W & Ors, R (On the Application Of) v Secretary of State for the Home Department

The secure transmission of limited, non-medical information about unpaid NHS debts to government bodies was lawful. The information did not disclose confidential medical details, and any interference with privacy would in any event have been proportionate to the legitimate aims of debt recovery and immigration control.

General statutory powers may authorise such transmission where it is sufficiently connected with the public body's functions. A specific statutory gateway is not required where the information falls outside the statutory control of patient information. NHS bodies were required to transmit qualifying information, so the Guidance did not unlawfully fetter their discretion.

The claim challenged the operation of an immigration-sanctions regime under which unpaid NHS debts of at least £1,000 could ordinarily result in refusal of immigration applications. The challenge concerned the transmission of limited identifying and debt information by NHS bodies to the Secretary of State for Health and then to the Home Office.

The claimants argued that the transmissions lacked statutory authority, breached confidentiality and privacy rights, and that departmental Guidance unlawfully required NHS bodies to disclose information when they should retain a discretion. The Secretary of State and the Home Office disputed each contention.

1. Claim dismissed. The NHS bodies had power to transmit the specified limited information to the Secretary of State, and the Secretary of State had power to transmit it to the Home Office.

2. The information comprised identity and debt details, but no medical history, diagnosis, treatment, prognosis or information about the patient's health. It therefore did not carry the badge of confidentiality or constitute private medical information in the relevant sense. The comparison with Campbell v MGN Ltd [2004] 2 AC 457 did not assist the claimants because that case concerned substantially more intrusive information.

3. Alternatively, any privacy interference was justified. The transmission pursued legitimate aims, including recovery of NHS debts and the effective operation of immigration sanctions. The court weighed the limited nature of the information, prior notice to patients, the public interest in recovering charges, and the restricted circulation of the information. The disclosure was proportionate.

4. No specific statutory gateway was required. Section 251 of the National Health Service Act 2006 concerned patient information processed for medical purposes, whereas the information transmitted here did not relate to health or treatment and was transmitted to facilitate debt recovery and immigration administration.

5. The general powers of NHS foundation trusts under section 47 and NHS trusts under Schedule 4 were sufficiently connected with their statutory function of making and recovering charges from overseas visitors. The transmission was necessary or, at least, expedient for that function. The Secretary of State's statutory power under section 2 and his common-law governmental powers likewise authorised transmission to the Home Office.

6. The Guidance did not unlawfully fetter a discretion. The relevant provisions required NHS bodies to transmit qualifying information, while discretion over whether to impose an immigration sanction remained with the Home Office. In any event, permitting NHS bodies to withhold information would undermine the consistent operation and debt-recovery purpose of the regime.

This was a first-instance judicial review in the Administrative Court. Permission had been refused by Collins J after an oral hearing and was later granted by Arden LJ.