Barnet Primary Care Trust v X [2006] EWHC 787 (QB)

This was a claim brought in the High Court by Barnet Primary Care Trust (Barnet), against one of its in-patients (X) for possession of part of its hospital premises. Barnet claimed that X, who had been an in-patient since 2002, had not had a medical reason to be in hospital since May 2003.  It was not possible for X to return his own home until refurbishment works being carried out at were completed.   Barnet had made repeated efforts to discuss arrangements for transferring him to a residential home of which there was a choice of three.  There was no nursing or health care available in the homes but he would receive a limited amount of social care.  Throughout this period X refused to engage with the process of discharging him.  Occasionally he expressed the view that he was still need of some medical treatment.  An independent opinion of X’s medical condition was offered to him but declined.   Barnet had tried unsuccessfully over a period of years to persuade X to leave hospital and take up the offer of alternative care packages before taking the unusual step of commencing proceedings to seek an order for possession of that part of the hospital which X was occupying.

The initial reason for X’s admission was due lower back pain causing an acute decline in his mobility.  He suffered from cellulitis in his leg and scrotum and had large bilateral inguinal hernias.  Following advice from a consultant it was decided not to operate as the operation might have worsened his condition.  X had an MRI scan for his spine following a fall which showed he had degenerative change and moderate lumbar canal stenosis at two sites.  It was explained to X that there was no specific medical treatment for this condition, and physiotherapy was recommended.  In January 2003 X was diagnosed with chronic pulmonary lung disease.  This flared up on two occasions which would have merited a short period of in-patient treatment but as far as the condition was concerned, that did not require any medical intervention.  Following further reviews of X’s medical conditions by a number of clinicians it was felt that he would not benefit from any surgical interventions.  X refused to accept that operating on his hernias was not in his best interests.  It was explained to X that clinicians were not permitted to offer treatments which they felt may not be helpful and which would be deleterious to his welfare.  There was an impasse.  In May 2003, X was not receiving any treatment from trained medical staff and only required assistance to wash his back, legs and feet.  He could eat and drink unaided and was mobile with the aid of a Zimmer frame and was able to make his own way to the toilet.   Overall he was given a minimum level of assistance.  He received no medication other than cream for his cellulitis and the occasional use of a nebuliser for his asthma.  In the opinion of the manager of the ward on which X was a patient, X would obtain suitable support if he were discharged to residential care, pending the completion of the refurbishment to his own home.

The court was satisfied that there were three residential homes each of which would have been appropriate and had indicated a willingness to take X subject to funding by him which would be means-tested.  X was not legally represented at the hearing nor did he put forward any evidence to contradict the evidence of Barnet or argue against the orders sought by Barnet.  The court considered the human rights issues. In particular the court considered X’s right to private life under Article 8. The court was satisfied that there would be no infringement.  The court made the declarations sought by Barnet, namely:

(i) X was not entitled to occupy the bed in the ward or any other part of Barnet’s hospital premises since he was not in need of any medical or nursing care which required admission to hospital.
(ii) The course of action proposed by Barnet was in accordance with the Human Rights Act 1998 and did not breach Article 8 of the ECHR.
(iii) Barnet may recover possession of any part of the hospital occupied by X.

The court allowed 14 days to enable the arrangements to be made.  X was ordered to pay a £10,000 contribution towards Barnet’s costs.

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