View source for ICLR Coombs v North Dorset NHS PCT (2013) EWCA Civ 471, (2013) MHLO 35

''MENTAL DISORDER — Admission for treatment — Compulsory detention — Claimant detained in mental hospital — Whether statutory or public policy prohibiting claimant contributing to cost of treatment or care — Mental Health Act 1983 — National Health Service Act 2006, s 1(3)''

'''Coombs v North Dorset NHS Primary Care Trust and another'''

'''[2013] EWCA Civ 471;  [2013] WLR (D)  158'''

CA:  Rix, Aikens, Black LJJ :  30 April 2013

There was nothing inherent in the structure or wording of the Mental Health Act 1983 or the National Health Service Act 2006, and nothing by way of public policy, to exclude the possibility of a person detained under a provision of the 1983 Act from paying or contributing to the cost of his treatment or care.

The Court of Appeal so held in a reserved judgment dismissing the appeal by the defendants, North Dorset NHS Primary Care Trust and Nottinghamshire Healthcare NHS Trust, from the order dated 17 February 2012 of Judge Platts sitting as a judge of the Queen’s Bench Division [2012] EWHC 521 (QB), who had held on a trial of a preliminary issue that a person compulsorily detained under a provision of the 1983 Act, such as the claimant, Timothy Coombs (suing by his brother and litigation friend David Coombs), could pay for his own care and treatment. The defendants had admitted liability for negligence in respect of brain injury suffered by the claimant in a fall from an ambulance, and the question had arisen in the context of the assessment of damages.

'''RIX LJ''' said that it was the defendant’s case that a detained patient was analogous to a prisoner; his care was wholly in the hands of the authorities, who had complete control over his treatment, and it would be against public policy for the patient to have a role in funding his treatment. However, the analogy broke down; the function of detention was not punishment, but a necessary adjunct to therapy. The defendants relied on section 1(3) of the 2006 Act, which required the services provision of which it was the Secretary of State’s duty to ensure to be free of charge. The subsection itself acknowledged that the NHS could charge for its services where expressly permitted by an enactment. A patient could be detained in a private hospital. There was nothing inherent in the structure or wording of the 1983 Act or the 2006 Act, and nothing by way of public policy, to exclude absolutely the possibilities of detained patients (or their family or others holding responsibility for looking after their assets) paying for or contributing in part to the cost of their treatment or care. Detained patients being looked after by an NHS authority might be able to purchase private accommodation or other top-up care facilities. It would not be possible to provide for care or treatment which was in conflict with the recommendations of a responsible clinician; however, responsible clinicians might recommend treatment or care which went beyond what it was the statutory duty of the NHS to provide. There was nothing to prevent the claimant from paying for his own care or treatment.

'''AIKENS''' and '''BLACK LJJ''' agreed.

'''Appearances:''' Jennifer Richards QC (instructed by DAC Beachcroft LLP) for the defendants; Martin Spencer QC and Tejina Mangat (instructed by Moore Blatch Solicitors, Lymington) for the claimant.

'''Reported by:''' Alison Crail, Barrister.

© 2012. The Incorporated Council of Law Reporting for England and Wales.