Law Report 20 July 1999: NHS Not Liable for All Nursing Care Regina V North and East Devon Health Authority, Ex Parte Coughlan (Secretary of State for Health and Royal College of Nursing Intervening) Court of Appeal (Lord Woolf Master of the Rolls, Lord Justice Mummery and Lord Justice Sedley) 16 July 1999

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WHILST NURSING care for a chronically sick patent might in appropriate cases be provided not by the NHS but by a local authority as a social service, the type of care required by the applicant could not be provided by the local authority.

The Court of Appeal dismissed the appeal of the North and East Devon Health Authority against the decision that its decision to close a facility at which the applicant was cared for and to transfer her care to local authority was unlawful.

The applicant was grievously injured in a road traffic accident in 1971. In 1993 she and seven other comparably disabled patients were moved by agreement from a hospital which was to be closed to a purpose-built facility, Mardon House. In 1998 the respondent health authority decided to close Mardon House and assign the applicant to local authority care. She sought judicial review of that decision.

The judge concluded, inter alia, that the applicant and the other patients had been given a clear promise that Mardon House would be their home for life; and that, in law, all nursing care was the sole responsibility of the NHS acting through the respondent, so that it was not open to the respondent to transfer the responsibility for long-term general nursing care of a patient such as the applicant to the social services department of the local authority.

The respondent appealed. The Secretary of State for Health was given leave to be heard on the appeal. The Royal College of Nursing was also given leave on two limited issues. The critical issue in the appeal was whether nursing care for a chronically ill patient might lawfully be provided by a local authority as a social service (in which case the patient paid according to means) or whether it was required by law to be provided free of charge as part of the NHS.

Richard Gordon QC, Tim Ward and Jennifer Richards (Mackintosh Duncan) for the applicant; James Goudie QC and Siobhan Ward (Bevans Ashford, Bristol) for the respondent; Nigel Pleming QC and Steven Kovats (Solicitor to the Department of Health) for the Secretary of State; Philip Havers QC and Kristina Stern (R. …