The experience of our client, RD, reiterates the importance of case management input to assist clients in the early stage of their rehabilitation journey.


RD is 66 years old and was rendered tetraplegic following a fall in May 2019. Stewarts was instructed by RD to investigate a potential clinical negligence claim arising from the delayed diagnosis of a spinal cord injury and the resulting grade 4 pressure sore.

RD was admitted to a regional spinal injuries centre in August 2019. He was discharged in early April 2020, a few weeks earlier than expected, due to the Covid-19 outbreak (as the unit was a major centre for Covid-19 admissions in the region).

RD had been making good progress following the commencement of his spinal rehabilitation. He was in a power chair, but had still only done a few slide board transfers, but could not yet sit up to eat. However, he had not had the opportunity to use all of the facilities on offer at the unit, for example, hydrotherapy, and RD and his family felt there was the scope for further functional improvements.

Being discharged from a spinal unit is a daunting experience for any patient, but it was particularly concerning for RD to be facing the uncertainties of an unknown care team at the outbreak of a global pandemic. RD was eligible for NHS Continuing Health Care (CHC), and the local clinical commissioning group organised a local care agency to visit RD at the unit. Unfortunately, the care agency did not provide RD with much confidence, which further exacerbated his anxieties about being discharged home.

As the claim was in the early stages, RD did not have interim funds to enable him to access much-needed support from a case manager. RD’s solicitor, Alison Goldney, a senior associate in our Clinical Negligence team specialising in spinal cord injury claims, was concerned about RD’s predicament and made enquiries with case management company Rehab Without Walls (RWW), which has a number of experienced case managers in RD’s locality who specialise in spinal cord injuries. RWW agreed to provide some initial free advice to RD, and Kate Lewis was introduced to the family. Kate’s input was invaluable as it resulted in him securing a CHC-funded placement at the excellent neurological rehab centre STEPS in Sheffield.

RD’s discharge was brought forward as a result of the Covid-19 pandemic. Kate was made aware of the discharge and was told by RD and his wife that he wasn’t ready to go home, the property wasn’t ready, and there was no care package. Many of RD’s rehabilitation goals were yet to be achieved. Kate felt that there was a significant chance that RD could become more independent and that this would reduce the amount of support he would need when he returned home.

RD and his consultant at Midlands Centre for Spinal Injuries agreed that there was still rehabilitation potential, so Kate approached NHS England to see if they would fund an initial two-week placement at STEPS in Sheffield. The first two weeks went quickly as RD relearned many of the skills necessary to increase his independence and reduce his reliance on others.

Having seen the importance of obtaining specialist clinical support from a case manager, RD decided to use his own funds to instruct Kate to provide further input to assist him in the transition from STEPS to home.

Kate attended the discharge meeting as an advocate for RD, and identified that RD wanted to remain at STEPS rather than move to a placement nearer to his home, something which was being proposed by the CHC. Kate, with STEPS, approached the CHC and identified the benefits of RD remaining in STEPS rather than moving nearer to home, as RD was highly focused on rehabilitation. The CHC agreed to another 10-week placement.

At STEPS, RD has physiotherapy and occupational therapy twice daily. He also undertook hydrotherapy. He has worked hard to become more independent. Kate has provided the family with independent therapy contacts to consider that she has previously worked with or still works alongside, to ensure eventual discharge is as seamless as possible. Kate has identified other local services so that RD can maintain the level of independence he has achieved.

Kate has also been able to work with and guide the CHC to identify and choose a care agency whose staff have the skills, knowledge and experience to work with someone like RD, who has a spinal injury, in his own home.

This case study reiterates the importance of early case management input to assist clients at the early stage of their rehabilitation journey.  We at Stewarts are committed to assisting our clients with accessing early rehabilitation even when interim payments are not yet available.


Testimonial from RD’s wife

“Alison and her colleagues have explained everything to us from the very beginning. We had absolutely no knowledge of the procedure to make a claim or even if we should, so we were grateful for her support and clear explanations with realistic expectations.

“When we were looking to appoint a solicitor we liked the no-nonsense approach – there was no ‘big sell’ of herself or of previous client’s cases as we had from some other companies. She was genuinely interested in RD as a person pre-accident and his ongoing health issues towards his recovery.

“Alison was patient and courteous in explaining things to myself so I could relay them to RD as he started to get better. The documents and fact-gathering that I had collected made me useful and valued.

“Alison and her paralegal Claudia came to see RD at the hospital a few times and helped me/us get power of attorney to deal with family matters. Alison and team knew the hospital and consultants well, and had expertise in spinal injury, and made us feel confident in the expert witnesses matched to RD for his health issues and through his interests. RD was unaware of this to start with but expressed gratitude in this when he was well enough. Overall we are pleased we asked Stewarts to represent RD.

“Alison told us some pro gratis advice that we could have from Rehab Without Walls, a rehabilitation company specialising in Neuro-Rehab. At first I was reluctant to take this up, as I felt I may be thought lacking in my care/knowledge about RD or about our home and other things. I was very wrong. We spoke with Kate at Rehab Without Walls and from her first chat to us she instilled confidence and knowledge that we were so lacking.”

“Kate gave us practical advice and then when Covid occurred and RD was going to be discharged from the hospital without achieving all his goals and with a very unsuitable care team and package. That is when she told us about STEPS in Sheffield.

“After this, we asked Kate to help us further, now funded by ourselves as it is unclear how RD’s claim will pan out. RD has remained at Steps for the last 22 weeks, achieving skills way beyond his expectations, through the intense rehab and full timetable of physio and therapies. Without Kate we would not have secured funding for this length of stay or the care package that RD will have when he comes home in October, 17 months after his accident.

“Without that initial offer of some hours of case management RD would have come home in a power chair but mostly spending days in bed, being fed and drinking from a sippy cup. Now he can use adapted cutlery, enabling him to enjoy his meals, hold and drink from any mug, and is in a bespoke manual chair – having freedom to move around inside and outside. He is getting stronger each day that he is well (Autonomic Dysreflexia, BP issues, and infections hinder at times). His quality of life has changed beyond measure.”

“Kate has liaised with STEPS, the CCG and other departments and now his new care team throughout his rehabilitation. This has really reassured RD knowing that as much as possible is being done for him. She has also helped my daughter and myself – listening to us, seeing me cry, and to plan for the future when RD is home.

“Although we have not actually met – due to Covid, we have had numerous meetings through Teams and Whatsapp and (she may not feel it) we feel like she is a family friend who has our best interests at heart – and her knowledge, expertise and contacts have truly changed RD’s life so much for the better.”



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