Injury Cost Recovery Campaign Update
Trevor Sterling | 03.06.2019
The best possible outcome in your recovery from a major trauma will be achieved by appropriate and effective assessment, treatment and rehabilitation. This is our primary focus as major trauma lawyers and to ensure it happens, we work closely with the hospitals and organisations that will provide your care and support.
At a time when NHS budgets are under extreme pressure, we work hard to secure you the highest possible standards of care, whilst also easing the financial burden on the NHS wherever we can.
We have carried out extensive research, which has allowed us to develop a service which not only supports individual patients, but also helps the NHS in particular. This is achieved by supplementing treatment through insurance payments.
Our signposting service is based on a holistic, patient-centric approach that provides you with support and advice from the point of admission onwards, along the various health and social care pathways to your recovery.
There are three elements of your journey following a major trauma: pre-hospital, in-hospital and rehabilitation. The trauma network is designed to ensure that you receive the appropriate treatment for your injuries throughout these stages.
Financial constraints mean that when a major trauma patient is discharged into the community (to go home or to other suitable accommodation) there can often be gaps in provision and support. This can result in delayed hospital discharge or a patient sometimes not having the appropriate level of support.
There is also a huge strain on the NHS to support patients through out-patient rehabilitation, and a shift from health to social care, which results in funding challenges. This means the discharge process is often frustratingly long.
To help overcome this, our team has built up a comprehensive understanding of all the available health and social care routes, so we can support you through your recovery journey, whilst also assisting the NHS and community services in their work.
Whenever possible, we will obtain private funding so you can benefit from an earlier hospital discharge and full support as you move back into the community.
It’s well-known that the NHS is under strain, and to help relieve some of their financial pressures, the Major Trauma team at Moore Blatch is campaigning for a review of the relevant legislation.
The Health and Social Care (Community Health and Standards) Act 2003 states that when insurers, employers who fail to protect their employee, or any other at-fault party make a compensation payment for an injury, they are also liable to pay the NHS charges if the injured person has:
• received NHS treatment at an NHS hospital.
• been provided with NHS ambulance services.
The legislation currently in force places a limit on the amount of NHS charges that can be recovered, which is known as the ‘capped’ tariff amount. The tariff for treatment and ambulance costs is reviewed each financial year and is currently £49,824. In addition, the NHS cannot then recover for both in-patient and out-patient treatment on behalf of the same injured person.
The unintended consequence has been to create a system that now leaves the NHS to pick up the large bulk of the costs, in cases where insurance companies have the resources to contribute.
For someone who has suffered a major trauma, the immediate urgent care and ongoing rehabilitation costs can far exceed the current cap, meaning that the NHS picks up the rest of the bill.
We consider that a review of the cost recovery system for major trauma treatment is long overdue and the government should look at whether the caps on money the NHS can claim from insurers should be raised or abolished altogether. The result would be a more equitable spread of the costs, taking into account the high cost of medical treatment.
We are working hard to maximise injury costs recovery for those trusts that have treated our clients, so that they may continue to help others.