Judicial review of hospital closures Detailed Explanation with Case Law
Judicial Review of Hospital Closures
Hospital closures often spark public concern due to potential impacts on access to healthcare, patient safety, and community wellbeing. When health authorities decide to close or downsize hospitals, those decisions may be subject to judicial review if affected parties claim:
The decision was unlawful, e.g., beyond the decision-maker’s powers (ultra vires).
There was a failure to follow proper procedure, such as inadequate consultation.
The decision was irrational or unreasonable (Wednesbury unreasonableness).
The decision violated legitimate expectations.
There was a breach of human rights, e.g., right to life or health.
Courts generally give some deference to health authorities’ expertise but will intervene if these legal principles are breached.
Case Law Studies with Detailed Explanation
1. R (Save Lewisham Hospital) v Secretary of State for Health [2013] EWHC 2875 (Admin) – United Kingdom
Facts:
Lewisham Hospital was facing closure of its Accident & Emergency (A&E) department and major services. The Save Lewisham Hospital campaign argued the Secretary of State’s approval of the closure was unlawful.
Issue:
Was the Secretary of State’s decision to approve the hospital reconfiguration lawful?
Held:
The High Court quashed the approval on grounds of procedural unfairness and failure to consider relevant factors, including proper consultation and impact on local residents.
Significance:
Emphasized the importance of adequate public consultation.
Authorities must consider the impact on local health services before closure.
Procedural irregularity can lead to quashing of closure decisions.
2. R (Winston) v Secretary of State for Health [2012] EWCA Civ 638 – United Kingdom
Facts:
A group challenged the government’s plans to close a hospital ward citing inadequate consultation and ignoring public health impact.
Issue:
Did the health authority’s closure decision breach procedural requirements and reasonableness?
Held:
The Court of Appeal held that while the Secretary of State had discretion, failure to conduct proper consultation and consider alternatives amounted to unlawful decision-making.
Significance:
Reiterated the need for meaningful consultation with stakeholders.
Closure decisions must be rational and consider alternatives.
Courts can intervene where there is a procedural flaw.
3. Daly v Secretary of State for Health [2015] NZHC 1208 – New Zealand
Facts:
A health board decided to close a rural hospital citing financial constraints and efficiency. The community challenged the decision alleging failure to consider access and impact on vulnerable groups.
Issue:
Was the closure decision unlawful due to failure to consider public health needs?
Held:
The High Court found the health board had not adequately considered the equity and access issues, which was required under the Health Act and principles of administrative law.
Significance:
Highlights the duty of public bodies to consider health equity.
Decisions must be transparent and justified with evidence.
Courts can review the substantive fairness of closure decisions.
4. Ex parte West Berkshire Health Authority [1992] 2 All ER 769 – United Kingdom
Facts:
West Berkshire Health Authority proposed to close a hospital, arguing resources needed reallocation. The proposal was challenged for inadequate consultation.
Issue:
Was the authority’s decision to close lawful and procedurally proper?
Held:
The Court of Appeal held that adequate consultation is a mandatory procedural requirement. Failure to consult properly meant the closure decision was unlawful.
Significance:
Established the legal principle that consultation is essential before major hospital closures.
The decision must consider public and professional opinions.
A procedural breach invalidates closure decisions.
5. R v North and East Devon Health Authority, ex parte Coughlan [2001] QB 213 – United Kingdom
Facts:
Miss Coughlan was promised a “home for life” in a hospital facility which was later planned to be closed as part of NHS reorganization.
Issue:
Could the closure breach her legitimate expectation based on prior promises?
Held:
The Court of Appeal ruled that where a public authority has made a clear promise creating a legitimate expectation, it cannot renege on that promise without an overriding public interest.
Significance:
Protects individuals against unilateral policy changes harming their interests.
Legitimate expectation is a key doctrine in hospital closure cases.
Closure plans must respect reliance interests if promises were made.
6. Brown v Secretary of State for Health [2001] EWCA Civ 226
Facts:
The applicant challenged a health authority’s decision to close a hospital ward without adequate consultation and without properly considering impact.
Issue:
Was the decision unlawful for failing consultation and irrationality?
Held:
The Court of Appeal quashed the closure decision citing procedural unfairness and irrationality.
Significance:
Courts can invalidate closure decisions if they fail the Wednesbury test.
Reinforces that consultation and reasoned decision-making are mandatory.
Summary Table of Key Principles
| Legal Principle | Explanation | Key Cases |
|---|---|---|
| Adequate Consultation | Health authorities must meaningfully consult affected parties before closure | Lewisham, West Berkshire, Winston, Brown |
| Procedural Fairness | Decisions must be made fairly, with proper notice and opportunity to respond | Lewisham, Brown |
| Reasonableness and Rationality | Closure decisions must be rational and based on relevant evidence | Winston, Brown |
| Legitimate Expectation | Authorities must honor clear promises to individuals or communities | Coughlan |
| Consideration of Public Health Impact | Authorities must consider access, equity, and community health consequences | Daly |
Conclusion
Judicial review in hospital closure cases focuses primarily on process and fairness rather than substituting the court’s view on healthcare policy. Courts insist that authorities:
Engage in meaningful consultation.
Act rationally with evidence.
Respect legitimate expectations.
Consider the broader public health impact.
Failure to do so risks having closure decisions quashed as unlawful.
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