McMeekin, R. v

A serious medical condition, even where custody is especially difficult, does not automatically justify a reduced sentence. A further reduction as an exceptional act of mercy is available only rarely. The court must take a broad view of the additional hardship caused by illness, rather than reassessing sentence whenever the condition departs from its anticipated course.

Significant deterioration may be considered on appeal, but it must make imprisonment materially harder than previously assessed and render the reduced sentence manifestly excessive. The offender's health must be balanced against the gravity of the offending, the harm caused and the public interest in appropriate punishment.

The applicant pleaded guilty at Leeds Crown Court to two offences of causing death by dangerous driving and two offences of causing serious injury by dangerous driving. He received concurrent terms producing a total sentence of seven years and six months' imprisonment. The sentencing judge reduced the sentence substantially because the applicant had become tetraplegic in the collision.

More than ten months late, the applicant sought leave to appeal, permission to amend his grounds and permission to adduce fresh medical evidence. He contended that his condition had deteriorated unexpectedly and that exceptional mercy required his immediate or early release. The Crown submitted that the original reduction already reflected severe disability and that the deterioration was materially attributable to the applicant's refusal to cooperate with treatment.

The central issue was whether the later medical evidence made the sentence manifestly excessive.

1. The court refused the application for an extension of time. The applications to amend the grounds and to rely on fresh evidence therefore fell away, and the sentence remained unchanged.

2. The court applied the exceptional-mercy principles in R v Bernard [1997] 1 Cr app R(S) 135, as considered in R v Stevenson; R v Minhas [2018] EWCA Crim 318. Serious ill-health may exceptionally justify a lesser sentence, but it does not do so automatically. The court must balance the additional hardship of custody against the gravity of the offending, the harm to victims and the public interest in appropriate punishment.

3. Post-sentence deterioration in a known medical condition may exceptionally be considered on appeal. However, a sentencing court can only make a broad assessment of the likely additional hardship of imprisonment. A further reduction is not justified whenever the illness worsens or develops unexpectedly. The deterioration must make custody materially harder than previously assessed, so that the exceptional-mercy principles are engaged and the sentence is manifestly excessive.

4. The sentencing judge had correctly made a substantial reduction from the otherwise appropriate sentence. Although the applicant's condition had deteriorated, the original medical picture was already one of severe disability and dependence. His refusal, despite capacity, to cooperate with treatment had significantly contributed to the deterioration. Continued non-cooperation could not justify a further reduction which would fail to give proper weight to the deaths, serious injuries and grave offending.

5. A detailed care plan was in place. The applicant no longer alleged a breach of his article 3 rights or inadequate prison care. Even taking the medical case at its highest, the court was not persuaded that the sentence was manifestly excessive.

• Court of Appeal (Criminal Division): Refused an extension of time to seek leave to appeal against sentence and consequently did not grant the related applications.
• Crown Court at Leeds: On 21 October 2016, imposed a total sentence of seven years and six months' imprisonment following guilty pleas to two offences of causing death by dangerous driving and two offences of causing serious injury by dangerous driving.