HP & Anor, R (on the application of) v Islington

A local authority’s eligibility criteria for specialist mental-health services cannot determine whether a person requires generic community care services. The authority must assess the person’s potential community-care needs independently and then decide whether those needs call for services. A failure to separate those processes is an error of law and may invalidate the assessment as a whole. Where responsible medical opinions conflict, a public authority may rationally prefer one over another, provided it has properly considered the competing opinions and its choice is not irrational. Eligibility criteria requiring consideration of hospital admission involve both a relevant illness or disorder and sufficient seriousness to prompt consideration of admission.

The claimants challenged Islington’s assessment of Mr P under National Health Service and Community Care Act 1990, section 47, and its subsequent refusal to provide community-care services. Mr P had serious mental-health symptoms and substantial dependence on his family, but Islington concluded that he did not have a severe and enduring mental illness within its CPA eligibility criteria.

The assessment identified risks of severe self-neglect and deterioration, together with needs concerning personal care, medication, treatment, accommodation and social contact. After considering competing psychiatric opinions, Islington maintained its decision that Mr P was outside the CPA criteria and therefore did not qualify for community-care provision. The central issue was whether that approach lawfully determined his entitlement to generic community-care assessment and services.

1. The claim succeeded in part. The court rejected the first three complaints but upheld the fourth. The Community Care assessment process had to start again.
2. There was a sufficiently firm working diagnosis of reactive depression. The absence of a firm diagnosis of a particular psychiatric illness did not mean that there was no diagnosis at all. Islington was entitled to proceed on the basis of the opinions of Dr McK, Dr B and the social worker that Mr P did not have a psychiatric illness falling within the CPA criteria.
3. Islington had considered Dr H’s later and more serious diagnosis. It was faced with an acute conflict between apparently responsible and reasonable medical opinions. Neither opinion was self-evidently correct. Islington was therefore entitled, applying the Wednesbury standard, to prefer Dr McK’s opinion, provided that choice was rational. Its decision was rational and lawful.
4. The CPA criterion concerning depressive illness, anxiety disorders and obsessive-compulsive disorders involved two requirements: a relevant illness or disorder, and sufficient seriousness of risk of self-harm or harm to others to have led to consideration of hospital admission within the previous two years. A conclusion that the patient was not sectionable under the Mental Health Act 1983 did not satisfy that test.
5. CPA eligibility was not determinative of the need for generic health or social-services community care. Islington was required first to conduct a needs assessment identifying needs potentially capable of being met by community-care services. It then had to make a separate service-provision decision on whether those needs called for services.
6. Islington had treated the absence of a severe and enduring mental illness as determinative of both questions. That was a fundamental error of law. It invalidated the service-provision decision and cast sufficient doubt on the needs assessment to invalidate the process as a whole. A proper and comprehensive Community Care assessment was required.

This was a first-instance judicial review claim. Permission was initially considered by Davis J and was later granted by Munby J on an amended claim form. The substantive issue was determined by Munby J on 8 January 2004.