Condliff, R (On the Application Of) v North Staffordshire Primary Care Trust

Factual and Procedural Background

This claim concerns a judicial review of the decision made by the Defendant, a Primary Care Trust ("the PCT"), on 13 October 2010, which refused a renewed individual funding request ("IFR") by the Plaintiff for laparoscopic gastric by-pass surgery funded by the NHS. The Plaintiff is morbidly obese with multiple co-morbidities and deteriorating health. The Plaintiff initially applied for funding under the PCT's primary policy, which provides surgery routinely only to those with a BMI over 50. Since the Plaintiff's BMI was below this threshold, he applied for funding on grounds of exceptionality.

The initial IFR was rejected in March 2010. A renewed IFR was submitted in September 2010 but was delayed and incomplete when received by the PCT. The PCT refused to reconsider the application, stating no new evidence of exceptionality was presented. The Plaintiff challenged the PCT's refusal on several grounds, including the legality of the PCT's policy excluding social factors from consideration in IFR decisions.

Legal Issues Presented

1. Whether the PCT's exclusion of social factors from consideration in individual funding requests breaches Article 8 of the European Convention on Human Rights (ECHR).
2. Whether the PCT failed to provide adequate reasons for its decision in breach of Article 6 of the ECHR.
3. Whether the PCT breached its own IFR policy in handling the Plaintiff's renewed funding request.
4. Whether the decision lacked sufficient reasons generally and was therefore irrational.

Arguments of the Parties

Appellant's Arguments

• The Social Factors Exclusion in the IFR policy infringes the Plaintiff's Article 8 rights by failing to consider private life factors relevant to exceptionality.
• The PCT did not provide adequate reasons for its decision, violating Article 6 rights.
• The PCT breached its own IFR policy by failing to treat the renewed IFR as prima facie exceptional and by procedural missteps.
• The decision was irrational due to lack of sufficient reasons.

Defendant's Arguments

• The Social Factors Exclusion is lawful and justified, reflecting a fair balance in allocating limited medical resources.
• Article 8 does not impose a positive obligation to consider social factors in funding decisions.
• The PCT provided adequate reasons through its published policy documents and witness statements.
• The handling of the renewed IFR complied with the policy and was rational.

Table of Precedents Cited

Court's Reasoning and Analysis

The court first considered whether the PCT's Social Factors Exclusion breached Article 8 ECHR by failing to consider private life factors relevant to exceptionality. It found that generally, the allocation of medical resources by public bodies does not engage Article 8 positive obligations, and there is no obligation to consider social factors beyond clinical relevance. The court distinguished cases involving positive obligations to provide adjudicatory frameworks, noting that no such deficiency existed here.

The court examined the PCT's IFR policy and the rationale for excluding social factors, including concerns about fairness, discrimination, and administrative feasibility. It held that the policy represented a fair balance between individual interests and community medical resource needs, justified under Article 8(2).

Regarding the adequacy of reasons under Article 6, the court concluded that no Article 8 positive obligation arose, so Article 6 was not engaged. Even if it were, the reasons implicit in the public IFR policy and witness evidence sufficed.

The court rejected claims that the PCT breached its own IFR policy in handling the renewed request, finding no procedural unfairness or irrationality in the clinical assessment that no new evidence of exceptionality was presented.

Although the decision letter of 13 October 2010 contained minimal reasons, the court found that supplementary evidence explained the rationale adequately. It declined to quash the decision for lack of reasons, noting the Plaintiff could have sought clarification or used complaint procedures earlier.

Holding and Implications

The court DISMISSED the Plaintiff's claim for judicial review.

The direct effect is that the PCT's decision to refuse the renewed IFR for laparoscopic gastric by-pass surgery stands. The Social Factors Exclusion in the IFR policy is lawful and justified, and no breach of Articles 6 or 8 ECHR was found. No new precedent was established; the decision reaffirms established principles regarding the allocation of limited medical resources and the limited scope of positive obligations under Article 8 in this context.