[2025] EWHC 2684 (KB)

And in respect of the meeting to agree terms

“At this meeting we agreed block purchase of six beds at a core cost of £360 per day and agreed specialling costs at £13 per hour, which is now known as extra care. At this stage there was no written definition of what extra care would be. However my understanding of the service would be to pay for extra staff as needed.” (underlining added)

These extracts are not in line with the Claimants’ explanation of how extra care worked or how it was clearly explained to Commissioners. Ms Todd then explained that in January 2004, after an incident involving one of her placed patients, that she was given an oral definition which was the same as that later given in the March 2006 SLA. That was the definition which referred to the deployment of senior and experienced clinicians for a greater level of input than normal. She said that if the staffing levels were sufficient to provide extra care to patients being charged for it as they needed it, that would be acceptable, but if there was no increase in basic staffing levels, no increase to senior staff or therapists, or no evidence of care above and beyond the standard provisions, then it would not be acceptable and she would be disappointed that the PCT had been charged for extra care as she had to rely on the provider

“to deliver the service they are contracted to provide.”

Had she known extra staffing had not been provided to care for particular patients she had placed, the invoice would have been challenged.