High Court judge allows claim over level of support for disabled 13-year-old

In WND, R (On the Application Of) v NHS West and North London Integrated Care Board [2026] EWHC 2356 (Admin) (16 September 2026), David Pittaway KC, sitting as a Deputy High Court Judge, allowed the claim brought by WND, who has complex medical disabilities including a rare genetic disorder.

The claim concerned a decision made by the Haringey Continuing Care Panel (‘the panel’) in January 2026, regarding the level of support to be provided to WND.

The defendant was NHS West and North London Integrated Care Board (ICB).

The ICB, which commissions individualised health care, called "continuing care", has provided continuing care for the claimant since 2015.

The judge said: “Since 2023, the claimant has received 126 hours of support from the ICB per week, (delivered at a 2:1 ratio across 63 hours). […] The plan did not include provision for 24/7 care, instead it provided for nine hours nursing care each day.”

WND is at high risk of sudden unexpected death in epilepsy ('SUDEP'). The claimant is looked after at home by his parents with health and social care support.

Outlining the claimant's case, the judge said: “It is submitted that the healthcare support provided is so inadequate as to put him at risk of death and in doing so places his parents under intolerable strain which further compromises the safety of their son.

“As said, the defendant has not provided 24/7 care but provides healthcare support by a nurse and carer for 9 hours each day. The claimant's parents have chosen to provide night-time care themselves, which they consider is unsustainable. They instance one recent example where the claimant's mother fell asleep in the early hours….. while caring for the claimant. The claimant had a seizure. The claimant's father woke up and was able to respond to the situation.”

The claimant's case was that the defendant's decision was reached following an irrational process.

The claimant submitted that after a substantial delay of more than two years in undertaking an updated assessment of his needs, the defendant's Decision Support Tool ('DST') disregarded overwhelming medical evidence and assessed the claimant as ineligible for continuing care.

This included downgrading the claimant's seizure risk to 'moderate' despite the defendant accepting in previous High Court proceedings that the claimant was at high risk of SUDEP.

The DST recommendation that the claimant was ineligible was not adopted at the defendant's Continuing Care Panel meeting in September 2025, December 2025, or in January 2026.

However, it was alleged by the claimants that the defendant's subsequent decision-making adopted and built upon a flawed initial assessment.

The judge said: “The claimant submits that the DST was flawed because it did not recommend continuing care. It is observed that the DST dated 31 July 2025 ends by noting ‘conflicting evidence’ from professionals and that the claimant required SALT and respiratory reviews, and independent physiotherapy, OT, and teaching assessment.

“The defendant maintains that the panel did not accept that conclusion and, subsequently, made decisions favourable to the claimant, falling short of providing 24/7 care.”

In September 2025, the panel decided that WND was eligible for continuing care.

A report in January 2026 from the Clinical Lead Manager at the current care provider said that the inclusion of a registered nurse within WND’s care package was “essential” and that his care required continuous clinical assessment rather than the completion of predictable tasks.

Her report stated that WND’s needs were “complex, volatile and high risk” and that he always required two-to-one support. It concluded that two carers alone could not meet his needs safely and that a nurse and carer model was required.

Although there were conflicting recommendations and views within the panel, in late January 2026 the defendant's panel recommended that the health care should be given by a nurse and a carer delivered at a 2:1 ratio across 63 hours per week.

Analysing the case, the judge said: “I consider that the decision not to provide for 24/7 care falls into a very small number of cases where it was outside the range of reasonable responses. Although the defendant's panel had very detailed information before it about the claimant's needs in reaching its conclusions, I consider that the reasoning process did involve a recognised species of error of approach, both as an error of logic and disregard of an obviously relevant consideration.”

He continued: “Whilst I accept the defendant's submissions that the decision was made by a multi-disciplinary panel with both relevant experience and expertise, I do not consider that the provision made for the claimant and the process by which it was made was reasonable, where there was a report from [Clinical Lead Manager] which clearly recommended 24/7 hour nursing care. In my view, it was illogical to disregard it, or if it was the case, to misinterpret it as submitted by the defendant, as only relating to commissioned care, either as a matter of process or outcome rationality. It seems to me that the panel having rejected the DST's recommendation were gradually moving towards the parents' position, falling short of the recommendation for 24/7 hour care. To reach any different conclusion was, in my view, irrational. The panel failed to grasp the issue raised clearly in [Clinical Lead Manager’s] report.”

Allowing the claim for judicial review, the judge quashed the defendant's decision from January 2026.

Finally, he added: “In view of the panel decision [in] July 2026, which also did not authorise 24/7 care, I do consider that it is in the interests of all parties, particularly the claimant and his parents, that the matter should be reconsidered expeditiously, although it would not be appropriate for me to impose a timeframe.”

Lottie Winson