R (on the application of Val Compton (on behalf of Community Action For Savernake Hospital)) v Wiltshire Primary Care Trust [2009] EWHC 1824 (Admin)

This application, to judicially review the reorganisation of health services by the defendant Primary Care Trust [the ‘PCT’], was on the basis of a lack of consultation and apparent bias. The PCT proposed as part of the re-organisation to close a minor injuries unit at the community hospital. This it claimed would allow for more patients to be treated in their homes or Primary Care Centres, which was said to fit in with the approach in a government white paper about developing modern health services which were good value for money and could be accessed by all. Prior to publishing its proposals the PCT had undertaken a public consultation exercise explaining that this would inform the strategic review of services within the area. Once the proposals were published the PCT again undertook a more extensive consultation process focussing on the specific proposals and, as part of this exercise, employed Red Bridge Solutions Ltd. to analyse the feedback. C’s challenge of bias was on the basis that one of the directors of Red Bridge Solutions Ltd.  was in a personal relationship with an individual from the Strategic Health Authority. She argued that the decision to close the minor injuries unit had no clinical support and was based purely on financial reasons so was unreasonable; in addition she was of the opinion that the closure of the unit at the hospital was an effective closure of the hospital, which had not been consulted upon.

The Court recognised that appointing Red Bridge Solutions Ltd. to carry out the analysis was ‘an error of judgment’, but it did not believe that as a matter of law the charge of bias had been made out. The doctrine of apparent bias requires that justice is seen to be done and the test for this is whether a fair minded and informed observer, having considered the facts, could determine that there was a real possibility of bias. In the case of potentially biased advisors it would be necessary to establish that such bias of the advisor had adversely infected the views of the decision maker before this would invalidate the decision, Porter v Magill (2001) and R v Gough (Robert) (1993) followed. The Court, rejecting the application, found that the evidence was not there to support the charge of bias, firstly because a fair minded and informed observer would recognise that Red Bridge Solutions Ltd’s report had only summarised the responses from the consultation and had not made recommendations or advised the decision makers. Furthermore, the role of the strategic health authority had only been to advise on the processes to be followed; it had not been involved in decision making.

In addition the Court did not accept Mrs Compton’s assertion that the closure of the unit amounted to a closure of the hospital. It accepted that the services were no longer offered within the building of the hospital, but instead took the view that the services previously offered at the hospital were still available either within people’s homes or elsewhere, often performed by the same clinicians. The Court were satisfied that the previous consultation on these changes was adequate and so rejected this aspect of her application. Finally the Court was persuaded that the reasons behind the closure of the unit was a  mix of clinical, operational and financial all of which were set out within the consultation document. It commented that to explore Mrs Compton’s complaint regarding the PCT’s financial decision making would amount to an “unwanted degree of interference in the operational decision-making of a public body”. It was not a matter for the Court, particularly given the finding that the PCT had not acted unlawfully, irrationally or with apparent bias.

Application Refused.

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