VI, R (On the Application Of) v London Borough of Lewisham

A Care Act needs assessment must address the adult’s individual needs, their impact on well-being, desired outcomes and whether care or other provision could contribute to those outcomes. The assessment must be read practically and holistically. The court will not conduct its own merits assessment or subject a social worker’s document to over-zealous textual analysis. Pain is a relevant well-being consideration, although it is not itself one of the specified eligibility outcomes. The Care Act does not impose an absolute requirement for specific NHS input during every assessment. A local authority’s assessment remains lawful where it has considered the relevant evidence, statutory factors and eligibility outcomes, even if the claimant disputes the evaluative conclusions.

The claimant, a woman with degenerative muscular dystrophy, sought judicial review of a needs assessment under section 9 of the Care Act 2014. The assessment confirmed a reduction in her care package from 104 to 40 hours per week, including the removal of waking night care.

She alleged irrationality, inadequate consideration of well-being and prevention duties, failure to assess the statutory eligibility outcomes, and failure to cooperate with NHS occupational therapy and physiotherapy services. The central questions were whether the assessment complied with the statutory scheme and whether its conclusions were irrational or reached without regard to relevant considerations.

1. Application dismissed. The assessment was not unlawful and the court declined to quash it.
2. A local authority is the primary decision-maker on the facts. The court’s role is supervisory and it must avoid substituting its own view on the merits. Community care assessments should be construed practically, against their factual background, to identify their substance. They should not be subjected to over-zealous textual analysis.
3. The March 2018 assessment, read as a whole, did not merely adopt earlier decisions. It considered the claimant’s current circumstances, degenerative condition, toileting needs, pressure-sore risk, pain, social needs, equipment, professional evidence and continuing monitoring. Its conclusions were not irrational.
4. Pain was a relevant consideration because physical and mental health and emotional well-being are matters within section 1(2) of the Care Act 2014. A local authority deciding how to meet an eligible need should consider whether one method is more likely than another to avoid or alleviate pain. Pain itself is not one of the specified eligibility outcomes.
5. The assessment adequately addressed the section 9(4) well-being matters, the claimant’s desired outcomes, relevant alternatives and the eligibility outcomes applicable to her circumstances. The absence of specific reference to work, training, education or volunteering did not make the assessment unlawful where those matters were not shown to be relevant to her day-to-day life.
6. Section 3(1) of the Care Act 2014 does not impose an absolute requirement for particular NHS or physiotherapy input during every needs assessment. Occupational therapy had been involved, physiotherapy input was considered, and the evidence did not show that the assessment was unlawful for lack of further health-service involvement. A reassessment might be required if the existing care hours proved inadequate in practice.
7. The claimant’s needs and care package required continuing monitoring, but the evidence did not establish a significant deterioration or additional eligible needs caused by the removal of night care.