Collins, R (on the application of) v Lincolnshire Health Authority

A public authority deciding whether to move a person with severe learning difficulties from institutional care must consider her wishes and those of her family, but those preferences are not decisive. The authority may conclude that a move is in the person’s best interests where it reasonably considers that community living will promote autonomy, development and citizenship. A promise of a home for life must be taken into account, but its effect depends on the circumstances and may be outweighed by substantial benefits from the proposed change. Under European Convention on Human Rights Article 8, the assessment must address the applicant’s protected interests as a whole. The court may afford the authority a degree of deference in making that evaluative judgment.

The applicant, a woman with severe learning difficulties, challenged the decision of Lincolnshire Health Authority to cease providing her long-stay care at Long Leys Court and move her into community accommodation. She relied on government policy, a promise that residents would have a home for life, Article 8 of the European Convention on Human Rights, and alleged defects in the assessment of the move’s impact.

Mr David Pannick QC, sitting as a Deputy High Court Judge in the Administrative Court, dismissed the challenge. The applicant renewed her application for permission to appeal. The central issue was whether the authority and the deputy judge had lawfully assessed her preferences, the promise, her Convention rights and the evidence concerning the proposed move.

1. Permission refused. The Court of Appeal, comprising Brooke LJ and Latham LJ, agreed with Laws LJ that the deputy judge had reached the right conclusion for the right reasons.
2. The authority had not misunderstood government policy. Policy favoured movement away from long-term institutional care, particularly where there was no medical need, but did not impose an absolute rule requiring every resident to move. The authority had assessed the applicant’s circumstances and considered that community living would enhance her autonomy and potential.
3. The authority had properly considered the applicant’s and her parents’ strong preference that she remain at Long Leys. A judgment about the patient’s best interests must take those preferences seriously, but they are not conclusive. The court rejected the suggestion that they were necessarily decisive.
4. The deputy judge was right to distinguish R v North and East Devon Health Authority ex parte Coughlan [2000] 2 WLR 622. Although the deputy judge’s comments concerning uncertainty about the home-for-life promise could be discounted, his principal reasoning remained sound. The promise had been considered and the authority was entitled to conclude that positive benefits justified the move.
5. The deputy judge had also directed himself correctly under Article 8. The authority considered not only respect for the applicant’s home but the wider rights protected by that Article, and was entitled to a degree of deference in reaching its evaluative conclusion.
6. The alleged assessment failure did not disclose an arguable error of law. R v Merton, Sutton and Wandsworth Health Authority ex parte Perry [2001] Lloyd's Med Rep 73 was materially different. The consultant psychiatrist’s evidence addressed the applicant’s likely response to changes in routine and the proposed support arrangements.
7. The application for permission to appeal was refused, with assessment of the applicant’s costs.

• Administrative Court, High Court: Mr David Pannick QC, sitting as a Deputy High Court Judge, dismissed the challenge to the Health Authority’s decision.
• Court of Appeal (Civil Division): The renewed application for permission to appeal was refused.