Steele v The Home Office

Prison authorities owe a duty to make reasonable arrangements for inmates’ dental care. The duty is not confined to emergencies and includes treatment available to other NHS patients. A general arrangement with one prison dentist may be reasonable, but a rigid one dentist, take it or leave it policy is unacceptable. Where authorities know that a prisoner needs treatment, has lost confidence in the available dentist, or is part-way through treatment begun elsewhere, reasonable arrangements may require alternative provision. A complaint may amount to an implied request for that provision. General damages must be assessed within the ordinary framework for personal injury awards, rather than by mechanically multiplying a weekly figure.

Michael Steele, a Category A prisoner, claimed damages from the Home Office for failures to provide adequate dental care during transfers between prisons. HH Judge Bailey found breaches during several periods and awarded £45,000 general damages, £16,000 for future dental treatment, and £66,400 inclusive of interest.

The Home Office appealed two liability findings concerning alternative dental provision when the claimant objected to particular dentists. It also challenged the assessment of general and pecuniary damages. The central issues were the scope of the duty of care, the effect of the claimant’s refusal or loss of confidence, causation of the treatment cost, and the appropriate award for prolonged dental pain.

1. Disposition. The appeal was allowed only on quantum. The award of £45,000 general damages was quashed and £25,000 substituted. Liability and the £16,000 award for pecuniary loss were upheld.
2. Scope of duty. The Prison Service’s duty was to make reasonable arrangements for dental provision. It was not confined to emergency treatment and included treatment which other citizens were entitled to receive on the NHS. The court declined to lay down general rules, stressing that the duty was fact-sensitive.
3. Alternative provision. A prison may generally have one dentist available, but a hard-and-fast one dentist, take it or leave it policy is unacceptable. Reasonable arrangements may require alternative provision in particular circumstances. The trial judge was entitled to infer that this policy operated at Full Sutton and to find a breach where the authorities knew that the claimant had lost confidence in the dentist, was part-way through treatment begun elsewhere, and was not offered another dentist.
4. Implied request. The claimant’s July 2002 complaint, including his threat to seek private treatment, amounted to an implied request for NHS treatment from an alternative dentist. The authorities could not rely on his attitude when the resident dentist was in any event unwilling to treat him except in an emergency. Failure to provide a dentist willing to treat him was a breach throughout the relevant period.
5. Damages. The court accepted the findings of persistent severe pain, additional moderate pain and deterioration in dentition. A prisoner’s confinement could be considered when assessing the effect of pain, but did not justify a higher award merely because the claimant was imprisoned. General damages could not be constructed mechanically from a weekly figure and were assessed by reference to the general framework of personal injury awards. The appropriate award was £25,000.
6. Pecuniary loss. The £16,000 award was proper because the claimant should have received the necessary treatment free on the NHS but had not received it. The fact that the need for treatment arose naturally did not prevent recovery of its cost on that basis.

Interest was to be recalculated, taking account of the interim payment, with costs left for agreement or further order.

1. Court of Appeal (Civil Division). On 25 June 2010 the court allowed the appeal on quantum to the limited extent of substituting £25,000 for general damages, and dismissed it in all other respects.
2. Central London County Court. HH Judge Bailey’s order of 15 July 2009 awarded £45,000 general damages and £16,000 pecuniary loss, producing a total award of £66,400 inclusive of interest.