Hall, R (on the application of) v University College London Hospitals NHS Foundation Trust & Anor

Article 2 requires a real and immediate risk of death before it is engaged in the context of detention. Article 3 requires treatment to reach a high minimum level of severity. The court assesses the conditions and their overall effect, including duration, physical or mental effects, and the victim’s circumstances. Care which falls below the optimal or reasonable standard does not necessarily breach Article 3. Detention and ill health are important factors, but they do not lower the threshold. A hospital’s clinical decision to discharge a patient to prison will be approached cautiously where it was made after a careful assessment and a comprehensive care package was arranged. Article 8 has a distinct focus on privacy and family life. On the evidence, none of the claimant’s human-rights or Equality Act grounds was arguable.

The claimant, who had Friedreich’s ataxia and required extensive assistance, was serving a sentence for importing cocaine. After a period in prison he was admitted to hospital. He claimed that his treatment in prison, and a proposed discharge from hospital to prison, breached Articles 2, 3 and 8 of the European Convention on Human Rights. He also alleged failures to make reasonable adjustments under the Equality Act 2010.

The claim was heard with applications arising from an earlier judicial review claim and with the claimant’s sentence appeal. The central questions were whether the evidence disclosed an arguable breach of the Convention rights and whether the Equality Act claim should proceed.

1. Article 2. Article 2 imposed, in the detention context, an obligation to preserve life and provide necessary care, but it was engaged only where there was a real and immediate risk of death. The evidence showed that the claimant’s deterioration was attributable principally to thyrotoxicosis associated with long-term amiodarone use, rather than treatment in prison. There was no evidential basis that imprisonment had reduced his life expectancy or that return to prison would create a real and immediate risk of death. The Article 2 claim was therefore unarguable.
2. Articles 3 and 8. Article 3 required a high minimum level of severity. The assessment was contextual and included the duration and effects of the treatment and the claimant’s age, sex and state of health. The court considered the prison conditions and their overall effect. Even assuming some care fell below a proper or accustomed standard, the treatment fell far short of the Article 3 threshold. Detention by the State and the claimant’s serious disability were material considerations, but did not reduce that threshold. Article 8 had a different focus on private and family life. None of the matters relied upon arguably engaged or breached Article 8, particularly where the Article 3 claim failed.
3. Discharge decision. The hospital’s decision to discharge the claimant was a clinical judgment reached after multidisciplinary consideration and the preparation of a comprehensive care package. The court was slow to interfere with that judgment, which was based on full and appropriate evidence. The hospital had delayed discharge until satisfied that the prison could implement the required care, and the claimant could be readmitted if his health deteriorated.
4. Equality Act 2010. The evidence concerning reasonable adjustments was incomplete and weak. The court was not satisfied that the prison had acted unlawfully in any respect. It refused permission to proceed with the Equality Act claim. It also refused permission on every amended ground and discharged the interim order restraining discharge. In consequence of the concurrent Court of Appeal decision, discharge was to the claimant’s home rather than the prison.

This was a first-instance decision of the Divisional Court refusing permission for judicial review. The judgment records that the court had also sat as the Court of Appeal (Criminal Division) and delivered a separate decision concerning sentence: [2013] EWCA Crim 82. That decision is part of the same litigation and is not a judgment appealed in this case.