University College London Hospitals NHS Foundation Trust v MB (Rev 1)

A hospital may withdraw permission for a patient to occupy a bed and may enforce its proprietary rights, provided its decision is lawful in public law. Where an interim injunction would effectively grant final relief, the court must be satisfied that there is clearly no defence, while also considering the balance of convenience.

Human rights and equality duties do not entitle a patient to insist on a particular care package, chosen therapists or continued in-patient treatment. Rational allocation of scarce hospital resources may justify discharge, even where discharge will cause serious distress or create a managed risk of self-harm. The court should not substitute its own clinical judgment for that of the treating team.

The claimant NHS foundation trust sought urgent interim injunctive relief requiring MB to leave a hospital neuropsychiatry ward. Her licence to occupy the hospital room had been terminated, and the trust contended that she could safely move to specially adapted accommodation with a 24-hour care package and community mental-health support.

MB opposed discharge. She relied on concerns about future care-package reviews, the identity of therapists and adaptations to the accommodation. She contended that discharge before those concerns were resolved could cause extreme distress, self-harm or suicide, contrary to Articles 3, 8 and 14 of the ECHR and sections 29 and 149 of the Equality Act 2010. The central issues were whether she had an arguable public law defence and whether interim relief should be granted during the COVID-19 emergency.

1. Private law and interim relief. A patient has no right to occupy a hospital bed except with the hospital’s permission. The hospital may withdraw that permission. Since the proposed injunction would be tantamount to final relief, the court had to be satisfied that there was clearly no defence, while considering the balance of convenience and other discretionary factors.
2. Evidence and clinical judgment. The court declined to adjourn for independent expert evidence. A collateral challenge to clinical judgment should not permit evidence which would not be admissible on a direct judicial review challenge. Clinicians cannot be required to provide treatment contrary to their clinical judgment. The treating team’s detailed multidisciplinary evidence showed that MB could be safely discharged, with 24-hour care and specialist mental-health support.
3. Human rights. Article 3 did not preclude discharge merely because it might cause extreme distress or create a risk of self-harm. In-patient care is a scarce resource, and a rational, lawful allocation decision may take account of the needs of other patients. The hospital’s decision engaged a limited positive obligation to take reasonable steps to avoid Article 3 suffering, rather than an absolute duty not to inflict such suffering. On the evidence, the risk was moderate to low and appropriately managed.
4. Article 8 was engaged but the interference was justified by the need to protect the rights of patients requiring in-patient treatment. Article 14 added nothing: MB was treated according to clinical need, and any disability-related difference was justified.
5. Equality Act 2010. The public sector equality duty was a matter of substance, not form. The relevant disability-related factors had been fully considered. The alleged discrimination and failure to make reasonable adjustments were not arguable. MB was not entitled to insist on a particular level of care, therapists of her choice or every requested adaptation.
6. Outcome. Interim relief was granted. MB was required to leave the ward by noon on 10 April 2020, once arrangements had been made for her transfer and belongings. She was prohibited from obstructing the arrangements and from re-entering the hospital without permission, save if admitted by ambulance.