TR v Ludlow Street Healthcare Ltd and TR [2011] UKUT 152 (AAC) (07 April 2011)
Decision
of the Upper Tribunal
(Administrative Appeals Chamber)
In respect of the application for permission to appeal
against the decision made by the President of the Mental Health Review Tribunal
for Wales on 21 February 2011:
Permission to appeal is refused.
DIRECTION:
Save for the cover sheet, this decision may be made public
(rule 14(7) of the Tribunal Procedure (Upper Tribunal) Rules 2008 (SI No
2698)). That sheet is not formally part of the decision and identifies the
patient and his nearest relative by name.
Reasons
for Decision
A.
THE PROCEEDINGS
1.
These proceedings began as an application for judicial review of a
decision made by the President of the Mental Health Review Tribunal for Wales (MHRTWales) by letter and email on 21 February 2011. The MHRTWales was the respondent
to the application. It was lodged with the Upper Tribunal. The solicitors were
unaware of the recent decision of the Upper Tribunal in LS v London Borough of Lambeth [2010] UKUT 461 (AAC). The three-judge panel in that case decided
that all decisions of the First-tier Tribunal were appealable to the Upper
Tribunal, except for those decisions excluded by section 11(5) of the
Tribunals, Courts and Enforcement Act 2007. That would suggest that an
interlocutory decision such as that made by the President is appealable and I
have proceeded on that basis, although the reasoning in LS may require
some qualification as applied to section 78A, because that section contains no
category of excluded decision. Accordingly, I treated the application as an
application for permission to appeal and waived the irregularity caused by the
failure to apply for permission from the MHRTWales before coming to the Upper
Tribunal.
2.
In view of the change in the nature of the application, the parties have
changed. The MHRTWales is no longer a party. The appellant is the father and
nearest relative of the patient who is detained under section 3 of the Mental
Health Act 1983. The managers of the hospital where he is detained are
respondents. The patient is also a respondent. He is a party to his nearest
relative’s proceedings before the MHRTWales (see the definition of ‘party’ in
rule 2(1) of the Mental Health Review Tribunal for Wales Rules 2008 (SI No
2705)) and, therefore, also before the Upper Tribunal (see head (a)(i) of the
definition of ‘respondent’ in rule 1(3) of the Tribunal Procedure (Upper
Tribunal) Rules 2008 (SI No 2698)).
3.
I directed an oral hearing of the application, which was held on 6 April
2011. The appellant was represented by Mr Mark Mullins of counsel, instructed
by Conroys solicitors. The other parties were not represented. I am grateful to
Mr Mullins for his submissions at the hearing.
B.
THE TRIBUNAL’S
DECISION
4.
As his son’s nearest relative, the appellant has various powers and
rights under the Mental Health Act 1983. On 4 January 2011, he applied under
section 23(2)(a) for his son to be discharged and under section 24(1) for him
to be visited and examined. On 6 January 2011, the responsible clinician barred
the discharge by certificate under section 25(1). This allowed the appellant to
apply under section 66(1)(g) to the MHRTWales, which he did on 12 January 2011.
5.
The case was listed for hearing on 23 February 2011. Conroys advised
that it was necessary to obtain the patient’s medical records in order to
advise the appellant in the proceedings and to consider whether to obtain an
expert report. They were able to obtain some, but not all, of those records.
Their correspondence with the tribunal culminated in two letters being sent on
behalf of the President. The first was sent on 16 February 2011:
[The President] is of the view
that it is not appropriate to issue directions to compel disclosure of the
medical and social care records on the grounds that you have not received the
consent of the Patient to access such records. Further, [she] is of the opinion
that it is for the Tribunal panel to determine whether there is sufficient
information available at the time of the hearing to fully consider your
client’s application. Consequently, any subsequent representations in regards
to disclosure of these records must be made to the Tribunal Panel at the
Hearing.
The solicitors made a detailed request for her to reconsider
on 18 February 2011 and she replied on 21 February 2011:
[The President] has considered
the content of your letter and has made the following observations.
The remit of the Tribunal is to
determine whether the Patient satisfies the criteria for detention under the
Mental Health Act 1983. Dispute between the funding authorities as to hospital
placements are a separate matter. Representations can be made to the panel at
the Hearing if it is thought that the Patient should be discharged if
appropriate accommodation can be identified, but it is not a matter for which
[the President] is prepared to grant a postponement for an independent report.
With regards to the issue of
[the patient’s] capacity to give consent to access his records, the Patient’s
solicitor has not raised capacity with us and consequently it would appear that
they are currently acting on [his] instructions. Again, the question of
capacity can be argued before the panel if it is thought to be relevant.
…
Consequently, the Tribunal will
go ahead on the 23 February.
6.
The solicitors were concerned that a hearing before a panel was
premature. They considered that it would be detrimental to the patient’s health
to be prepared to attend a hearing only for it to prove abortive. The nearest
relative would also need to arrange cover for his wife, for whom he is a carer.
They advised him to seek permission to apply for judicial review, which he did.
The tribunal then vacated the hearing.
C.
THE LAW
GOVERNING PERMISSION TO APPEAL
7.
An appeal lies against decisions of the MHRTWales to the Upper Tribunal
under section 78A of the Mental Health Act 1983. This provides for an appeal,
with permission, ‘on any point of law arising from a decision made by’ that
tribunal. On basic principle, I may give permission to appeal if there is a
realistic prospect that the decision was erroneous in law or if there is some
other good reason to do so (Lord Woolf MR in Smith v Cosworth Casting
Processes Ltd [1997] 1 WLR 1538).
8.
As the decision under challenge is a case management one, special
considerations apply. I discussed these in RM v St Andrew’s Healthcare
[2010] UKUT 119 (AAC). The circumstances of that case were very different in
that it concerned an order by the First-tier Tribunal that a patient should not
be told that he was being covertly medicated. However, on the principles that
govern the approach to appeals against case management decisions, I said:
7. The non-disclosure
order was a case management decision. Appellate courts are supportive of these
decisions and discourage appeals against them. They often have to be made with
little time for analysis or reflection. Appeals can disrupt the proceedings,
produce inefficiency and increase costs. They are capable of being used for
tactical purposes. Ultimately, the judge dealing with the case is probably best
placed to make a judgment on how best to proceed in the context of the
proceedings. Challenges are best considered at the end of the proceedings, when
it is possible to judge whether the decision adversely affected the outcome.
8. This does not mean that
case management decisions are immune from scrutiny. The decision may have been
given after a hearing and with time for analysis. If it is made ahead of the
final hearing, it may be possible to deal with an appeal quickly to avoid
disrupting the First-tier Tribunal’s timetable. There may be no question of
seeking a tactical advantage. The issue may be severable from the more routine
management of the proceedings. And it may be possible to anticipate the likely
effect.
9. On the spectrum of case
management decisions, the non-disclosure order is more susceptible to scrutiny
than most. The judge held a hearing and took time before issuing her reasons.
The issue is severable from the routine management of the case. It is important
and its effects can be anticipated: the patient’s solicitors argue that they are
unable to obtain his instructions on the real case for his continued detention.
There is no question of tactical advantage being sought and it has been
possible to deal with the appeal quickly.
D.
MY ANALYSIS
9.
The applications to the tribunal and the President’s responses were made
rather informally through correspondence. It is appropriate to read that
correspondence as a whole and not to take one letter or passage in isolation.
10.
Taking the correspondence as a whole, it is clear that the President was
doing two things. First, she was refusing to make any order for disclosure,
saying that it was a matter for the panel. Second, she was refusing to postpone
the hearing. They are essentially linked.
11.
A different judge might have taken a different view, but that is the
nature of many case management decisions. The issue for me is whether the
President’s decision was one that she was not entitled to make. I have decided
that she was entitled to make it. The solicitors had set out the case for needing
the disclosure order, and for postponing the hearing of the application, in
order to advise their client and to avoid any harm to the patient. I consider
that the President was entitled to decide that those issues should be
considered by a full panel. The argument turned on whether further medical
evidence was required. That was something best judged by panel member with
appropriate knowledge and expertise. And it was a decision best made in the
context of the proceedings as a whole. That would include the views of those representing
the patient; it is not clear that they were in agreement on all matters with
the solicitors acting for the nearest relative.
12.
The President was also entitled to decide that the hearing of the
application should go ahead. I am sure she was aware of the possible risk to
the patient if the hearing proved abortive, but she had to balance that risk
against the possibility that the panel might be prepared to decide in favour of
the nearest relative without the need for further evidence. A telephone directions
hearing, as suggested by the solicitors, could not have that effect. I tried to
put this possibility to Mr Mullins, but regret that my powers of explanation
failed. He replied that the nearest relative had a right to participate in
proceedings. My point was, and is, that he might have succeeded without needing
to participate, rendering the issues of consent and disclosure redundant. The
President had to consider that as one of a number of outcomes. Under modern
case management procedures, she was in control of the procedure and could not
limit herself to the perspective of any one party.
13.
The context explains the President’s reference to a dispute about where
the patient should be detained. Underlying the nearest relative’s case is a
concern that his son is detained in Wales rather than nearer his home and
family. That is a legitimate concern, but it is not a matter over which the
tribunal had jurisdiction, as the President pointed out.
14.
Mr Mullins argued that the President had made a clear error of law by
misdirecting herself on R (S) v Plymouth City Council [2002] 1 WLR 2583.
He took me through the details of Hale LJ’s reasoning, which I have to accept
as a correct statement of the law. Mr Mullins is correct that the consent of
the patient, and the patient’s capacity to give consent, are not decisive and have
to be balanced along with other factors.
15.
I am not sure that the President did misdirect herself on the relevance
of consent to disclosure of medical records. This argument relies on the
sentence in the letter of 16 February that reads:
‘[The President] is of the view
that it is not appropriate to issue directions to compel disclosure of the
medical and social care records on the grounds that you have not received
the consent of the Patient to access such records.
The passage that I have italicised is ambiguous. There are
two possible readings. It may indicate the reason why she considered that it
was not appropriate to issue directions. In other words, the President was
saying: I refuse to issue the directions that you have requested, because
disclosure requires the patient’s consent. That is how the solicitors have read
it. If that is correct, she does appear to have misdirected herself on R (S)
v Plymouth City Council. The other possible reading is that it merely
records the solicitors’ reason for requesting the direction. In other words,
the President was saying: I refuse to issue the directions that you have requested
after being refused disclosure without the patient’s consent. On this reading,
there is no misdirection; the passage is merely a matter of fact.
16.
Even if the President did misdirect herself in law in respect of R
(S) v Plymouth City Council, the issue would have been reconsidered by the
panel at the hearing. Mr Mullins argued that fee-paid judges may in practice be
reluctant to differ from decisions of the salaried judiciary. I accept that
that may be so in some respects, but in this case the President was saying that
it was a matter for the panel to decide. In those circumstances, the panel
would be implementing the President’s wish that it should decide the issue, not
differing from her.
17.
Mr Mullins argued that the President’s reasons were inadequate, as she
had not carried out the balancing exercise required by R (S) v Plymouth Cit y Council. Her reasons are indeed short and perhaps little more than her
conclusions. That is only to be expected of case management decisions. Judges
are not expected to write judgments when required to make routine rulings on
the future conduct of a proceedings. Specifically on the balancing exercise, it
was unnecessary for the President to deal with that in detail anyway, as she
was saying that the panel should conduct that exercise at the hearing, if it
arose. What is clear from the letters she wrote is the President’s view that
the issues were appropriate for a full panel and a hearing.
E.
HOW MHRTWALES
SHOULD PROCEED WHEN A CASE MANAGEMENT DECISION IS CHALLENGED
18.
This case was unusual as it began as an application for permission to
apply for judicial review. The President’s decision to vacate the hearing may
be explained by that context. It is, of course, a matter for her and not for me
to decide how to proceed if a party applies for permission to appeal against a
case management decision. In many such cases, she may consider that it is
appropriate to continue with the proceedings. I have already said that it is
the nature of many case management decisions that the Upper Tribunal will be
unlikely to give permission to appeal. It is preferable to judge the impact, if
any, of the decision on the outcome of the proceedings. That can only be done
when the outcome is know. There is also the danger, which does not arise in
this case, of a party using an application for permission in order to obtain
the advantage that the case management decision has denied. That tactic must
not be allowed to succeed.
F.
THE EFFECT OF
MY DECISION
19.
As I have refused permission, the future handling of the case is a
matter for the MHRTWales. Circumstances may have changed since February and the
tribunal’s case management directions will no doubt reflect those changes.
Signed on original
on 7 April 2011
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Edward Jacobs
Upper Tribunal Judge
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