Louisa G v Wandsworth

A local authority must assess a person’s community-care needs and decide how those needs should lawfully be met. A finding that nursing care is required does not automatically require placement in a nursing home. The authority must consider the appropriate setting separately, having regard to the assessed needs, available services and relevant policy.

In reviewing clinical assessments, the court does not resolve conflicting professional opinions. It asks whether the decision was irrational or otherwise flawed in public law. Where the statutory scheme requires NHS consent for nursing-care decisions, the local authority may ordinarily rely on an appropriately qualified NHS clinician’s assessment unless it is unreasonable or irrational.

The claimant, an elderly woman living in a registered residential care home, fractured her femur and was admitted to hospital. The defendant local authority decided that she required Level 2 nursing care and should be placed in a registered nursing home, rather than returned to her existing home.

The claimant sought judicial review, alleging procedural unfairness, failure to follow policy, unlawful delegation, irrationality, failure to consider relevant matters and an automatic equating of nursing care with nursing-home placement. Following interim arrangements, a further meeting took place at which the claimant’s litigation friend and updated clinical material were considered.

The central issues were whether the assessment and decision-making process was lawful, whether the banding decision was irrational, and whether the decision on the setting for care was separately and lawfully made.

1. Outcome. Permission was granted, but the application for judicial review was dismissed.
2. There were procedural defects before the October meeting. The continuing-care panel had not received a full community-care assessment, the claimant’s litigation friend was not given the panel’s written reasons, and the initial reference to the consultant did not provide the relevant assessment or a proper opportunity for informed participation.
3. Those defects did not remain determinative after the meeting of 6 October. The claimant’s litigation friend participated fully, the updated reports and community-care assessment were considered, and the concerns about incontinence, medication, cognition, deterioration and prognosis were discussed. The meeting was not a sham.
4. The court would not resolve the conflicting professional evidence. The consultant geriatrician had relevant expertise and had considered the applicable local criteria. Given their overlapping nature, the conclusion that the claimant fell within Level 2 was not Wednesbury unreasonable or irrational. The local authority was entitled to rely on that clinical assessment.
5. A finding of nursing need did not automatically determine the place in which care had to be provided. The authority had to consider that question separately. In the circumstances, however, the consultant’s view that the claimant required immediate access to a trained nurse, because her condition fluctuated and might require nursing attention at any time, justified the conclusion that a nursing-home environment was required.
6. The authority had taken account of the material considerations, including the community-care assessment, the consent order, the family’s wishes and the effect of moving the claimant. Article 8 added nothing because the decision was otherwise lawful and directed to safeguarding her physical and psychological integrity.

The judgment describes earlier stages of the judicial-review proceedings. Permission was initially considered by Burton J, and the substantive hearing was later adjourned by Jackson J to permit further discussions and interim care arrangements. The present court granted permission but dismissed the claim.