Summary of Judgment

Factual and Procedural Background

The First Applicant and the Second Applicant were prisoners with long-standing drug addictions who sought assessment for suitability for Opiate Substitution Therapy (OST) provided by the prison healthcare service for which Company A was responsible. The Second Applicant waited over three years on an OST waiting list; the First Applicant waited over two years without receiving an assessment. The trial judge (Judge McAlinden) found breaches of Articles 3 and 8 ECHR in the Second Applicant's case and unlawful discrimination under Article 14 read with Articles 3 and 8 in both applicants' cases, issuing declarations and awarding damages (£5,000 to the Second Applicant and £2,000 to the First Applicant). Company A (respondent) and Company B (notice party) appealed the findings. The Court of Appeal (Judge Keegan LCJ, Judge Colton LJ and Judge McLaughlin J) considered the appeals; the applicants maintained their Convention claims (Second Applicant asserted breaches of Articles 3, 8 and 14; First Applicant primarily pursued Article 14 read with Article 8 and later Article 3).

Legal Issues Presented

1. Whether the delay in assessing and providing OST to the Second Applicant amounted to treatment breaching Article 3 ECHR (torture, inhuman or degrading treatment).
2. Whether delay or non‑provision of OST engaged Article 8 ECHR (right to respect for private and family life) and, if so, whether any interference was justified under Article 8(2).
3. Whether differential treatment of prisoners waiting for OST assessments, compared with community patients, amounted to unlawful discrimination contrary to Article 14 read with Articles 3 and/or 8.

Arguments of the Parties

Applicants' Arguments

• Second Applicant: prolonged delay in assessment and provision of OST caused repeated withdrawal, mental deterioration and distress and therefore breached Articles 3 and 8; additionally alleged discrimination under Article 14 when compared with community patients.
• First Applicant: delay in assessment constituted discrimination under Article 14 when compared to timely community OST assessments; initially relied on Article 14 read with Article 8 and later permitted to add Article 14 read with Article 3.

Appellants' Arguments (Company A and Company B)

• The trial judge erred in applying Article 3: the minimum severity threshold was not met and the judge failed to distinguish suffering from the underlying addiction from state‑caused treatment and to assess whether reasonable steps had been taken.
• The trial judge mischaracterised delay as a positive decision not to provide care and failed to take account of operational and resource constraints in prison healthcare provision.
• The Article 8 findings were flawed: any interference was rationally connected to the legitimate aim of providing adequate and safe prison healthcare and was proportionate given resource limits and clinical prioritisation.
• The Article 14 findings were incorrect: prisoners seeking OST are not in an analogous position to community patients in the context of prioritisation and resource pressures; the differential treatment was objectively justified and within a wide margin of appreciation (the judge failed to apply Re SC [2021] UKSC 26 correctly).
• The judge erred in remedy reasoning; the assessment of damages and declarations required reconsideration (issue reserved in part for later consideration).

Table of Precedents Cited

Court's Reasoning and Analysis

The court structured its analysis around Articles 3, 8 and 14 and the applicable Strasbourg and domestic principles. Key steps were:

• Article 3 framework: the court reiterated that Article 3 is absolute, requires a fact‑sensitive assessment of minimum severity, and includes positive obligations to provide requisite medical care, including adequate specialist assessment and measures to prevent unnecessary exacerbation of illness. The court relied on Blokhin, Wenner, McGlinchey and other Strasbourg authorities.
• Context and evidence: the court accepted that prison healthcare was chronically underfunded and that demand for OST within the prison population was far higher than in the community. It accepted Company A's evidence (including the affidavits of the lead prison addictions clinician and the clinical director) that clinical prioritisation, capacity constraints, safety considerations and operational factors (including effects of body scanners and re‑inductions) drove a policy of prioritising prisoners already on OST and maintaining a waiting list for new assessments.
• Evaluation of competing clinical evidence: the court examined the applicants' evidence (self‑reports and a report from an external psychologist) and the Trust clinicians' evidence (notably Dr Flanagan and Dr Kirk). It identified significant inconsistencies in the Second Applicant's records and limited objective evidence of frequent withdrawal in the period in issue, contrasted with the applicants' self‑reported symptoms.
• Application of Article 3 standard: applying the severity test and taking account of the care actually provided (regular reviews, ADEPT addiction service interventions, symptomatic medication and clinical safeguards), the court concluded the judge at first instance erred in finding treatment reached the minimum level of severity required for an Article 3 breach. The court emphasised that lack of equivalence alone did not establish ill‑treatment and that the Trust's prioritisation and clinical safety concerns were legitimate factors.
• Article 8 assessment: the court was sceptical that Article 8 was properly engaged where Article 3 is the lex specialis, but proceeded to assess proportionality. It found any interference was justified by the legitimate aim of providing adequate, safe prison healthcare and that the Trust's measures were rationally connected and proportionate given resource and clinical constraints.
• Article 14 analysis: the court applied the cumulative Article 14 test (status, analogous situation, ambit, causal link and justification). While accepting in principle that prisoner status can be an "other status" and that a difference in treatment could be identified, the court found the differential treatment was objectively justified by clinical prioritisation and resource considerations and not manifestly without reasonable foundation given the wide margin afforded in policy areas, so the Article 14 claims failed.
• Appellate standard: the court acknowledged deference to first instance factual findings but explained it was entitled to reach a different legal conclusion when applying legal principles to the established facts. It found the trial judge had given too much weight to equivalence and had not sufficiently credited Company A's evidence about clinical risk and resource constraints.

Holding and Implications

APPEALS ALLOWED

Holding: The Court of Appeal allowed the appeals by Company A (and Company B as notice party) and concluded there was no breach of Articles 3, 8 or 14 ECHR by Company A in the applicants' cases on the evidence before the court. The first instance findings of breach against Company A were set aside.

Implications: The direct effect is that the declarations and damages awarded at first instance for breaches of Articles 3, 8 and 14 by Company A were overturned; no relief was granted against Company B in these proceedings. The court noted the Departmental commitment to seek additional funding for OST in prisons but did not base its decision on such political or funding promises. The court did not purport to create any new legal principle beyond applying existing Strasbourg and domestic authorities to the facts; the decision turns on the application of established Article 3/8/14 principles to the factual matrix of prison OST provision and resource‑driven clinical prioritisation.