Condliff, R (On the Application Of) v North Staffordshire Primary Care Trust

A public healthcare body has a wide area of discretionary judgment when allocating limited medical resources. Subject to rationality, Article 8 does not generally require it to fund particular treatment or to consider non-clinical factors in an individual funding request.

A positive Article 8 obligation to provide an effective adjudicative or enforcement framework arises in materially different circumstances, where an existing Convention right would otherwise be theoretical or illusory. An IFR decision involving evaluative judgments and no underlying right to treatment does not generally engage Article 6. A failure to give adequate reasons may be established, but relief may properly be refused where the reasons are later established, no useful purpose would be served by remission, and the decision itself was rational.

The claimant sought judicial review of the defendant primary care trust’s refusal to reconsider an individual funding request for laparoscopic gastric bypass surgery. The trust’s policy routinely funded the surgery only for patients with a body mass index above 50, but permitted funding for exceptional cases.

The claimant challenged the policy’s exclusion of social factors, relying on Articles 8 and 6 of the European Convention on Human Rights. He also alleged breaches of the trust’s IFR policy and a failure to give adequate reasons for the refusal to reconsider his application.

1. Article 8. The court rejected the challenge to the Social Factors Exclusion. The allocation of limited medical resources is subject to a wide area of discretionary judgment. Provided the policy is rational, the court should not second-guess the healthcare body’s priorities. The refusal of treatment does not, without more, constitute an interference with Article 8 rights or create a positive obligation to provide treatment.
2. A positive obligation to establish an effective adjudicative or enforcement framework may arise where an existing Article 8 right would otherwise be ineffective. The cases concerning therapeutic abortion and criminal protection of private life were materially different. The IFR process was simply part of medical resource allocation, in which Article 8 was generally not engaged. The claimed positive obligation therefore did not arise.
3. In any event, excluding non-clinical social factors was justified. The policy pursued the legitimate aims of rational resource allocation, fairness between comparable applicants and avoidance of discrimination. Social factors with clinical significance were not excluded. The policy struck a fair balance and was proportionate. No separate Article 8 assessment was required when an individual decision applied the lawful policy.
4. Article 6. The IFR decision involved administrative and evaluative judgments. There was no underlying civil right to the treatment sought. Article 6 was therefore not engaged. Alternatively, the publicly available policy contained the essential justification for excluding non-clinical factors, so adequate reasons existed for that aspect of the decision.
5. Reasons and policy compliance. The October refusal breached the duty to give reasons because it did not explain why the further information was not new. However, the court admitted and accepted the decision-maker’s evidence explaining the short clinical reasoning. Remission would serve no useful purpose and the decision was not irrational. The trust’s screening of the renewed request did not breach its IFR policy, and the claim was dismissed.