Rabone & Anor v Pennine Care NHS Foundation

Factual and Procedural Background

While on two days’ home leave from The Hospital’s psychiatric ward, a 24-year-old informal patient (“the Deceased”) took her own life on 20 April 2005. She had recently been admitted after a serious suicide attempt and was clinically assessed as presenting a high suicide risk. Her parents (“Plaintiffs”) contended that the treating clinicians should have refused home leave or, if necessary, invoked powers under the Mental Health Act 1983 to detain her.

Proceedings were issued on 11 August 2006. The Plaintiffs advanced (i) a negligence claim under the Law Reform (Miscellaneous Provisions) Act 1934 on behalf of the Deceased’s estate and (ii) a claim in their own right that the Defendant Trust (“Defendant”) had breached the substantive, life-protective duty implicit in article 2 of the European Convention on Human Rights. The negligence action settled for £7,500 in May 2008. Liability for breach of article 2 was denied. At first instance Judge Simon ruled that article 2 imposed no operational duty toward voluntary psychiatric in-patients and, in any event, the risk was not “immediate.” The Court of Appeal agreed as to duty but held that, had a duty existed, it would have been breached. The Plaintiffs appealed to the Supreme Court.

Legal Issues Presented

1. Whether an article 2 operational duty can exist in respect of an informal (non-detained) psychiatric patient.
2. If so, whether a “real and immediate” risk to the Deceased’s life existed on 19 April 2005 and whether reasonable preventive measures were taken.
3. Whether the Plaintiffs qualify as “victims” under article 34 of the Convention.
4. Whether any victim status was lost through the negligence settlement and related admissions/apology.
5. Whether the article 2 claim was time-barred and, if so, whether an extension was equitable under section 7(5)(b) of the Human Rights Act 1998.
6. The appropriate quantum of “just satisfaction” if breach were established.

Arguments of the Parties

Plaintiffs' Arguments

• Article 2 duties extend beyond detained persons to any psychiatric patient for whom the State has assumed responsibility and control, especially where statutory detention powers are available if needed.
• The risk of suicide was both real and immediate; clinicians themselves recorded a high suicide risk and the decision to grant leave was one no reasonable psychiatrist would have taken.
• They remained “victims” because the negligence settlement compensated only the estate, not their own bereavement, and the Defendant never acknowledged an article 2 breach.
• The four-month filing delay was short, caused by the Defendant’s protracted internal investigation, and caused no evidential prejudice.
• Comparable Strasbourg awards support damages of at least £5,000 each.

Defendant's Arguments

• The operational duty recognised by Strasbourg applies only to detainees or categories expressly identified (e.g., prisoners, conscripts); voluntary patients fall within the Powell line of “ordinary medical negligence” cases.
• The quantified suicide risk (5–10%) was neither likely nor immediate; clinicians exercised a professional discretion entitled to a “margin of appreciation.”
• Victim status was lost because the negligence settlement and written apology constituted adequate redress and an implicit acknowledgment.
• The claim was issued out of time without good reason.
• If damages were payable, they should be modest (c. £1,500 each) given that the litigation’s primary objective was declaratory.

Table of Precedents Cited

Court's Reasoning and Analysis

Operational Duty: The Court, per Judge Dyson, held that Strasbourg jurisprudence is trending toward broader protection where the State assumes responsibility and the individual is highly vulnerable. Although the Deceased was not formally detained, the Defendant exercised control: it could have used Mental Health Act holding powers and the Deceased would not, on the findings, have resisted. Her position was therefore materially akin to that of detained patients addressed in Savage.

Real and Immediate Risk: Expert evidence placed suicide risk between 5–20% over the leave period—“substantial and significant.” “Immediate” was interpreted as “present and continuing,” not limited to last-minute imminence. The risk existed when home leave was granted and persisted throughout.

Breach: All competent psychiatrists would have refused leave; no alternative protective measures (e.g., closer supervision or detention) were explored. Respect for autonomy did not excuse ignoring a high suicide risk. Accordingly, the operational duty was breached.

Victim Status: Strasbourg cases confirm close relatives may be substantive article 2 victims. The negligence settlement compensated only the estate and contained no admission of article 2 breach; thus neither limb of the Eckle / R.R v Poland test was met and victim status persisted.

Limitation: Issuing four months late was equitable due to the Defendant’s delayed internal investigation, absence of prejudice, and the strength of the claim.

Damages: Strasbourg awards for bereaved relatives typically range from £5,000 upward. Given close family ties, foreseeability, and the Plaintiffs’ distress, £5,000 each was necessary for “just satisfaction.”

Holding and Implications

HELD: The appeal was ALLOWED. The Court declared that the Defendant breached its article 2 operational duty; extended time; and awarded £5,000 to each Plaintiff.

Implications: This decision confirms that UK healthcare providers owe an article 2 operational duty to informal psychiatric in-patients when a real and immediate suicide risk is or should be known. The ruling narrows the gap between voluntary and detained patients and will likely influence hospital leave decisions, mental-health protocols, and future litigation on State responsibility for vulnerable persons’ safety.