05/09/2025
High Court confirms that Medical Director must act as Case Manager in MHPS proceedings
High Court upholds doctor’s contractual right to have the Medical Director act as Case Manager. In addition, the Court indicated that terms of reference concerned matters which, if proven, were properly classified as conduct and/or capability and it was not open to the Trust to change course and to subject the doctor to a different process merely because the Trust wished to label the matters being investigated as trust and confidence. To do so would amount to a breach of the implied term of trust and confidence that the Trust owes the doctor.
Background
NHS Foundation Trust L commenced an investigation into Dr MN’s “judgment, decision making and actions” concerning his involvement in facilitating visits by Lucy Letby to Hospital X and also relating to his communications with Letby about a specific patient.
The Trust’s position was that the matters were ones of trust and confidence which were not therefore required to be determined under MHPS. It was also the Trust’s position that MHPS / the Trust’s local equivalent did require the Medical Director act as Case Manager in all cases involving consultants.
Dr L issued a claim for breach of contract seeking declaratory and injunctive relief.
High Court Judgment
Dr L succeed in his claim for breach of contract– see judgment of Sheldon J handed down on 31 July 2025.
Regarding the identity of the case manager, the High Court held that:
- the Trust’s local MHPS policy was incorporated into the doctor’s contract of employment;
- paragraph 1.6 of the local MHPS policy which provided that “The Medical Director will act as the Case Manager in cases involving Clinical Leaders ie Clinical Directors and Service Group Leads and consultants and may delegate this role to a senior manager to oversee the case on his or her behalf in other cases” was apt for incorporation;
- paragraph 1.6 was applicable to the concerns in this case;
- it was a requirement of paragraph 1.6 that the Medical Director be the Case Manager in cases involving consultants and is not permitted to delegate that role;
- the express requirement of paragraph 1.6 is subject to an implied term that the Medical Director is not required to act as Case Manager where it would not be appropriate for him to do so as a matter of fairness (eg where he has direct knowledge of the matter being investigated or is the partner or close relative of the person being investigated) or because he could not do so due to ill health;
- the Trust had therefore acted in breach of contract by appointing someone other than the Medical Director to act as Case Manager / permitting delegation of that role to someone other than the Medical Director.
Regarding the scope of MHPS and whether the concerns fell within it, the High Court indicated that:
- it is clear from case law that the Trust will not be permitted to side-step the local MHPS procedures by treating the matters complained of as being concerned with trust and confidence, and therefore subject to a different process, when they ought to be treated as matters of conduct and/or capability. To do so would itself be a breach of the duty of trust and confidence that the Trust owes to the doctor;
- in the instant case, the terms of reference for the investigation concern matters that go to Dr MN’s conduct and/or capability even if the effect of these matters, if proven, would impact the trust and confidence that the Trust would have in Dr MN.
- based on the investigation so far and the tramlines set by the terms of reference, it would not be open to the Trust to change course and subject Dr MN to a different process at the end of the investigation merely because the Trust wishes to label the matters being investigated as being related to trust and confidence;
- if the Trust did choose to alter the scope of the investigation to include reputational issues, then it would be open to the Trust, if the evidentiary threshold was made out, to take Dr MN though a procedure in which the reputational issue could be determined as a matter of trust and confidence, but only so long as no reliance was place on allegations which went to Dr MN’s conduct and/or capability.
The High Court granted declaratory relief, it having been agreed between the parties that injunctive relief was not necessary in circumstances where the Trust had made clear to the Court that it would comply with the terms of any declaration granted by the Court.
Representation
Mark Sutton KC and Nicola Newbegin acted for Dr MN, instructed by Rosie Shapiro and Rukmanie Hodges of DWF.
You can read the full judgment here.
NB This case is subject to restricted reporting orders prohibiting the disclosure of the names or addresses of the parties or Dr MN’s current workplace or any matters likely to identify the same.
