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Assessing care where there is a pre-existing condition

Reaney v University Hospitals of North Staffordshire NHS Trust [2015] EWCA Civ 1119

  • This case concerns the valuation of care where C has a pre-existing care requirement.
  • The eggshell skull principle does not apply.
  • Where the care is quantitatively different, D is only liable for the increased need.
  • Where the care is qualitatively of a different kind, D is liable for all of those needs.
The Facts

C suffered a non-negligent condition which meant she was mid thoracic paraplegic.  She therefore had a care requirement of an hour a day.  As a result of D’s clinical negligence, she suffered deep pressure sores and other serious complications.  She then needed a significant care package, involving two carers and a larger property.

At first instance, C was awarded the cost of all of her care, accommodation and other needs on the basis that D had to take their victim as they found her.  The total award was almost £2.9 million.  Foskett J said, had C not established her case on a conventional causation approach, D would be required to compensate her fully on the basis of having caused a material contribution to her care needs.

On appeal, D argued that the underlying condition had been exacerbated.  D should only be liable to the extent that the condition had been worsened.  There should be no compensation for needs which would have existed in any event.


Held: D must compensate only to the extent that C’s condition has been worsened.

Where the needs are quantitatively different, ie more of the same, D is liable only for the additional needs.

Where the needs are qualitatively different, ie of a different kind to the underlying need, those need should be treated as entirely caused by D’s negligence.

Bailey v MOD [2009] 1 WLR 1052, (the principle where the contribution of the negligent cause was more than negligible) did not apply to this issue.

Practical Point

Kemp & Kemp Volume 1 13-003 sets out the correct approach.

Stuart Frampton
Stuart specialises in personal injury. Acting for claimants and defendants, Stuart has a range of experience in all aspects of PI.
Our Personal Injury Team:
Stuart Frampton | Russell James | Garth Richardson | Scott Horner | Nicholas Bradley | Jennifer Tear | Richardo Childs
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