Public Law Experts Help Family Overturn Wiltshire CCG Decision

The family of a Trowbridge man with Asperger’s syndrome who were left frustrated when his local NHS denied him access to vital care support has called for lessons to be learned after lawyers helped him get access to the care he needed.

Richard Jackman, 28, has a condition called panhypopituitarism which means he is at risk of falling into a potentially fatal adrenal crisis at any time. Patients with the condition are generally able to administer an emergency injection of hydrocortisone themselves, though it is quite complicated,  but Richard’s Asperger’s syndrome means he does not recognise the symptoms soon enough and also does not have the fine motors skills to prepare the medication.

While his parents Alice and Andrew have been trained to administer the injection, they were keen to boost Richard’s levels of independence by asking Wiltshire Clinical Commissioning Group (CCG) to provide him with a care worker who could assist with injections if they were required.

The CCG refused to commission this care, stating that Richard’s care needs could be met by a carer who was trained to recognise the signs of a crisis and call an ambulance. After years of attempting to persuade the CCG, Richard instructed specialist lawyers at Irwin Mitchell to investigate his case and help him access the support he requires.

Now, after the legal experts successfully challenged the decision under the Equality Act 2010, Richard and his family are hoping that their case will ensure that all people with complex needs are able to get the medical support they require.

Expert Opinion

This case contains a significant lesson for all NHS commissioners and providers who need to support patients with both learning difficulties and a physical illness or condition.

“The CCG ultimately accepted that the support being sought by Richard was a reasonable adjustment under the Equality Act. CCGs need to ensure they are meeting their responsibilities when it comes to supporting disabled people and making reasonable adjustments where appropriate.

“The issues raised in this case should act as a wake-up call to CCGs on this hugely important matter.” Fiona McGhie - Partner

Irwin Mitchell did not challenge the decision through a judicial review but instead chose to consider the CCG’s move as a breach of its duties under the Equality Act 2010. It successfully argued that the CCG was failing to make ‘reasonable adjustments’ in the way it commissioned support.

Wiltshire CCG defended its decision until the second day of a trial at Bath County Court, when it settled the case and agreed to provide an injecting carer to support Richard when his parents were not available. It also agreed to pay a five figure sum in damages for the impact that lack of appropriate care has had on Richard for the past few years.

Commenting on the case, Richard’s mother Alice said: “We are determined to ensure that, despite his disabilities and needs, Richard is able to enjoy as much independence as possible. As such, we felt that at his age he simply should not have to live in the shadow of his parents.

“It was very hard to understand why the CCG would not initially offer us the right support on this issue but we are delighted that common sense has prevailed and Richard will now get the help he needs to lead a full and independent life.

“We also hope that by taking this action, we have ensured that many other people across the country in a similar position to Richard are also able to access support that will help them get the best from life.”

Eve Jackson, Activism Campaigns Manager at Mencap, said:  "Richard Jackman's case highlights the battle many people with a learning disability and their families face in getting the reasonable adjustments they need from the NHS. We know these small adjustments to someone’s care can make all the difference between good and poor quality healthcare.

“We’re pleased that Wiltshire CCG has seen sense in awarding Richard the crucial adjustments he needs in his own home and we hope they are aware of the need for greater training in learning disability across all their staff."

Professor Peter Hindmarsh, of the Pituitary Foundation, added: “It is good to hear that Mr Jackman has been granted the support that he needs.  This is a special case because he has the combination of adrenal insufficiency and Asperger Syndrome which makes the management of the former more difficult. As a consequence of the Asperger Syndrome, Mr Jackman has a low somatic awareness that delays his ability to recognise the symptoms which could precipitate a life threatening adrenal crisis.

“The case involved a lot of preparatory work which I provided for the family based on previous experiences and how adrenal problems interact closely with other issues in peoples' lives.  I am delighted the court was able to consider the importance of understanding these complexities which made this case different.  This is a huge step forward for people with multiple complex conditions.”

Read more about Irwin Mitchell's expertise in handling public law cases.