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NHS closures, reorganisations and access to treatment

Established over 60 years ago, the National Health Service’s three founding principles are (1) it should meet the needs of everyone, (2) be free at the point of delivery and (3) be based on clinical need, not ability to pay.

Recent years have seen a plethora of legislation which has resulted in great changes to the way NHS services are delivered, some of which has caused great concern amongst the public.

Reorganisation programmes, changes to the NHS structure, the creation of foundation trusts and the introduction of the private sector to the NHS have all led many individuals and campaign groups to question the appropriateness of these reforms, some of whom have instructed Leigh Day to advise them on their challenges.

Previous Cases

Access to NHS treatment

Yvonne Watts: Leigh Day was instructed by Yvonne Watts regarding a refusal by the NHS to allow her to travel abroad for treatment she required at NHS expense.

At the time of her instruction, Ms Watts was 75 years old and in need of a hip replacement. Her local NHS service had a long waiting list for the operation and she therefore had no option but to pay for private treatment, at a cost of £4000. When she requested the NHS to pay back this money to her, they refused.

She issued proceedings, challenging this decision. The European Court of Justice, to whom the High Court had referred the case, found that the NHS must refund patients who are driven abroad to seek treatment for medical conditions where they have waited longer than clinicians advised, even if waiting time targets are met.   


Smith v. North Eastern Derbyshire PCT: Pam Smith, a local parish councillor, instructed Leigh Day to challenge the award of a contract to United Health Europe. The contract was to provide General Practitioner services at the Creswell Primary Care Centre Nottinghamshire. Ms Smith challenged the decision on the basis that she and the other patients at the surgery had not been consulted about the proposal and that the PCT had made the decision without taking into consideration their views.

The Court of Appeal found in her favour. As commented by Richard Stein at the time: “This case shows that the NHS must involve patients and their representatives in all of their thinking about service plans and developments.  The Court of Appeal’s judgment confirmed that where patients have not been fully involved, the courts will be likely to force the NHS bodies to do so”.

Privatisation of the NHS

Fudge v. Bristol PCT and others: Leigh Day was instructed by a local patient in Bristol about the failure her local Primary Care Trust (PCT) and/or Strategic Health Authority (SHA) to consult the public about a decision to set up an Independent Sector Treatment Centre (ISTC) in the area.

The Department of Health argued that consultation was not required because the contract establishing the ISTC was between the Department and the private company. It was not between the SHA and/or PCT and the consultation obligations therefore did not apply.

The Court of Appeal rejected this argument. The judges held that given the SHA and PCT were involved in the proposal they should have involved the public in the plans. 

For more information please contact Richard Stein or Rosa Curling on 020 7650 1200

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