St Helens Borough Council v Manchester Primary Care Trust & Anor

Under the statutory scheme governing continuing healthcare, the primary care trust is the primary decision-maker on whether a person has a primary healthcare need. Its determination is subject to orthodox judicial review. The court does not adjudicate the merits afresh merely because a local social services authority takes a conflicting view.

The health legislation is dominant because it identifies healthcare needs and makes the resulting determination decisive. The assessment process must nevertheless respect the limits of the local authority’s statutory competence. Complexity, intensity and unpredictability are relevant only when assessing needs which are healthcare needs in the first place.

A woman with Dissociative Identity Disorder required constant and expensive care in her home. St Helens Borough Council had funded that care for several years. Manchester Primary Care Trust decided, after a multidisciplinary assessment and consideration by an expert panel, that her needs were not primarily healthcare needs.

St Helens sought judicial review. Beatson J refused permission in [2007] EWHC 2391 (Admin), holding that the Trust’s decision was reviewable on conventional public law grounds. The Court of Appeal granted permission on the limited question whether the court should instead determine the substantive allocation of responsibility where two public authorities had reached conflicting conclusions.

1. Appeal dismissed. May LJ held that Manchester Primary Care Trust was the primary decision-maker under the statutory framework. Its decision was amenable to orthodox judicial review, but the court was not required to determine the substantive merits afresh. Scott Baker LJ and Sir Peter Gibson agreed.

2. The determination whether the individual had a primary healthcare need arose through a highly structured process deriving principally from sections 1 to 3 of the National Health Service Act 2006. The process required agreed eligibility criteria, participation by health and social care professionals, a multidisciplinary recommendation and a decision by the Trust’s expert panel. The nature of that expert determination placed it outside the normal fact-finding function of a court in judicial review proceedings.

3. The local authority did not possess an equivalent decision-making process capable of producing a determination of equal statutory standing. There was therefore one primary decision-maker rather than two competing decision-makers. The Trust had to consult and take account of social services expertise, but its determination remained decisive subject to challenge for unlawfulness, irrationality or procedural unfairness.

4. Consistently with R v North and East Devon Health Authority, ex parte Coughlan [2001] QB 213, the health legislation was dominant. This did not mean that any decision made under it automatically displaced a local authority decision. It meant that the health legislation supplied the governing framework for identifying healthcare needs and that the resulting determination fixed the dividing line between healthcare and social care.

5. The scheme permitted no gap between the respective responsibilities. The Trust’s assessment therefore had to consider the limits of the services which a local authority could lawfully provide. Complexity, intensity and unpredictability were relevant, but could not by themselves transform social care into healthcare. The needs had first to be healthcare needs.

6. The court declined to decide how the subsequently introduced National Framework would affect a comparable dispute. It also left open whether the substantive approach taken in R (T.D. and B.) v London Borough of Haringey and Haringey Teaching Primary Care Trust [2005] EWHC 2235 (Admin) was correct. The renewed application for permission on the remaining grounds was left for St Helens to pursue if so advised.

1. Court of Appeal (Civil Division): The appeal on the permitted ground was dismissed unanimously. The court upheld the conclusion that the Primary Care Trust’s determination was subject to orthodox judicial review rather than a substantive redetermination by the court: [2008] EWCA Civ 931.
2. High Court, Queen’s Bench Division (Administrative Court): Beatson J refused permission to seek judicial review, rejecting the challenges to the assessment process and accepting that the Trust was the primary decision-maker: [2007] EWHC 2391 (Admin).