Reaney v University Hospital of North Staffordshire NHS Trust & Anor

Where negligence worsens an existing disability, recoverable loss is confined to the additional loss caused by the negligence when the resulting needs are substantially the same kind as the pre-existing needs. A materially larger package of the same care does not make the defendant liable for the whole package. Full recovery is appropriate only where the resulting needs are qualitatively different. The distinction is one of causation and requires a reasoned finding; a worse quality of life or greater quantity of care is insufficient. The availability of another compensator is irrelevant. Material contribution has no role where the pre-existing condition and the injuries caused by negligence are established, and the issue concerns the needs flowing from those injuries.

The claimant, who had a pre-existing T7 paraplegia, developed pressure sores and related injuries during hospitalisation. The defendants admitted negligence. Causation and damages remained in issue. Foskett J held that the negligence caused the claimant’s entire 24-hour care regime and related accommodation, transport, equipment, holiday and physiotherapy costs.

On appeal, the defendants argued that liability extended only to the increase in needs attributable to the negligence. The claimant contended that the resulting care and physiotherapy were qualitatively different from her pre-existing needs. The central issue was whether the judgment contained a sufficient finding of qualitative difference to justify full recovery.

1. Appeal allowed. The case was remitted to Foskett J to assess damages for the relevant heads of loss in accordance with the judgment.
2. The claimant had to be taken as found. Where negligence worsened an existing disability, the defendant was liable only for additional needs where the needs caused by the negligence were substantially of the same kind as the pre-existing needs. If the resulting needs were qualitatively different, they were caused in their entirety by the negligence. This approach was consistent with Steel v Joy [2004] 1 WLR 3002; [2004] EWCA Civ 576 and Baker v Willoughby [1970] AC 467.
3. The judge’s findings that the claimant’s position and care package were materially worse did not establish a qualitative difference. A worse quality of life, a larger care package, or evidence that more skilled carers might be desirable did not suffice. The judge had made no reasoned finding that the care or physiotherapy needs were different in kind, and the Court of Appeal would not fill that evidential gap. The conclusion that all care, physiotherapy, accommodation, equipment, transport and holiday needs were caused by the negligence therefore could not stand.
4. The possibility that another person might have caused some loss, or that compensation could not be recovered from that person, was irrelevant to causation and could not enlarge the defendants’ liability.
5. The decision in Sklair v Haycock [2009] EWHC 3328 (QB) could be supported on causation grounds where the post-accident care regime was qualitatively different. The approach focusing on causation was correct. However, the distinction between the need for care and the person who would pay for it was material: payment and any credit for avoided costs concerned quantification, not causation.
6. The material-contribution approach described in Bailey v Ministry of Defence [2007] EWHC 2913 (QB), as upheld in the Court of Appeal at [2009] 1 WLR 1052, was an accurate statement of the law for cumulative-cause cases involving evidential uncertainty. It was unnecessary here. The claimant’s condition and the injuries caused by negligence were established, and the issue was the needs resulting from those injuries. The principle had no part to play.

• Court of Appeal (Civil Division). The Court allowed the appeal and remitted the assessment of damages to Foskett J: [2015] EWCA Civ 1119.
• High Court, Queen’s Bench Division. Foskett J held in judgments dated 19 September 2014 and 31 October 2014 that the negligence caused the claimant’s full care and related needs.