YZ v NHS Trust & Ors

A court exercising judicial review does not decide which medical treatment is clinically appropriate or order a clinician to provide treatment contrary to professional judgment. That remains so where a detained patient later expresses willingness to accept a previously refused medication.

The court supervises whether the responsible authorities have achieved a proper balance between the patient’s best treatment, the least restrictive setting reasonably available, and the protection of the patient, others and the public. A rational, procedurally proper clinical decision to transfer a patient to higher security will not be disturbed merely because another clinician supports an alternative treatment or placement.

The claimant, a detained psychiatric patient subject to a hospital order and restriction order, challenged proposed transfer from medium security to Broadmoor Hospital. He also challenged the refusal to prescribe Clozapine, the absence of an alternative medium-secure placement, Broadmoor’s decision to accept him, and the use of an appeal panel rather than reconvening the original admissions panel.

The central issues were whether the clinical treatment and transfer decisions were unlawful, whether the proposed conditions would breach Articles 3 or 8 of the European Convention on Human Rights, and whether the admissions process was procedurally unfair or irrational.

1. Permission and claim. Permission was refused. The challenges to the first defendant’s treatment and transfer decisions and to the second defendant’s admissions decisions disclosed no arguable ground for judicial review.
2. Clinical treatment. The court applied AVS v A NHS Foundation Trust and A PCT [2011] EWCA Civ 7, following R (Burke) v GMC [2005] EWCA Civ 1003. The court cannot and should not determine what treatment is appropriate or declare an informed and justified clinical decision unlawful. The claimant’s later willingness to take Clozapine to avoid transfer did not alter the treating clinicians’ professional judgment that it was unsuitable.
3. Supervisory role and least restriction. Judicial review remains available to examine whether the proper balance has been achieved between the best treatment in the least restrictive setting and restrictions required in the patient’s and public’s interests. The court does not investigate requests for alternative treatment or second opinions merely because a patient is dissatisfied with clinical care.
4. Transfer and security. The decision that medium security was no longer appropriate was reached carefully and through the correct procedures. There was no alternative medium-secure hospital able or willing to accept the claimant. Broadmoor’s acceptance rationally addressed the chronic and acute risks identified, including violence, weapons, absconding, fire-setting and risks to others. The proposed arrangements did not approach the threshold for treatment contrary to Article 3 and were not unlawful under Article 8.
5. Admissions process. The appeal panel considered the material before it, including the claimant’s further submissions, and rationally concluded that no materially new information required reconvening the original admissions panel. Its reasons were clear and open to it on the evidence.