Forge Care Homes Ltd and Others, Regina (on The Application of) v Cardiff and Vale University Health Board and Others: SC 2 Aug 2017

The court was asked who is legally responsible for paying for the work done by registered nurses in social rather than health care settings. Is the National Health Service responsible for all the work they do or are the social care funders responsible for at least some of it? The local authorities now appealed. The Health Boards and Secretary of State argue that the consistent view of the case law has been to respect the decisions of the NHS as to what services are necessary to meet all reasonable requirements, under section 3(1) of the 2006 Act, subject only to challenge on the usual judicial review grounds. Thus, it is said, there is nothing unusual in the NHS defining the limits of its responsibilities for itself. The proper construction of section 49(2) depends upon what the NHS decides is reasonably required. Against this, it is true that the courts have normally respected those decisions, subject only to challenges on conventional judicial review grounds; but in this case the NHS is arguing that it should be free to define the extent of the responsibilities of others, the local authorities or residents, by deciding for itself what is and what is not a nursing task, because all are agreed that there should be no funding gap between what is funded by the NHS and what is funded by local authorities with means-tested contributions from the clients. The limits of the local authorities’ responsibilities are defined by Parliament in section 49.
The local authorities’ primary argument was that the court should focus on the application rather than the interpretation of section 49. If it is accepted that the NHS must fund the presence of a nurse who is there to fulfil the legal or practical requirement that a nurse must be on duty at all times, then it follows that the NHS must fund everything that that nurse does while on call in this way.
Held: ‘stand-by’ time should have been included, and the Health Boards’ decisions were based on a misinterpretation of section 49(2) and must be quashed and re-taken in the light of the guidance given in para 44 of this judgment. The argument by the LAs failed: ‘The task of this court is to interpret the meaning of the words used by Parliament to impose a restriction on what local authorities may provide or arrange and thus indirectly to impose an obligation on the NHS to fund what the local authorities cannot provide or arrange. Interpretation must come before application. Once interpreted, it is for those on the ground to put that interpretation into practice.’ and: ”nursing care by a registered nurse’ covers (a) time spent on nursing care, in the sense of care which can only be provided by a registered nurse, including both direct and indirect nursing time as defined by the Laing and Buisson study; (b) paid breaks; (c) time receiving supervision; (d) stand-by time; and (e) time spent on providing, planning, supervising or delegating the provision of other types of care which in all the circumstances ought to be provided by a registered nurse because they are ancillary to or closely connected with or part and parcel of the nursing care which she has to provide.’


Lady Hale, Deputy President, Lord Clarke, Lord Wilson, Lord Carnwath, Lord Hodge


[2017] UKSC 56, [2017] WLR(D) 559, [2017] PTSR 1140, UKSC 2016/0054


Bailii, WLRD, Bailii Summary, SC, SC Summary, SC 20170426 am Video, SC 20170426 pm Video


Health and Social Care Act 2001 49, Care Homes (Wales) Regulations 2002 18(3), Social Services and Well-being (Wales) Act 2014




At AdmnForge Care Homes Ltd and Others, Regina (on The Application of) v Cardiff and Vale University Health Board and Others Admn 11-Mar-2014
The claimant care home sought judicial review of decisions setting the rates for funded nursing care. The care homes’ challenge was on the basis that too restrictive an interpretation of ‘nursing care by a registered nurse’ had been adopted.
At CAForge Care Homes Ltd and Others v Cardiff and Vale University Health Board and Others CA 2-Feb-2016
The Health Trusts appealed against the quashing at first instance of the rates they were to pay for nursing care to certain residents in care homes. The Health Boards conceded, as they had done below, that they had been wrong to exclude the nurses’ . .
CitedPepper (Inspector of Taxes) v Hart HL 26-Nov-1992
Reference to Parliamentary Papers behind Statute
The inspector sought to tax the benefits in kind received by teachers at a private school in having their children educated at the school for free. Having agreed this was a taxable emolument, it was argued as to whether the taxable benefit was the . .
CitedRegina v North and East Devon Health Authority ex parte Coughlan and Secretary of State for Health Intervenor and Royal College of Nursing Intervenor CA 16-Jul-1999
Consultation to be Early and Real Listening
The claimant was severely disabled as a result of a road traffic accident. She and others were placed in an NHS home for long term disabled people and assured that this would be their home for life. Then the health authority decided that they were . .
CitedRegina v Secretary of State for the Environment Transport and the Regions and another, ex parte Spath Holme Limited HL 7-Dec-2000
The section in the 1985 Act created a power to prevent rent increases for tenancies of dwelling-houses for purposes including the alleviation of perceived hardship. Accordingly the Secretary of State could issue regulations whose effect was to limit . .
CitedSt Helens Borough Council v Manchester Primary Care Trust and Another CA 6-Aug-2008
The Trust and Local authority disputed responsibility for the care of a woman whose mental and psychological conditions required constant and expensive care.
Held: Responsibility for the decision fell on the Primary Care Trust as agent for the . .
CitedGrogan, Regina (on the Application of) v Bexley NHS Care Trust and others Admn 25-Jan-2006
The claimant was elderly and in need of care in a nursing home. She claimed that her care needs had been assessed by an unlawful protocol applied by the health authority. She said that she qualified under the criteria for Continuing Health Care.
Lists of cited by and citing cases may be incomplete.

Health, Local Government

Updated: 04 September 2022; Ref: scu.591357