A, R (On the Application Of) v North Central London Integrated Care Board

Factual and Procedural Background

The Appellant is a 12-year-old child with a severe genetic disorder requiring 24-hour care. He is eligible for continuing care under the NHS National Framework. The Respondent, an Integrated Care Board responsible for commissioning the Appellant's care, initially contracted a third party, Company A, to provide care but terminated this contract due to dissatisfaction. Subsequently, a new provider, Company B, was engaged, but the Appellant's parents rejected this provider and continued privately funding care through Company A. The Appellant brought a judicial review challenging the Respondent’s actions on three grounds: failure to ensure a lawful health care plan, irrational termination of Company A’s contract, and a claim for restitution of costs incurred by the parents after the contract termination. The trial judge granted permission and found in favor of the Appellant on the first ground, ordering the Respondent to arrange a health care plan, but dismissed the other grounds. The Appellant appeals the dismissal of the restitution claim, while the Respondent cross-appeals the finding of breach regarding the health care plan, introducing fresh evidence in the form of a draft updated health care plan prepared after the original hearing. The appeal also involves a Notice to Affirm by the Appellant, seeking to uphold the breach finding for additional reasons.

Legal Issues Presented

1. Whether the Respondent breached its mandatory, non-delegable duty under section 42(3) of the Children and Families Act 2014 to arrange an up-to-date health care plan reflecting the November 2023 EHC Plan.
2. Whether the draft health care plan produced after the trial judge’s decision affects the breach finding and the remedy to be granted.
3. Whether the Appellant is entitled to restitution for costs incurred by his parents in privately funding care after the Respondent terminated Company A’s contract.
4. Whether the Appellant’s Notice to Affirm, seeking to uphold the breach finding on grounds of inadequacy of the June 2023 health care plan, should be allowed.

Arguments of the Parties

Appellant's Arguments

• The Respondent failed to comply with its absolute and non-delegable duty to arrange a lawful, updated health care plan as mandated by statute.
• The Respondent acted unlawfully by terminating Company A’s contract without ensuring a proper transition of care, causing the parents to incur costs which should be reimbursed via restitution.
• The draft health care plan prepared after the trial court’s judgment remains inadequate and does not discharge the Respondent’s statutory duty.
• The Notice to Affirm argues that the June 2023 health care plan was inadequate in content, supporting the breach finding.

Respondent's Arguments

• The Respondent contends that it reasonably relied on Company A to update the health care plan, and the June 2023 plan was sufficient at the material time.
• Fresh evidence (the August 2024 draft health care plan) shows the Respondent took reasonable steps and that the breach was mitigated.
• The Respondent lawfully terminated Company A’s contract due to safety and service concerns and was ready to commission alternative care, which the parents declined.
• The costs incurred by the parents are their choice and not caused by any unlawful conduct of the Respondent, thus no restitution claim arises.
• The Respondent challenges the adequacy arguments regarding the June 2023 health care plan and submits that the Notice to Affirm should be dismissed as unnecessary.

Table of Precedents Cited

Court's Reasoning and Analysis

The Court first addressed the Respondent's cross-appeal concerning the breach of duty to arrange an updated health care plan. It admitted the August 2024 draft health care plan as fresh evidence, finding it relevant and important for a just resolution. The Court reasoned that although the Respondent had delayed in arranging an updated plan, the existence of the draft mitigated the breach. The draft was incomplete and unsigned by the parent, so it could not be treated as a completed plan fulfilling the statutory duty. The Court also found that by the time of the judicial review hearing, the Respondent was no longer commissioning care, limiting its ability to finalize the plan. The Appellant's parents, now privately funding care, could press for its finalization. Consequently, the Court quashed the mandatory order for the Respondent to arrange a new plan and substituted no order as remedy.

Regarding the Notice to Affirm, the Court held that it was unnecessary to consider the adequacy of the June 2023 health care plan, as the breach related to the absence of an updated plan reflecting the November 2023 EHC Plan. The Court dismissed the Notice to Affirm accordingly.

On the restitution claim, the Court analysed whether the Respondent was unjustly enriched by the parents’ payment for care after the contract termination. It accepted the Respondent’s lawful termination of the contract and the parents’ choice to continue privately funding care. The Court found no causal link between the breach (failure to update the health care plan) and the costs incurred post-termination. It distinguished relevant precedents and concluded that the Respondent was not unjustly enriched in a manner warranting restitution. Therefore, the restitution claim was dismissed.

Holding and Implications

The Court’s final decision is as follows:

• The Respondent's cross-appeal is allowed to the extent that the mandatory order requiring the Respondent to arrange a new health care plan is quashed and substituted with no order for remedy.
• The Appellant's Notice to Affirm is dismissed.
• The Appellant's appeal on the restitution claim is dismissed.

The direct effect of this decision is that while the Respondent was found to have breached its statutory duty to arrange an updated health care plan, the remedy originally granted is set aside in light of the new evidence. No mandatory order will compel the Respondent to produce a plan, given the changed circumstances and the parents’ private commissioning of care. The dismissal of the restitution claim means the parents must bear the costs they incurred after the Respondent lawfully terminated the contract. No new legal precedents are established by this decision; rather, it clarifies the application of existing principles to the facts of this case.