COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM ADMINISTRATIVE COURT
MR JUSTICE BEATSON
Strand, London, WC2A 2LL
B e f o r e :
Vice-President of the Civil Court of Appeal
LORD JUSTICE CHADWICK
LORD JUSTICE WALL
| The Queen on the Application of Goldsmith
|- and -
|The London Borough of Wandsworth
Smith Bernal Wordwave Limited, 190 Fleet Street
London EC4A 2AG
Tel No: 020 7421 4040, Fax No: 020 7831 8838
Official Shorthand Writers to the Court)
Miss Elisabeth Laing (instructed by D M H Solicitors) for the Respondent
Crown Copyright ©
Lord Justice Wall:
Introduction and overview
The application for permission came before Burton J on 25 September 2003. Burton J ordered the application for permission to be heard with the substantive hearing, and adjourned it to 14 October to enable the parties to discuss the nature and extent of the Claimant's needs. A meeting attended by (Linda Goldsmith), a friend of hers, Mr. Vincent Kelly, the Defendant's social work manager responsible for this case, Dr. Cottee, a consultant geriatrician at the Chelsea and Westminster Hospital, legal representatives and an employee of the Defendant's took place on 6 October. (Linda Goldsmith) sought to persuade the Defendant that her mother could remain in the residential home but was unsuccessful. On 14 October the matter came before Jackson J. It was again adjourned on the following basis. First, that (Linda Goldsmith) and the Defendant agreed to meet with other relevant parties to discuss possible nursing home placements and levels of care and facilities for the Claimant. Secondly, that she should return to (Mary Court) on an interim basis with her daughter arranging and funding the provision of 24 hour nursing care for her and the Defendant paying the weekly contribution to her residential charges. She returned to (Mary Court) on 20 October 2003.
The legislative framework
… where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority –
(a) shall carry out an assessment of his needs for those services; and
(b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services.
If at any time during the assessment of the needs of any person under subsection (1)(a) above, it appears to a local authority –
(a) that there may be a need for the provision to that person by such Primary Care Trust or Health Authority as may be determined in accordance with regulations of any services under the National Health Service Act 1977 …
the local authority shall notify that Primary Care Trust [or] Health Authority … and invite them to assist, to such extent as is reasonable in the circumstances, in the making of the assessment; and, in making their decision as to the provision of the services needed for the person in question, the local authority shall take into account any services which are likely to be made available for him by that Primary Care Trust [or] Health Authority …'
(1) Subject to and in accordance with the provisions of this Part of this Act, a local authority may with the approval of the Secretary of State, and to such extent as he may direct shall, make arrangements for providing –
(a) residential accommodation for persons aged 18 or over who by reason of age, illness, disability or any other circumstances are in need of care and attention which is not otherwise available to them …'
(1) Subject to subsections (1A) and (1C) below, arrangements under section 21 of this Act may include arrangements made with a voluntary organisation or with any other person who is not a local authority
(a) that organisation or person manages premises which provide for reward accommodation falling with subsection (1)(a) or (aa) of that section, and
(b) the arrangements are for the provision of such accommodation in those premises.
Subject to subsection (1D) below, no arrangements may be made by virtue of this section for the provision of accommodation together with nursing without the consent of such Primary Care Trust or Health Authority as may be determined in accordance with regulations.
(1) Nothing in the enactments relating to the provision of community care services shall authorise or require a local authority, in or in connection with the provision of such services, to –
(a) provide for any person, or
(b) arrange for any person to be provided with,
nursing care by a registered nurse.
(2) In this section 'nursing care by a registered nurse' means any services provided by a registered nurse and involving –
(a) the provision of care, or
(b) the planning, supervision or delegation of the provision of care,
other than any services which, having regard to their nature and the circumstances in which they are provided, do not need to be provided by a registered nurse'.
the objective of ensuring that service provision should, as far as possible, preserve or restore normal living implies the following order of preference in constructing care packages:
- support for the user in his or her own home …
- a move to more suitable accommodation …
- a move to another private household …
- residential care;
- nursing care;
- long-stay care in hospital.'
The individual service user and normally, with his or her agreement, any carers should be involved throughout the assessment and care management process. They should feel that the process is aimed at meeting their wishes. (my emphasis)
The statutory criteria as applied by Wandsworth
17. As well as National Guidance and Directions, in March 2003 the South West London Strategic Health Authority and a number of London Borough Councils, including the Defendant, entered into an agreement entitled "NHS and Local Authority Responsibilities for meeting Continuing Care Needs". This agreement was made pursuant to the Department of Health's Guidance on Nursing Care and Residential Accommodation. Miss Richards, on behalf of the Claimant, described this agreement as containing the Defendant's policy. Miss Laing, on behalf of the Defendant, submitted that the Defendant followed and properly applied the criteria in it.
18. The agreement states that the Guidance in it is to assist in the promotion of better practice in assessing the health and social care needs of people who need care support from the NHS and social service departments. It is part of a programme which aims to achieve a number of objectives, including "that decisions about how needs are met and how risks to health are addressed are made as far as possible in full partnership with the people concerned, their carers and relatives where appropriate" (my emphasis).
19. Section 1.3 of the agreement states that all patients requiring continuing care will fall into one of three categories. Level 1, which is not relevant in the present case, concerns 100% NHS funding care. Level 2, "continuing health and social care" is "a package of care which both NHS and social services contribute to. The NHS input may include registered nursing care contributions for those people in a care home with nursing, plus in all settings other NHS services…". Level 3 is local authority funded care, applicable where the local authorities responsible for the totality of the care package and there are no additional health care needs input, apart from the usual access to primary care and health services as required.
20. In the present case the issue is whether the Claimant should be assessed at Level 2 or at Level 3 and if at Level 2, whether her particular circumstances require her to be placed in a registered nursing home.
21. The agreement contains tables indicating in respect of Levels 2 and 3 the care characteristics and criteria, the services available, and the care options. It is stated that those requiring health input as part of a level 2 package of care may, for example, have: a progressive medical condition that is likely to result in an increase of dependency; mobility needs requiring the skilled assistance of more than one person for the majority of transfers; single or double incontinence which is controlled / managed by the use of drugs, toileting regimes catheterisation, or incontinence pads; and cognition impairment or lack of motivation which places them at risk of self-harm, neglect or exploitation. It is clear from the agreement that the services available as part of a level 2 package include health care input to people resident in care homes and in their own homes as well as those who are in nursing homes.
22. The care characteristics at Level 3 include people who need help with washing, dressing, toileting and means but who are able to transfer from a wheelchair with or without assistance of one another; who are occasionally incontinent or whose incontinence (single or double) is manageable using incontinence aids; and who have a degree of cognitive individual supervision arising from extreme behavioural disturbance.
23. Part 2 of the agreement contains guidance on the process and implementation of the criteria, including assessments. It is stated in section 2.2 that there should be a single assessment process. Section 2.3 describes the joint health and social services continuing care panel. It recommends that completed continuing NHS health care assessment to be read at the panel should be co-ordinated by one central point within the primary care trust so that the assessments can be checked for completeness before being forwarded to the decision making members of the panel. It is said that it is important that the panel has a balanced representation of social services and primary care trust members and that each carried the delegated authority of their respective organisations to agree the assessed level of care and individual needs. Paragraph 2.4 states: "decisions on levels of care should be based on fully completed assessment materials, this should include either: a single assessment document or full community care needs assessment and nursing needs assessment together with the completed medical report and relevant therapy reports". It also states "all decisions at panel should be minuted and in addition recorded on their pro forma…. which outlines the rationale for the decision against the criteria. All parties must be informed in writing of [the decision]. (my emphasis)
Whilst it is recognised that individual PCT and Local Authorities may have varying operational policies and procedures, it is considered good practice for each panel to have identified terms of reference which give the following details: -
- Confirmation that the panel has been established to provide a forum for receiving and agreeing assessments of an individual's needs and confirming which level of care they are eligible to receive.
- The terms of reference should identify membership of the panel and the roles and responsibilities of each member including delegated powers. The terms of reference should also include the venue and frequency of meeting. The chair of the panel should be agreed by Primary Care Trusts and Social Services Departments.
- It is important that there is balanced representation of Social Services and Primary Care Trust members and that each carries the delegated authority of their respective organisations to agree the assessed level of care an individual meets.
- That both Primary Care Trusts and Boroughs are comfortable with level of representation from each organisation.
It is manifest from the facts of the instant case, to which I will now turn, that there were several, and in my judgment serious, breaches by Wandsworth of the guidance (which I shall call "the local guidance") contained within the Agreement.
The relevant facts
1. Subject to (Wandsworth's) continued compliance with paragraph 3 hereof (Servite) agrees to continue to provide residential accommodation with board and care at Mary Court to the Appellant(s) until the earlier of the respective Appellant's death or the event set out under paragraph 2 below.
2. (Servite's) obligation to provide residential accommodation with board and care at Mary Court to each of the Appellants will cease 28 days after receipt by Servite of a lawful local authority community care assessment stating that the respective Appellant's assessed needs can no longer be met at Mary Court and / or that nursing care is required such that it would not be lawful for the respective Appellant to remain at Mary Court.
3. (Wandsworth) agrees to provide funding pursuant to its obligations under Part III of the National Assistance Act 1948 in respect of the first and second Appellants respectively at such rates as may be agreed between (Servite) and (Wandsworth) from time to time.
33. The Continuing Care Panel met on 8 July and considered reports prepared in June and early July by social services, the hospital and the primary care trust. From the hospital there were medical, nursing, night nursing, physiotherapy and TO reports. From the primary care trust there was a physiotherapy report and a nursing needs assessment. These described the claimant as needing two people on a bad day to help her to transfer and assistance three or four times during the night. There are references to cognitive problems, disorientation and confusion. The Panel also had before it a document by (Linda Goldsmith) and her sister, expressing their views as to what should happen and their disappointment at not being permitted to attend the meeting of the panel.
34. The Panel concluded that the claimant had nursing care needs at Level 2 and recommended that they should be met in a nursing home. Mrs. Linda Goldsmith was notified of the decision by telephone later the same day. She had asked to attend the meeting but was informed by Mrs. Graham (the social worker then dealing with the Appellant's case on behalf of Wandsworth) that she could not attend as the Panel was considering clinical evidence only. As a result, the claimant's solicitors wrote to Wandsworth (on 14 July 2003) stating that the decision, taken on observations made in the first few weeks of the claimant's hospitalisation and without an up-to-date Community Care Assessment, was unlawful. They asked that the decision be withdrawn and that the claimant be returned to her home with extra care provided to help her manage while her hip was mending. They informed Wandsworth that failing a satisfactory response, judicial review proceedings would be instituted.
35. On 17 July 2003 a community care assessment was undertaken by Ann Forster, one of Wandsworth's social work team managers. Miss Forster met the claimant and Linda Goldsmith. Her report stated that the claimant needed supervision and all support of one person with all activities of daily living. There is a detailed assessment of needs in section 9 of the report in which the designated action in many of the fields is "to seek to provide this case in her present residential setting if practical and safe in all other aspects of her care". The overall conclusion was that the claimant had "made a good recovery from her injuries and surgery and would appear to me when I saw her on 16 July 2003 to be "residential care fit". She noted the conclusion of the panel a week earlier that the claimant's clinical nursing needs indicated she required nursing care but stated that should her clinical situation remain as it was on the day she saw her the Chair of the panel should review the decision.
At the present time therefore further assessment and consideration is being given to the Appellant's changing needs and how to meet them appropriately in order to ensure a safe discharge from hospital. This includes careful consideration by staff from Mary Court registered care home as to whether her current assessed needs can be safely met in that environment or not."
The instruction of Dr. Cottee
First, Servite indicated that it could accept the claimant back if additional resources were provided. Secondly, the further Nursing Care Needs assessment was initiated by a letter from Mrs. Graham to Dr. Cottee, a consultant geriatrician at the hospital. The reason for writing to Dr. Cottee was that Dr Coles, the consultant in geriatric medicine who chaired the Panel was on leave. Dr. Cottee responded on 12 August.
Dear Dr. Cottee,
Re Louise Goldsmith
I have enclosed up to date reports in respect of the above woman who is currently in Chelsea and Westminster Hospital and has been on the delayed discharge list for some weeks.
Mrs. Goldsmith ordinarily lives at Mary Court and the current view of the professionals involved is that her needs are too high for her to return there. Her daughter, however, is adamant that she should return there. There is a long history and it was Mrs. Goldsmith's daughter who took up the fight for her mother to remain in Mary Court when its status was changed from residential to sheltered accommodation.
I will be grateful if would will consider these recent reports in respect of Mrs. Goldsmith and confirm to us that the previous decision made at the Continuing Care panel on 8.7.03 is still accurate i.e. that she meets the criteria of Band 2 medium. Since following the decision, Mrs. Goldsmith's daughter believes that her mother has improved to the extent that she could return to Mary Court. Miss Goldsmith has taken legal advice and we are advised that a judicial review may be sought.
It will be greatly appreciated if you will kindly let us know as soon as possible whether you consider that the previous banding is still appropriate.
I write to advise my assessment of the recent reports sent to me in respect of the above-named
The reports indicate that Mrs. Goldsmith's needs are consistent with level 2 medium nursing care i.e. she meets the criteria:
(b) single or double incontinence which is managed by the use of drugs, toileting regimes, catheterisation or incontinence pads / sheaths, with occasions significant contact of skin with urine and / or faeces.(c) Stable drug regime requiring registered nurse supervision of administration and occasional GP review(f) cognitive impairment, lack of motivation or moderate degree of behavioural disturbance, which places the individual at risk of self-harm, or neglect.
Due to her cognitive impairment and the variability of her condition, Mrs. Goldsmith should have access to a nurse on a daily basis and may need access to a nurse at any time. Mrs. Goldsmith's condition needs to be monitored on a daily basis in order to determine whether she may be having "a bad day" or whether she may be unwell. This requires the knowledge and skills of a trained nurse.
…. she was not informed of the reference to Dr. Cottee, to this letter, or to his views and not given any opportunity to make representations or to provide further information to him. Moreover, Miss Forster's Community Care Assessment was not one of the reports sent to him.
To this Miss Richards adds that Dr. Cottee had neither seen nor assessed the Appellant.
Wandsworth's decision of 13 August 2003
Following your recent assessment by Social Services under section 47 of the (1990 Act) I am sending you the attached summary of your needs and details of the services that we hope will meet them. This care plan will give you the relevant information you need regarding the cost of your services and how to get in touch with the service provider.
To provide a practical and safe response to all aspects of personal care, to include assistance with washing, dressing, feeding, assistance with medication and personal hygiene.
To provide a practical and safe living environment which enables the assistance of one person and at times the assistance of two people for help in mobilising and transferring. This environment also to provide supervision to minimize the risk of accidental falls.
To provide an environment where your emotional as well as your health care needs are met.
To enable access to a qualified nurse so that any fluctuations in your ability to manage can be monitored appropriately and the appropriate assistance provided.
Following discussions with your current care provider, Servite Houses, and a review of your current health and social care needs, the above care needs cannot be made within Mary Court.
On going care should now be provided in a registered nursing care home.
The meeting with Dr. Cottee on 6 October 2003
The first was that her mother was not incontinent on any accepted definition as she could tell you that she wanted to go to the toilet and asked you to go with her. She said that she never asked nurses for help in taking her mother to the toilet and took her on her arm. She said that he mother passed urine on the toilet, that she had never been doubly incontinent expect when she had suffered from infections, and her incontinence was manageable.
Dr Cottee said that Linda Goldsmith had precisely put her finger on the matter as a regular toileting regime fell within the criteria. He said that he could only assess on the basis of the nursing reports he had before him. Linda Goldsmith's mother was not incontinent so long as she had a toileting regime. Linda Goldsmith said everyone knew that continence is managed regularly in residential care. Dr. Cottee said that it was a Level 2 criterion.
Linda Goldsmith asked Dr. Cottee if he made his assessment on the basis of other people's assessments and how this could be relevant to what her mother was like in Mary Court. Dr. Cottee said that he did not know what Linda Goldsmith's mother was like in Mary Court and that the agreed process was being followed.
Dr. Cottee said there was no evidence of behavioural disturbance but there was evidence of lack of initiative and repeated references in the reports to the need for constant prompting. Linda Goldsmith said she accepted this but said it was irrelevant, as her mother's cognitive function had not changed.
There were a whole lot of other medical conditions that had not manifested in the last two years because her mother had done so well. She said it was entirely meaningless to say that her mother required high levels of care. Her mother had the highest possible level of care in the country at Mary Court and she asked the meeting to consider this. She said that all that mattered was the quality of her mother's life and the quality of her death. She wanted her to die at Mary Court. She said that if there was somewhere that could care for her mother to a higher level she had not yet found it. She said that the nurse managers in the hospital said they could not give her mother care.
Mr. Kelly said the meeting was to discuss the type of care, not its location. Location would be the purpose of a second meeting and he was trying to keep the meeting on that discussion.
Mr. Kelly said the he would not take the meeting further. The understanding was for Linda Goldsmith to have a conversation with Dr. Cottee. The meeting with Dr. Cottee had ended, and he did not intend to continue the meeting. Linda Goldsmith said that Dr. Cottee had argued his case very clearly but it demonstrated that the system was flawed because it took too little account of context. She said that it alarmed her that the panel looked at things out of context. She said that she appreciated the way Dr. Cottee had reached his conclusion and that it was crystal clear. She said that it intrigued her that her mother could be put in a banding level that she does not perfectly fit.
Malcolm McKenzie said that the judge had ordered the meeting to reach agreement out of court. Linda Goldsmith said that the judge had also said that one of the biggest disagreements was the failure to accept the level of care. She said there was no disagreement about the level of care needed but that saying it was level 2 set a rigid boundary.
Dr Cottee then left to attend another engagement.
Mr. Kelly asked if Linda Goldsmith wanted to continue the meeting. Linda Goldsmith asked if Wandsworth would blindly follow Dr. Cottee's recommendation. Mr. Kelly said that Dr. Cottee had explained the reasons for his decision and had said that Linda Goldsmith had reinforced his view of her mother's care need. Dr. Cottee was not going to change his assessment that Level 2 (Medium) was required. He said that he was quite happy to discuss location, but it was quite clear that care could not be provided at Mary Court. Linda Goldsmith said that Dr Cottee left out the context. Mr. Kelly said that Dr. Cottee based his assessment on clinical judgments from the hospital. Linda Goldsmith said that Dr. Cottee accepted he could not look at the context. The court order required Wandsworth to show that her care needs had changed. Mr. Kelly said that Linda Goldsmith's mother's assessed care needs were for nursing care and that the current assessment of care needs required that to be in a nursing environment. Linda Goldsmith said that no one challenged that it was appropriate for her mother to stay at Mary Court at the time of the court order. James Cornwell said that the order made no reference to change in her condition and simply stated that she should live in Mary Court provided she did not need nursing care. Linda Goldsmith said that a lot was at stake and Wandsworth were placing her mother in a life-threatening situation. She had lots of written evidence to support the view that her mother's needs had not changed.
Malcolm McKenzie said that all the things Dr. Cottee was concerned about were open to negotiation and asked if it was possible to negotiate about containing these anxieties. Mr. Kelly said he could not talk about it, as Mary Court could not take her back.
Linda Goldsmith asked if they could talk about the fact that Mary Court had provided care for the last seven years. She said that the care plan at Mary Court would require only minor tinkering. She said it was Mary Court that had identified the are needs years ago and the risks they faced were no higher… Mr. Kelly said that he was not sure what scope there was for negotiation as Linda Goldsmith was asking them to look at what could be tweaked but he was saying that the assessment said that her needs could only be served in a nursing environment. He said that Servite could not do it because of its registration. Linda Goldsmith said that this was negotiable and asked what about her mother's best interests and her human rights
Mr. Kelly stated that he did not have a place (by which he plainly meant a nursing home) in mind for the Appellant, as they had not started that discussion. Linda Goldsmith said that she was surprised by this. She asked if everyone could agree to the principle that professionals should not intervene in a way that would harm a patient's best interests. Mr. Kelly said that he would have to think about this before agreeing.
Events after 6 October 2003
At the meeting (Linda Goldsmith) put her points to Dr. Cottee. He stated that the extra information she had given him confirmed and reinforced his view that Level 2 medium care was required. He also said that his role was to assess the information provided by the professionals against the Defendant's agreed criteria. He could not say where the care was to be delivered. Mr. Kelly took little part in the discussion at that stage but after Dr. Cottee had left he stated that the Claimant's assessed care needs were nursing care and the current assessment of care needs required her to be in a nursing environment. Dr. Cottee had made the point that there was a need for immediate access to nursing carers and this could not be provided in the residential home. In his report dated 10 October, Dr. Cottee stated that "the need to continuously monitor [the Claimant's] oral fluid intake and the variability of the required dosage of analgesia …. should ideally be overseen by qualified nursing staff" and noted that she had an abbreviated mental test score of 0/10, the lowest score possible. He considered that she had failed to make any significant improvement despite many physiotherapy and occupational treatments.
The judge's assessment of Wandsworth's decision-making process
The requirements of paragraphs 2.3 and 2.4 of the agreement between the Defendant and the South West London Strategic Health Authority "NHS and Local Authority Responsibilities for meeting Continuing Care Needs were not complied with. The Panel did not have a full community care needs assessment when it met on 8 July 2003. Miss Forster's report was indeed not undertaken until after the Panel's decision and the complaint made on behalf of the claimant. Neither those representing the Claimant nor the court have seen a minute of the panel's decision outlining its rationale as the agreement requires. The Claimant's litigation friend was not informed of the decision in writing, as is also required by the agreement, although she was informed of the substance of the decision.
74. I do not, however, accept the submission that at that stage paragraph 3.16 of the statutory guidance had not been followed. (Linda Goldsmith) attended the ward meeting on 12 June; her views were in the family submission before the Panel; and she met Mr. Kelly on 29 July. I do not consider that the Guidance entitled her to attend the Panel meeting. By the middle of July the Claimant's solicitors were involved and the Defendant informed them on 1 August that they were arranging a further Nursing Care Needs Assessment. They were not, however, informed of the terms of the reference to Dr. Cottee and when he was initially asked to review the Panel's recommendations he was not informed of Miss Forster's community care needs assessment and does not appear to have had the family's views before him. The reference to Dr Cottee, moreover, asked him to "confirm to us" that the decision of the Panel was still accurate and he did this within 24 hours of the reference to him. Accordingly, the reference to him did not cure the flaws and indeed there appears to have been less input from the family before him than there had been at the Panel. For these reasons, I have concluded that at the time Linda Goldsmith launched these proceedings there were at least arguable grounds for challenging the decision and thus for permission to be granted.
Is it correct, as is submitted on behalf of the Defendant, to see that meeting as one at which the views of the Claimant's representatives were fully and fairly considered so that the Defendant's conclusion after it that the Claimant's needs required care in a nursing home setting was one it was entitled to reach and which is not impugnable on public law grounds? Miss Richards submits that this is not correct and that at the meeting there was no review by the Defendant of its decision and no consideration of the points advanced then and previously by (Linda Goldsmith). But the focus of the Claimant's challenge to the decision in the light of that meeting concerned the decision to place her needs in band 2 and the consequences of it; i.e. whether the Defendant assumed that the banding decision automatically meant that the care should be delivered in a nursing home setting.
76. Was the Defendant only going through the motions so that the meeting was in effect a sham? Prior to it, Dr. Cottee was sent up to date nursing reports and Miss Forster's community care needs assessment. At the meeting the points made in Dr. Cottee's report of 12 August were taken up by (Linda Goldsmith). They discussed incontinence, the drug regime and which required the supervision of nurses, the extent of cognitive impairment and deterioration, and the prognosis. I have concluded that the meeting of 6 October was not a sham. The recent nursing reports and Miss Forster's assessment were considered by Dr. Cottee. The Claimant's care needs and (Linda Goldsmith's) concerns about the banding decision and the method of assessment and the fact that she did not consider there had been a deterioration were discussed openly. The result was, however, that Dr. Cottee's view that the claimant needs nursing care was reinforced by what she said to him. The Defendant's conclusion expressed by Mr. Kelly at the meeting was that this nursing care must be provided in a nursing home.
77. The first and second of the individual grounds of the claimant's challenge "defective process" and "failure to apply own policy" primarily apply to the period before the meeting on 6 October. (Linda Goldsmith) and her representatives participated fully at the meeting and the Defendant and Dr. Cottee were fully aware of Miss Forster's assessment. It was, indeed, the reason the issue was referred to Dr. Cottee. In so far as these grounds are advanced with respect to the meeting, I do not think they have been made out.
The opinion of the doctor, OT, physio and ward staff at Chelsea and Westminster Hospital is that in order for this to happen, extra care would be needed at Mary Court to provide 24 hour supervision for Mrs. Goldsmith's safety.
Mrs. Goldsmith currently appears to need a higher level of care than can be provided by Mary Court.
Her daughter believes that, given extra input, her mother will rehabilitate at Mary Court.
The view of the professionals at Chelsea and Westminster Hospital and supported by OT is that Mrs. Goldsmith's ability to participate in and benefit from rehabilitation is very limited.
In order for Mrs. Goldsmith to return to Mary Court, additional funding would be required in order to keep her safe and given the attached medical reports it appears that this could be an ongoing cost and not one which could be time limited as on the previous occasion.
Article 8 of the European Convention on Human Rights
Lord Justice Chadwick:
Lord Justice Brooke:
Order: Appellant's order against Beatson J's order of 5th December 2003 dismissing her claim for judicial review set aside and appeal allowed; respondent's decisions taken on 13th August and 6th October 2003 quashed; local authority to pay appellant's costs for the claim for judicial review, to be assessed if not agreed; detailed assessment of the appellant's funding costs; if respondent wishes to seek permission to appeal, it may do so by way of written submissions, to be filed with the court by 28th September 2004.