16.27R v North and East Devon Health Authority ex p Coughlan [2001] QB 213, (1999) 2 CCLR 285, CA
In the absence of special circumstances a health authority was not required to assess the needs of patients before deciding to close a facility. The clear promise of a ‘home for life’ created a legitimate expectation that had not been fully taken into account, nor demonstrated to be overridden by a public interest
Facts: Ms Coughlan was rendered very severely disabled by a road traffic accident. After a period of treatment at Newcourt Hospital, which the health authority then wished to close, she and seven other patients were moved to Mardon House hospital, with an assurance that it would be their ‘home for life’. However, the health authority then resolved to close Mardon House. In addition, it determined that Ms Coughlan no longer met the criteria for NHS continuing healthcare, so that she had to resort to local authority residential accommodation. Ms Coughlan submitted that it was beyond the powers of a local authority to provide her with the nursing care she needed and that it was unlawful for the health authority to resile from its ‘home for life’ promise; and a breach of Article 8 ECHR.
Judgment: the NHS was entitled to close Mardon House in stages and it was not necessary that it fully assessed the needs of the Mardon House residents, and decided upon alternative service provision, before reaching a decision in principle to effect closure:
103. The concerns of the Health Authority about the practical implications of the judge’s decision on these two points are well understood. In the absence of special circumstances, normally we would expect it to be unrealistic and unreasonable, on grounds of prematurity alone, for the Health Authority in all cases to make assessments of patients and to take decisions on the details of placement ahead of a decision on closure. Neither the statutory provisions nor the Guidance issued expressly require assessments to be made or decisions on alternative placements to be taken before a decision to close can be lawfully made.
In this case, the ‘home for life’ promise had created legitimate expectations that North and East Devon had failed fully to take into account and had not demonstrated any overriding public interest that justified resiling from that promise:
89. We have no hesitation in concluding that the decision to move Miss Coughlan against her will and in breach of the Health Authority’s own promise was in the circumstances unfair. It was unfair because it frustrated her legitimate expectation of having a home for life in Mardon House. There was no overriding public interest which justified it. In drawing the balance of conflicting interests the court will not only accept the policy change without demur but will pay the closest attention to the assessment made by the public body itself. Here, however, as we have already indicated, the Health Authority failed to weigh the conflicting interests correctly. Furthermore, we do not know (for reasons we will explain later) the quality of the alternative accommodation and services which will be offered to Miss Coughlan. We cannot prejudge what would be the result if there was on offer accommodation which could be said to be reasonably equivalent to Mardon House and the Health Authority made a properly considered decision in favour of closure in the light of that offer. However, absent such an offer, here there was unfairness amounting to an abuse of power by the Health Authority.