Lowri Evans, R (on the application of) v Aneurin Bevan University Local Health Board & Ors

The claimant sought judicial review of the Joint Commissioning Committee's decision of 23 April 2024 approving a reorganisation of the Emergency Medical Retrieval and Transfer Service (EMRTS), which included consolidating the Welshpool and Caernarfon bases into a single north Wales base and approving development of a bespoke road-based service for rural/remote areas (Recommendation 4). The surviving grounds were (1) irrationality in approving Recommendation 1 absent finalised mitigation under Recommendation 4, (2) failure to take sufficient steps under the Tameside duty, (4) failures in consultation (including alleged failures to have regard to representations from Llais and to comply with the Gunning principles and Service Change Guidance), and (5) breach of the Equality Act 2010 (public sector equality duty and socio-economic duty).

The court applied established public law principles: irrationality/Wednesbury and the Tameside duty on adequate inquiry; the Gunning principles for consultation (formative stage, sufficient reasons to permit intelligent response, adequate time, and conscientious consideration of responses); the statutory duty to have regard to representations by the Citizen Voice Body under section 15 of the Health and Social Care (Quality and Engagement) (Wales) Act 2020 and associated guidance; and the PSED under section 149 of the Equality Act 2010. The court found that Recommendation 4 was a sufficiently distinct initiative, that the JCC had acted within its discretions and complied with the Tameside obligations, that consultation (including engagement with Llais) met the required standards and the Gunning principles, and that the PSED and socio-economic duty had been discharged in substance. An arithmetical error in the costing of one option was found not to be material under the E v Secretary of State test. The claim was dismissed.

This is a first instance judicial review. The claimant, a resident of mid-Wales, challenged the April 2024 decision of the NHS Wales Joint Commissioning Committee (JCC) approving four recommendations arising from the EMRTS Service Review, principally the consolidation of two north/mid Wales EMRTS bases into a single north Wales base and the development of a bespoke road-based enhanced/critical care service for rural and remote areas (Recommendation 4).

Background and parties:

• EMRTS provides specialist pre-hospital critical care (air and road) across Wales. The service is funded jointly by the Welsh Air Ambulance Charitable Trust (the Charity) and the Local Health Boards (LHBs).
• The JCC is a joint committee of the seven LHBs required by direction to plan and commission EMRTS pan‑Wales; Llais is the statutory Citizen Voice Body in Wales.
• The claimant and local campaigners opposed the proposed closure/merger of two bases and raised concerns about rural coverage and disproportionate effects on older, disabled and socio‑economically disadvantaged patients.

Relief sought and issues framed:

• Relief sought: quashing or other relief in respect of the JCC decision of 23 April 2024.
• Key issues decided: (a) whether the JCC acted irrationally or in breach of the Tameside duty by approving Recommendation 1 without finalised detail/costs for Recommendation 4; (b) whether consultation was unlawful for failing to have regard to Llais, to follow Service Change Guidance or to provide sufficient information in Phase 3 so consultees could give intelligent responses (the Gunning principles); (c) whether the Equality Act 2010 duties (PSED and socio‑economic duty) were breached; and (d) whether, alternatively, relief should be refused under section 31 Senior Courts Act 1981 as the outcome would not have been substantially different.

Court's reasoning and findings:

• On the relationship between Recommendations 1–3 and Recommendation 4 the judge examined the documentary history and concluded Recommendation 4 addressed different needs (broader first‑responder/rural ambulance capability) and was sufficiently distinct so that the JCC could lawfully approve the EMRTS consolidation while Task & Finish work on the bespoke road service proceeded. The court rejected the submission that the JCC's balancing was contaminated by a failure to have finalised mitigation/costs for Recommendation 4.
• An error in the arithmetic costing of one shortlisted option (Option 4) was found to be a mistake of fact. Applying the four‑part E v Secretary of State test the judge concluded the error was not material to the outcome because corrected scoring would not have changed the shortlist that went forward.
• On consultation the court held that Llais had been involved throughout, its representations had been considered, and the JCC had regard to the Llais Guidance; the Phase 3 materials reasonably presented the preferred options, the scoring and the rationale and permitted intelligent responses in the circumstances. The Gunning principles were satisfied on the facts; imperfections did not amount to clear and radical unfairness.
• On equality duties the judge found multiple EqIAs were prepared, the Final EqIA identified possible moderate adverse impacts and mitigation and the public sector equality duty and socio‑economic duty were exercised in substance and with rigour; no unlawful failure to consider indirect discrimination was demonstrated.
• In the alternative the court considered section 31 (Senior Courts Act) applying the Court of Appeal guidance in Greenfields and Bradbury and concluded that even if there had been flaws in consultation it was highly likely the outcome would not have been substantially different.

Conclusion: the judicial review claim failed and the JCC decision stands.

The claim is dismissed. The court concluded that the JCC lawfully approved the EMRTS reorganisation; Recommendation 4 was sufficiently distinct so that its final details and costings were not a precondition to endorsing the consolidation recommendations; consultation (including regard to Llais and the Gunning requirements) was adequate; the PSED and socio‑economic duty were complied with in substance; an arithmetical costing error was not material; and, in any event, section 31 Senior Courts Act 1981 would have precluded relief on consultation grounds.

Permission for judicial review was considered on paper by Eyre J (permission granted in respect of grounds 1, 2 and 5 and renewed permission for ground 4; permission issues dealt with on paper). The substantive rolled‑up hearing took place before Turner J (hearing dates 22–23 January 2025 and 7 February 2025; final written submissions 20 May 2025). Judgment handed down 19 June 2025.