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In R (Anaesthetists United Ltd and Others) v General Medical Council [2025] EWHC 2270 (Admin) (“Anaesthetists United”), Mrs Justice Lambert dismissed a judicial review claim brought by the claimants against the defendant regulator for Physician Associates (“PAs”) and Anaesthesia Associates (“AAs”) – collectively referred to hereafter as “Associates” – in the UK.
The claim is the most recent instalment in a brewing saga over the continued use and regulation of Associates in the UK’s healthcare system:
In April 2025, Lambert J dismissed the British Medical Association (“BMA”)’s judicial review challenge (R (British Medical Association v General Medical Council [2025] EWHC 960 (Admin)) to the GMC’s decisions to (i) apply the same basic professional standards to doctors and Associates, and (ii) refer to all three professions collectively as ‘medical professionals’.
Just prior to the handing down of Anaesthetists United, Professor Gillian Leng released her final report following the conclusion of her independent review into the Associate professions.
R (Ferguson) v HM Assistant Coroner for Sefton, Knowlsey and St Helens [2025] EWHC 1901 (Admin) concerned a challenge by the next of kin of Joseph Farley, who died after jumping from the fourteenth floor of a carpark. The Coroner conducting mr Farley’s inquest has determined that Article 2, ECHR, did not apply and that the inquest could be heard without a jury. Mr Ferguson challenged both of these decisions by way of judicial review.
In a thorough and detailed judgment upholding Mr Ferguson’s challenge, Mrs Justice Hill gave a useful restatement of the law on Article 2, as well as a useful illustration of how it applies if difficult and complex fact patterns. The judgment also contains helpful clarification on the different sorts of causation tests that apply to parts of the Coronial process.
Chamberlain J has provided new guidance on when the court may order a rolled-up hearing. The procedural point arose in the context of an ongoing piece of strategic litigation, and resulted in an interlocutory judgment in R (Al-Haq) v SSBT [2025] EWHC 173 (Admin).
Al-Haq is an independent Palestinian human rights organisation. It brought a judicial review claim to challenge various decisions of the UK government in the licensing of exports of military and dual-use goods destined for Israel for potential use in Gaza. The decisions were taken by the Secretary of State for Business and Trade. Oxfam, Amnesty International and Human Rights Watch were granted permission to intervene.
Following our recent Law Pod UK episode on judicial review, this case contains some useful guidelines to the differences between the kinds of remedy available via judicial review versus statutory appeal, private civil actions, private prosecutions and other avenues for compensation.
It involved an application for judicial review of decision-making by the regulator of landfill maintenance, where the regulator argued that the claimant had an adequate alternative remedy such that judicial review should be refused.
The applicant, Noeleen McAleenon, had claimed that the regulator had not taken appropriate action to prevent harmful chemical gases and noxious smells escaping from a neighbouring landfill site. But the public bodies maintained that judicial review should be refused because Ms McAleenon had adequate alternative remedies, in that she could herself launch a private prosecution against the owner of the site: Section 70 of the Clean Neighbourhoods and Environment Act (Northern Ireland) 2011 (“the 2011 Act”) provides that a person aggrieved by the existence of a statutory nuisance may make a complaint to the magistrates’ court for an order requiring abatement of the nuisance and prohibiting its recurrence and the imposition of a fine.) Alternatively, the defendants said, she could bring a nuisance claim against them in private law.
The first instance judge dismissed the alternative remedies defence. He observed (para 92) that the case concerned the public law issues of regulation and enforcement, whereas any private prosecution in the magistrates’ court under section 70 would centre on the issue of whether a nuisance had been caused. Whilst there is of course an overlap between the two questions, the two kinds of litigation have quite different purposes:
“a member of the public with sufficient interest is entitled to hold regulators to account by pursuing any public law wrongdoing. It would be an unfortunate and unattractive position if a regulator could effectively be immune from suit in this sphere by reference to alternative proceedings in the magistrates’ court”.
Let us turn to NIHRC and JR295’s applications for judicial review [2024] NIKB 35, in which the High Court disapplied sections of the Illegal Migration Act 2023 (IMA) – the Government’s flagship statute to tackle illegal migration – in Northern Ireland. It is important to understand why, despite some alarming reactions to the judgment, it was both foreseen and avoidable – and why the alarm should be sounded in the Houses of Parliament instead.
The pumping of raw, untreated sewage into Britain’s waterways is one of the defining political issues of the day. Its potency as a legal issue, however, is limited. That, at least, is the outcome of R (Wild Justice) v OFWAT [2023] EWCA Civ 28.
Sewage polluting the River Coln, at Fairford, Gloucestershire, this January. Photograph: Graeme Robertson/Guardian
The Claimant, a not-for-profit organisation which advocates for the protection of wildlife and nature, asked the Court of Appeal for permission to apply for judicial review of the Respondent’s alleged failure to perform its duties to regulate the discharge of raw sewage.
Permission had already been refused twice below – on the papers by Ellenbogen J, and at an oral hearing by Bourne J. This appeal was heard by Bean LJ.
UKHRB followers of a certain age may remember this advertisement for breakfast cereal, which went “viral” in the days before the internet: [deleted due to copyright rules]
Those were innocent times, when we believed that the combination of wheat, fat and sugar in a breakfast cereal was a good start to a child’s day. Now we know that foods high in sugar are major contributors to the child obesity epidemic in this country. Hence the government’s regulations on nutritional foodstuffs, introduced last year.
Background law and facts
The Food (Promotions and Placement) (England) Regulations 2021 (SI 2021/1368 – “the 2021 Regulations”) are part of the Government’s strategy to tackle childhood obesity. They introduce restrictions on the promotion, in supermarkets or other large outlets and online, of food which is classified as high in fat, sugaror salt.
Under these Regulations breakfast cereals are included in the categories of food which may be “specified food” and therefore subject to the relevant restrictions. Whether a given product within one of these categories is in fact classified as “less healthy” depends on the score which it is given under the Food Standards Agency’s Nutrient Profiling Model (“NPM”). The NPM requires that the nutrient content of a given product is analysed per 100g of the food or drink itself, rather than taking account of what the food or drink may be consumed with.
Kellogg’s – one of the main players in the breakfast market – relies on agreements with retailers to place its products in parts of stores (e.g. near the checkout, in a queuing area, at the end of an aisle) which maximise sales and to promote its products on the retailers’ websites.
Arguments before the Court
Kellogg’s pleaded claims were based on a number of grounds, the main one being that the Defendant failed to have regard to a relevant consideration, namely the fact that breakfast cereals are typically consumed with milk. This, they maintained was part of the nutrient profile of breakfast cereals.
Kellogg’s fundamental complaint about the 2021 Regulations was that, under the NPM, the fact that a portion of, for example, Kellogg’s “Frosties” would typically be consumed with milk, was not taken into account in assessing whether this product was food which is classified as high in fat, sugar or salt (“HFSS”). If the consumption of milk with breakfast cereal were taken into account, fewer Kellogg products would be classified as HFSS because the nutrient values of the added milk would contribute to the scoring. Kellogg argued that an approach which measured the relative levels of fat, sugar or salt in the product itself, rather than the health impact of the product as typically consumed, was disproportionate and irrational.
The High Court (Bean LJ and Garnham J) held in R (Gardner) v Secretary of State for Health [2022] EWHC 967 (Admin) that the Government’s March 2020 Discharge Policy and the April 2020 Admissions Guidance were unlawful to the extent that the policy set out in each document was irrational in failing to advise that where an asymptomatic patient (other than one who had tested negative) was admitted to a care home, he or she should, so far as practicable, be kept apart from other residents for 14 days.
About 20,000 residents of care homes in England died of COVID-19 during the first wave of the pandemic in 2020. Two of them were Michael Gibson, father of the First Claimant, and Donald Percival Maynard Harris, father of the Second Claimant. Mr Gibson died in a care home in Oxfordshire on 3 April 2020; Mr Harris in a care home in Hampshire on 1 May 2020.
The Issues
The Claimants sought declarations that particular policies of the Defendants (the Health Secretary, NHS England and Public Health England) during the relevant period constituted breaches of their fathers’ rights under the European Convention on Human Rights, or alternatively were unlawful and susceptible to judicial review on common law principles.
In a judgment handed down on 4 February 2022, the Court of Appeal dismissed an appeal for permission to apply for judicial review concerning the lawfulness of the England Infected Blood Support Scheme (EIBSS) (the “Scheme”). The Court of Appeal concluded that the Scheme’s exclusion of those infected with hepatitis B was not discriminatory. In any event, the Secretary of State’s justification for who was to be compensated under the ex gratia Scheme was to be given a wide margin of appreciation by the courts.
Background
CN
The Appellant, CN, suffers from hepatitis B virus (“HBV”) which he alleges he contracted when given blood transfusions on or after 14 April 1989. Consequently, CN has suffered from serious health problems, and was forced to abandon his business to receive medical treatment; he has been reliant on state benefits for the last 13 years. CN is a core participant in the ongoing infected blood inquiry, which was established to examine the circumstances in which NHS patients in the UK were given infected blood and blood products (read more about the Inquiry here).
In 1995, CN issued a civil claim against the NHS and the National Blood Authority (now the NHS Blood and Transplant Service). Despite obtaining expert evidence to the effect that his infection was obtained from infected blood, he had to discontinue his claim when legal aid was withdrawn.
Infected blood and the England Infected Blood Support Scheme (EIBSS)
The Scheme was set up on 1 November 2017, to provide ex gratia support to people historically infected with hepatitis C virus (“HCV”) and/or human immunodeficiency virus (“HIV”). Specifically, the 2017 Directions set out the EIBSS’s purpose as:
a scheme to make payments and provide support in respect of individuals infected with HIV or Hepatitis C (or both) from blood or blood products used by the NHS and to provide support to family members of such individuals.
The Scheme addresses the ongoing social issues concerning those infected and affected by HIV and HCV from unscreened products. The Scheme recognises a moral imperative to compensate those infected with HCV and HIV in circumstances where attempts to allege negligence against the NHS would run into significant difficulties of fault-based liability and evidential issues surrounding the state of scientific knowledge at the time. It also helps families and partners after the death of someone infected, who would otherwise be unable to make a civil claim.
Those infected with HBV do not fall within the remit of the Scheme. In basic terms, this is because the NHS screened blood and blood products for HBV from the mid 1970s, so the number of patients infected with HBV were low after screening. Within the Scheme, the cut-off date for HCV claims is September 1991, when screening was introduced. For HIV there is no cut-off, but the eligibility criteria make clear that after October 1985, when the NHS screened for HIV, it was very unlikely that HIV would be transmitted through infected blood.
This was an interesting ruling on the matter of standing, something that has fallen rather by the wayside since it formed the subject of much satellite litigation in the 1990s. In essence, the Court ruled that the GLP had no standing to bring this claim. Despite its articles of association, whose purposes include the provision of sound administration and equality, democracy, high standards in public administration, access to justice, preservation of the environment or “any other philanthropic or benevolent purpose ancillary”. Such a general statement of objects could not confer standing on an organisation:
That would be tantamount to saying that the GLP has standing to bring judicial review proceedings in any public law case. [58]
Arguments before the Court
The GLP and the Runnymede Trust brought a challenge to the government’s decision to appoint two individuals to head Covid projects such as the Test and Trace programme (Baroness Harding of Winscombe (Dido Harding) was one of the individuals named). Mike Coupe, Director of Testing, NHS Test & Trace, was the other.
The claimants contended that the government had a practice of appointing people to positions critical to the government’s response to the COVID-19 pandemic without open competition, that only candidates with some relevant personal or political connection to the decision-maker were appointed, and that, even though the positions to be filled were senior and strategically important, the person appointed was unpaid. The Claimants said this gave rise to indirect discrimination on grounds of race and/or disability. They made other complaints about the process used by the Defendants.
The Defendants disputed all these claims on their merits. In addition, they contended (a) that the matters complained of had now been overtaken by events rendering the claims academic, and that for that reason, the claims should not be determined by the court; (b) that the claims had been brought too late and should be dismissed for that reason; and (c) that the Claimants lacked standing to bring the claims. There was also one further matter, which the Court considered in the context of the standing issue, although it was conceptually distinct. That was whether the decisions challenged were amenable to judicial review. Each of the decisions challenged in these proceedings was an employment decision. Employment decisions, even when taken by public authorities, are not ordinarily challengeable by application for judicial review.
This was a renewed application by the claimants for permission to proceed with a judicial review challenge to the Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, which requires a registered person who runs a regulated activity in a care home to ensure that any person entering the premises has been vaccinated, unless for clinical reasons that person is exempt.
These new regulations regarding the mandatory vaccination of care workers came into effect on 11 November 2021. The claimants, both employed by care homes, challenged the legality of these regulations (passed under the Health and Social Care Act 2008). Whilst the claimants accepted that the 2021 Regulations fell within the scope of the 2008 Act, they argued that s.45E of the Public Health (Control of Disease) Act 1984 was engaged and, when the provisions are read together, s.45E precludes Regulation 5(3)(b). Section 45E provides that Regulations made under s. 45B or s. 45C may not include provision requiring a person to undergo medical treatment.
In the Queen’s Speech last week, the government presented its legislative programme for the next session of parliament, including a number of bills with important human rights implications. The speech was of particular interest because of the extent to which Brexit and COVID-19 have dominated the prime minister’s time in office so far.
Last Tuesday’s to-do list includes an enormous 31 bills, listed in full here and set out in greater detail here. Two bills with key implications are addressed below.
Sophie Basma (“Sophie”) is 10. She suffers from Type 3 Spinal Muscular Atrophy (“SMA”). SMA is a rare, genetic, neuromuscular disease which progressively leads to sufferers being unable to walk or sit unaided with devastating consequences on their quality of life. Sophie can no longer walk. There is medication for SMA sufferers which would have had the potential of helping Sophie regain her ability to work. But the NHS Trust had concluded that Sophie did not meet the eligibility criteria for this new medication, “Nusinersen”.
By her mother she challenged the decision by way of judicial review. The judge below found that the NHS Trust had lawfully reached the decision that they did. This was her appeal against that finding.
In the previous post under this topic, I referred to Mr Justice Binnie’s proposal for the exercise of the standard of reasonableness review in the 2007 case of Dunsmuir v New Brunswick. This would eventually resurface in Vavilov, where the majority of the Supreme Court of Canada held that the starting point should be a presumption that the reasonableness standard applied. In the interim, there had been much academic, practitioner and judicial commentary on the lack of clarity and consistency in the application of the principles espoused by the majority in Dunsmuir in subsequent cases and on the difficulty in applying such principles in claims. Members of the Supreme Court also expressed concerns in subsequent cases, for example, Abella J in Wilson v Atomic Energy of Canada Ltd 2016 SCC 29. The majority in Vavilov explicitly refers to such criticism coming from the judiciary and academics but also from litigants before the Court and organizations representing Canadians who are affected by administrative decisions. As the Court stated,
These are not light critiques or theoretical challenges. They go to the core of the coherence of our administrative law jurisprudence and to the practical implications of this lack of coherence.
The Court also referred to concerns that the reasonableness standard was sometimes perceived as “advancing a two-tiered justice system in which those subject to administrative decisions are entitled only to an outcome somewhere between “good enough” and “not quite wrong”.
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