St Helens Borough Council, R (on the application of) v Manchester Primary Care Trust & Anor

A public body deciding eligibility for NHS continuing health care must apply the relevant criteria lawfully and take account of salient facts. Judicial review remains available where the complaint is that criteria were misapplied or relevant matters omitted, although institutional expertise may justify restraint on a pure irrationality challenge.

A decision-maker need not read every document about an individual. It must know enough to ensure that facts necessary to a proper consideration of the issue are not omitted. A professional sifting and assessment process is lawful where the ultimate decision-maker retains responsibility, considers whether further material is needed, and evaluates the case in the round.

St Helens Borough Council sought permission to challenge the Manchester Primary Care Trust Panel’s decision that PE, who had dissociative identity disorder and received an extensive care package, was not eligible for fully funded NHS care. The Council argued that the multidisciplinary assessment and Panel decision misapplied continuing-care criteria, failed to consider relevant reports and daily records, failed to assess the cumulative effect of PE’s needs, and were irrational.

The claim concerned the boundary between NHS health-care obligations and local-authority community-care obligations. The central questions were whether the Panel’s decision was arguably unlawful and whether its process unlawfully excluded or sifted relevant material.

1. Permission refused. The claim was not sufficiently arguable to proceed to a substantive judicial review. The question was whether the Panel’s decision was arguably flawed on public-law grounds.
2. Judicial review was available notwithstanding the Panel’s expertise. The complaint concerned alleged misapplication of criteria and failure to take relevant matters into account, which fell within conventional judicial-review principles. Expertise justified greater restraint particularly on irrationality, but did not exclude review. The dispute was also between two public bodies with distinct statutory responsibilities, requiring the court to determine the boundary between health and social care rather than defer automatically to one body.
3. There was no arguable unlawful delegation. The multidisciplinary team was a recommending body, not the decision-maker. It assembled assessments after considering the available reports, and the Panel had the relevant criteria and material before it. The Panel considered whether further reports would materially add to the evidence and reached its own conclusion.
4. A decision-maker need not consider every report produced about an individual. Under the approach in R(Jones) v North Warwickshire Borough Council [2001] EWCA Civ 315, the decision-maker determines what to take into account, guided by the governing statute, subject to conventional Wednesbury review. The Panel was entitled to use the knowledge of members who had read additional reports. It had to know enough to ensure that salient facts necessary to a proper consideration were not omitted, and there was no arguable failure here.
5. The Panel had looked at the case in the round and had considered the cumulative position. Its conclusions that PE’s needs were unusual rather than unique, and that the complexity arose principally from the relationship and care arrangements rather than intrinsic health-care needs, could not arguably be characterised as irrational given the Panel’s expertise and the evidence.
6. The application was also unsuitable for relief because the national framework for NHS continuing health care had been introduced and would become mandatory shortly thereafter. Costs were reserved for written submissions, with the claimant liable in principle for the defendant’s costs of preparing its Acknowledgement of Service and potentially the hearing.

The judgment records no prior determination of the claim by another court. Munby J directed that the permission application be heard in open court on 19 June 2007.