UK: South Staffordshire And Shropshire Healthcare NHS Foundation Trust v. St George's Hospital Managers

Last Updated: 18 July 2016
Article by Claire Petts

This case considered whether a Hospital Manager's Panel can discharge a patient from detention under the Mental Health Act 1983

The decision of Justice Cranston relates to the ability of a Trust to seek judicial review of a Hospital Managers' Panel decision to discharge a patient from detention under the Mental Health Act 1983 ("MHA") and whether a Panel is required to take into consideration the Mental Health Tribunal's decision in reaching its own. In summary, the Court held that a Trust can seek judicial review of a Panel's decision (to whom it has delegated decision-making powers) given that the Panel is sufficiently independent from the Trust.

The Trust was not however successful on the substantive point regarding the Panel's decision. Firstly, a Tribunal's decision is not a "relevant consideration which a Panel must take into account in reaching a decision to discharge". Secondly, the decision of the Panel in this particular case did not fall outside a range of reasonable decisions open to the Panel. The Panel, whose members had considerable experience, had considered relevant evidence and considered that the needs of the patient would not be met by continued hospital admission and did not justify continued compulsory state detention under the MHA.

Facts

The patient ("P") had a long psychiatric history with and exhibited aggressive behaviour towards his parents, with whom he continued to live. Following 6 months of detention under s. 3 MHA, in March 2016, P appealed the Tribunal's decision not to discharge him (on account of their concerns of his compliance with medication and the risk to his parents). The Panel met in April 2016 following the appeal.

After hearing evidence from relevant experts, the clinical team, the patient himself and his parents, the Panel concluded that the patient was appropriate for discharge and that continued state detention could no longer be justified.  In making its decision, the Panel considered that the patient's bipolar state had stabilised.  They noted that over 30 years P's condition had only warranted hospital admission on two occasions, the patient had a clear motivation in light of his hospital experience to continue taking his medication in the community, and although his personality disorder was not yet treated, he had lived with it for the majority of his adult life without great incident.

The Trust did not agree with the outcome and sought a judicial review of the Panel's decision.

Capacity of the Trust to judicially review the Panel's decision

A public body cannot judicially review its own decision. In this situation however, the decision-making power had been delegated to the Panel. This was clear from the scheme of the legislation (s.23(6) MHA) allowing a Panel, as a separate body from the Tribunal and whose members must not be either an executive director of the board or an employee of the Trust, to discharge a patient detained under the MHA . 

A Panel's decision is only likely to be reviewable by the Court in exceptional circumstances (which does not include the Tribunal simply reaching a different decision). Importantly, judicial review is the appropriate remedy. Re-sectioning the patient is not a suitable alternative remedy and would undermine the intention of the MHA that a Panel decision has equal standing to a Tribunal's decision.

No requirement to consider the Tribunal's decision

The Court held that a Panel is not required to take the Tribunal's decision into account as a relevant consideration, although a Panel may choose to do so and how much weight to give it. In this case, the Panel had considered the Tribunal's decision. There was no legal requirement however under the MHA or the Code of Practice to take the Tribunal's decision into account or that it elevated it to a status as a "relevant consideration".  A Panel need not even read the Tribunal's decision. The Court held that in accordance with the intention behind the MHA in providing various avenues open to patients to regain their liberty means that it is up to these separate decision-makers to decide whether or not to take into account a decision of another and, if so, how much weight to give to it.

Reasonableness of the Decision

As above, the Panel (comprised of members experienced in making such decisions) had heard evidence from relevant parties in reaching its decision. It gave reasons for its decision as outlined above and balanced the risks of the patient being discharged to the community against his needs.

As a practical point, the Trust had challenged the detail of the written decision by the Panel. The relevant form designed by the Trust was noted to have left little room for more detail.

Key Learning Points

  • A Trust can seek judicial review of a Hospital Managers' Panel decision
  • A Panel decision and Tribunal decision are of equal standing
  • It is not an appropriate remedy simply to re-section a patient
  • Panels are under no obligation to take a Tribunal's decision into account
  • It is advisable to review forms designed for Panels  to ensure that the Panel's written decisions contain sufficient detail for the Trust to be able consider it, before taking further steps.

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