NATIONAL HEALTH SERVICE — Health authority — Provision of care — Patient requiring constant and expensive care — Whether primary care trust or social services authority to decide if requiring health care provided by trust or social care from authority — National Assistance Act 1948, ss 21, 29 — National Health Service Act 2006, ss 1-3.
It was for the primary care trust acting on behalf of the Secretary of State for Health and not for the local authority to decide whether the care needs of a woman with dissociative identity disorder were primarily for health care or for care which a social services authority should provide. The trust was required to define in its decision the services which the social services authority was required to provide to the woman, whose mental and psychological conditions required constant and expensive care. It was not satisfactory for the two parties to resolve the issue by costly litigation, since the money for the care and the litigation all came from the public purse.
The Court of Appeal so held on an appeal by the claimant, St Helens Borough Council, from a decision of Beatson J in the Administrative Court on 7 September 2007  EWHC 2391 (Admin) dismissing the claimant’s claim for judicial review of a decision taken on 30 November 2006 by a panel appointed by the defendant, the Manchester Primary Care Trust, that the needs of the patient, PE, were not primarily for health care and that, except for physiotherapy and other specific health care matters, the trust should not fund the care.
MAY LJ said the judicial review jurisdiction was flexible but not entirely unfenced. The court did not often make a factual decision which the primary decision maker had not made. His Lordship reviewed the statutory framework and held that the Secretary of State had the power to determine whether the local social services authority or the primary care trust should provide PE’s continuing care. There was a dividing line between health care and community care, but by common consent no gap. The dividing line, in an individual case, depended on whether the individual’s needs were primarily health care needs, or by contrast whether they were such as a local authority could be expected to provide. The 2006 Act dominated, but the local authority’s responsibilities were limited to those set out in s 21 of the 1948 Act. The social services authority did not have an equivalent or equivalently structured decision making process which could hold its own against that of the Secretary of State, through the primary care trust, under the 2006 Act. The trust’s decision could be challenged by way of orthodox judicial review and the court was not required to determine the conflicting substance of two decisions of equivalent standing.
SCOTT BAKER LJ gave a short concurring judgment.
SIR PETER GIBSON agreed.
R (St Helens Borough Council) v Manchester Primary Care Trust and another  EWCA Civ 931;  WLR (D) 288
CA: May and Scott Baker LJJ and Sir Peter Gibson: 6 August 2008
Appearances: Jenni Richards (Weightmans LLP) for the claimant; Stephen Knafler (Hempsons) for the defendant.
Reported by: John Spencer, barrister