A, R (on the application of) v Partnerships In Care Ltd.

Factual and Procedural Background

This case concerns a decision made by the managers of a private psychiatric hospital to change the focus of one of its wards. The remaining claimant alleges that this change has denied her the care and treatment appropriate to her severe personality disorder, for which she requires specialist psychology and psychotherapy. She was admitted to the ward after a long wait, funded by a health authority. The ward was originally intended as a single-sex unit for women with personality disorders, but on 6 August 2001, the hospital managers decided to refocus the ward to cater primarily to women with mental illness, with existing patients allowed to remain for up to 18 months. This change resulted in the departure of specialist staff and a lack of appropriate care for patients like the claimant.

The defendant, who owns and runs the hospital, acknowledges the change but asserts that the ward was initially mixed-sex and intended for both mentally ill and personality disorder patients. The decision to focus on mental illness followed the resignation of a key consultant psychiatrist specializing in personality disorders. The defendant admits that the claimant has not received the full care required but attributes this to unforeseen staff resignations.

The claim for judicial review challenges the decision of 6 August 2001. Initially, three claimants brought the claim, but two withdrew after securing alternative placements. The defendant did not oppose the judicial review proceeding or the expedition of the hearing and undertook not to further implement the ward change pending the outcome. The claim proceeds against the defendant, who is regarded as responsible for the hospital managers' decision.

Legal Issues Presented

1. Whether the decision of the hospital managers to change the ward's focus was made "in relation to the exercise of a public function" and thus amenable to judicial review under CPR r 54.1.
2. Whether the hospital managers constitute a public authority within the meaning of section 6 of the Human Rights Act 1998, thereby making any infringement of Convention rights unlawful.

Arguments of the Parties

Claimant's Arguments

• The claimant requires specialist psychological and psychotherapeutic treatment in a therapeutic setting for her severe personality disorder.
• The decision to change the ward's focus has denied her appropriate care and treatment.
• An alternative case is advanced that the decision infringed her rights under articles 3 and 8 of the European Convention on Human Rights.

Defendant's Arguments

• The ward was originally mixed-sex and intended to serve both mentally ill patients and those with personality disorders.
• The decision to focus on mental illness patients followed the resignation of a key psychiatrist specializing in personality disorders.
• The defendant accepts the claimant has not received full care due to unexpected staff departures but denies unlawful conduct.
• The defendant is responsible for the hospital managers' decision and does not contest the court's jurisdiction.
• The defendant applied for an adjournment to consider new evidence but agreed to limit the hearing to the two legal issues not dependent on disputed facts.

Table of Precedents Cited

Court's Reasoning and Analysis

The court began by examining the statutory framework governing the hospital and its functions. Although the hospital is privately owned, it operates under statutory duties imposed by the Mental Health Act 1983 and the Registered Homes Act 1984, including obligations to provide adequate staff and treatment facilities. The hospital admits patients detained under the Mental Health Act, who are deprived of liberty and require care in the public interest.

The court considered established case law distinguishing between private acts and acts of a public nature. It noted that the hospital managers perform statutory functions delegated from public health authorities, and the decision to change the ward’s focus directly affects the care of detained patients, implicating public law concerns.

The court rejected the argument that the hospital’s functions were purely private, emphasizing the statutory duties and the public interest in the care of detained patients. Drawing analogy with private prisons, the court held that despite the hospital’s private ownership, the managers' decision was a public act amenable to judicial review.

The court also considered the Human Rights Act 1998, concluding that the hospital managers qualify as a functional public authority for the purpose of the Act, making their acts subject to human rights obligations.

Accordingly, the court limited the initial hearing to the two legal issues not dependent on disputed facts: the public function status of the decision and the hospital managers as public authorities under the Human Rights Act.

Holding and Implications

The court held that the decision of the hospital managers to change the focus of the ward was an act of a public authority and is susceptible to judicial review. This establishes that private bodies performing statutory functions in the health context may be subject to public law scrutiny.

The claimant’s judicial review claim will proceed to a substantive hearing on the merits. The decision directly affects the claimant’s entitlement to appropriate care and treatment but does not establish a broader precedent beyond confirming the public authority status of the hospital managers in these circumstances.