King's / Queen's Bench Division of the High Court

[2025] EWHC 2684 (KB)

Fecha: 17-Oct-2025

However he also explained that

However he also explained that:

“It's more a case of the true care and treatment that is given to the patient. The Clinicians don't think about, the individual nurses, support workers and unit managers don't think ah this person is extra care, I need to give them extra care. They’re there treating those particular things with that patient. It's then someone like Simon, predominantly it was Mark or Andrew, that's a right, having discussed these patients and having read the report that is all about these patients, clearly this person is absorbing a lot more of our resources that we've already put in...”

And

“It's not all, it's not totally tangible, no elements of it would be tangible, but because we're not trying to attribute a body to a patient it does become that little bit more intangible.”

168.

When asked how the figure for the charge had been arrived at Mr Wilson said that he knew what the charge for specialing was; usually £600-700 per day and that they halved that figure to come up with the price for extra care.

169.

In his second Interview Mr Wilson stated that the extra care charge system was not the same system as in place at Kelling (which runs contrary to the argument/evidence that it was effectively the same system) and that:

“Extra care is a charge levied on the more difficult, challenging risky patients on the basis that they do pose more of a risk and are likely to be using more resources than less challenging, risky, difficult patients.”

Again it might reasonably be thought, this is a reference to a risk premium in advance of actual need for extra staff input (so payable whether or not the patient was actually more difficult or demanding) as distinct from an ex post facto assessment of the actual use of additional staff resources. The difficulty with having two different bases for the charge (in the absence of a clear explanation of either any audit trail) is that PCTs may not be aware what they are paying for and on what basis.