinical Commissioning Group to withdraw their refusal and make a lawful decision, not least given all parties involved were publicly funded.
A hearing was listed for December 2016 and in the days immediately before this final hearing, the Clinical Commissioning Group finally agreed to withdraw its refusal and to provide funding for the specialist treatment Ms AA had been seeking for over four years by this time.
Although the Clinical Commissioning Group suggested this change in their position was due to new evidence seen by them in the days before the final hearing, Ms AA could clearly show this information had been provided months previously.
“Whilst securing access to much needed mental health treatment for our client is a fantastic outcome, it is regretful that considerable public funds were spent in the process.
"To reach this outcome, Ms AA has endured a lengthy and stressful process, during which she has felt the Clinical Commissioning Group made unfair and untrue assumptions about her.
"I am delighted that Ms AA now can receive the specialist treatment she needs and improve her health and quality of life. The outcome should also help other patients seeking NHS funding for specialist mental health treatment.
“This case could not have been pursued without legal aid being granted and we are grateful to the Legal Aid Agency for their support of the case.”
Ms AA said:
“I would like to thank all at Leigh Day, especially Merry Varney, as well as my Barrister David Lock QC for their hard work and dedication in securing funding for the specialist treatment that I have been in need of for more than four years.
"It has been an exhausting fight but I cannot fault my legal team's support in this case and hope that this very positive outcome will not only afford me a better quality of life and renewed hope for the future but help prevent other people with D.I.D having to fight so long simply for the correct diagnosis and treatment.”