High Court Rules Against West Sussex PCT in Landmark Healthcare Funding Case

Citation: [2008] EWHC 2252 (Admin)
Judgment on


In the judicial review case of Ross, R (on the application of) v West Sussex Primary Care Trust, several critical legal principles were scrutinized, ultimately resulting in a significant decision. This article delves into the case where the High Court evaluated the lawfulness of decisions made by the West Sussex Primary Care Trust regarding the funding of a cancer drug for an individual patient. Key to the discussion was the application of policy surrounding ‘exceptionality’ and the balancing of a PCT’s budgetary restraints against individual patient care needs.

Key Facts

Colin Ross, diagnosed with multiple myeloma, was at the core of this case. He had undergone prior treatments that eventually became intolerable due to peripheral neuropathy, necessitating consideration of the drug Lenalidomide which was not standardly funded by the PCT. His application for the funding under the Individual Cases Policy (ICP) was rejected following the claim that his case was not ‘exceptional,’ and the cost-effectiveness of the drug did not justify its provision outside of the annual operational budget.

Several key legal principles emerged from this case’s deliberation:

  1. Role of the Courts: As per ex parte B (Cambridge Health Authority) [1995] 1 WLR 898, the court does not arbitrate on the merits of medical treatment decisions but instead reviews the lawfulness of the decisions made by bodies like the PCT.

  2. Allocation of Scarce Resources: Illustrated in R v North West Lancashire Health Authority [2000] 1 WLR 977, PCTs must juggle limited budgets, making complex decisions about which treatments to fund.

  3. Exceptionality in Funding: The panel’s decision emphasized the argument that funding outside of the normal protocol requires the applicant to be ‘exceptional.’ However, the interpretation of ‘exceptional’ was scrutinized, questioning whether it necessitated uniqueness or simply being out of the ordinary.

  4. Right to life: Article 2 of the European Convention on Human Rights, concerning the right to life, though not directly cited, underpins the gravity of NHS funding decisions, demanding careful scrutiny.

  5. Judicial Review of Administrative Decisions: E v Secretary of State for the Home Department [2004] QB 1044 defined an unreasonable decision as one beyond the range of responses a reasonable decision-maker would make, especially important in life and death cases.


Upon scrutiny, the High Court held that the decisions of the PCT failed on several grounds. Most notably, the application of the ‘exceptionality’ policy was deemed to be irrational and legally flawed, effectively setting an impossible threshold by conflating exceptionality with uniqueness. Further, the PCT’s decision-making process was faulted for material errors, particularly regarding the clinical effectiveness and cost-effectiveness of Lenalidomide for Mr. Ross. The verdict called for immediate interim relief, with the stipulation that treatment should commence posthaste, pending a reevaluation by the PCT in line with the court’s findings.


In conclusion, the High Court’s decision in Ross v West Sussex Primary Care Trust underscores the obligation of NHS bodies to make difficult funding decisions within the constraints of their resources while ensuring processes and policies are rationally applied and legally sound. The case further clarifies the concept of ‘exceptionality’ within healthcare funding, urging for more accessible interpretation to safeguard individual patient rights without compromising the broader budgetary considerations of healthcare providers. The judgment mandates a revisiting of policies to align with lawful and practical expectations, facilitating fairer decision-making in future similar contexts.