In CDE, R (On the Application Of) v NHS North East London Integrated Care Board & Anor [2026] EWHC 2109 (Admin) (05 August 2026), Deputy High Court Judge Nigel Cooper KC concluded there was no arguable case that the North East London Integrated Care Board or the London Borough of Tower Hamlets were in breach of their legal obligations to the child.
The child, referred to in the judgment as CDE, is non-verbal, severely sight-impaired, life-limited and medically fragile. He requires complex medical care.
CDE was in hospital from April 2026 until July 2026. After a few days at home, he was re-admitted to hospital because of severe pain and deterioration which could not be managed at home.
At the date of the hearing, he remained an in-patient with palliative care input.
For approximately nine years until December 2025, CDE had access to specialist hospice care which provided specialist hospice short breaks and formed part of CDE's crisis safety net. However, the establishment closed in December 2025.
The judicial review concerned a joint response by the defendants in 2026 setting out the provision they intended to provide for CDE’s health and social care needs going forward.
The First Defendant was the integrated care board (ICB) with responsibility for the provision of health care to CDE.
The Second Defendant was the local authority responsible for delivering short breaks and respite care for CDE.
The claim argued that the defendants had failed to secure a “written child specific and operationally deliverable pathway for a disabled, non-verbal, medically fragile and life-limited child”.
CDE’s case included claims of illegality, irrationality and procedural unfairness, including an alleged failure to provide a coherent pathway for respite, palliative and end-of-life care, urgent escalation and post-discharge support.
The ICB argued that it had made suitable arrangements to meet CDE’s health needs and that there was no legal obligation to provide the detailed written plan sought.
Tower Hamlets maintained that it had made arrangements for short-term respite care either at a hospice or through care at home.
Judge Cooper said that matters had moved on since an earlier refusal of permission in June 2026. He said any issue over the ordinary home to specialist care route had been “materially resolved”, while a meeting with a hospice in July had “further narrowed matters with no exclusive hospice choice being required”.
At the renewal hearing, the claimant pointed to the following matters:
- That there were two occasions on which his family arranged private ambulance transfers due to their concerns about his medical needs.
- That no respite care had been provided since the closure of Richard House.
- That EDC (his mother) had not yet been able to have the surgery she requires.
- That EDC required emergency mental health attendance.
Refusing permission for judicial review, Judge Cooper agreed with Deputy High Court judge Vikram Sachdeva KC that there is no legal obligation on either Defendant to provide the type of "operationally deliverable plan" sought by the Claimant.
He said: “There is an adequate respite plan in place providing for overnight care…. or for care to be made available at home at the request of [CDE’s mother].”
He also found that palliative care was available and that an Advanced Care Plan was in place.
Judge Cooper continued: “There is no legal obligation to identify an operational lead responsible for coordinating the interface between social care-funded response, health-funded hospice provision, palliative/end of life planning, urgent escalation, hospital provision and post-discharge support.
“Nor does the evidence establish a failure to provide sufficient information to EDC to enable her to understand what provision is available, who is responsible for providing it, when it will start, what happens after discharge and how the Claimant will be kept safe in a crisis.
“I also agree that references to the ECHR and PSED [public sector equality duty] do not add anything to the grounds advanced by CDE in support of his claim.”
In relation to the ICB, the judge found the evidence established that there was no failure to provide for the health-funded elements of CDE’s pathway.
He said: “There is a package of NHS care available for CDE, which has been assessed, planned and either being delivered or is available for delivery. To the extent that the plan for CDE's care requires reassessment due to material changes in CDE's condition, the evidence shows that it is being reassessed.”
Judge Cooper reached a similar conclusion regarding the council, finding that there was “a plan for the delivery of social care for CDE and his family, which is responsive to material change and is available as required by CDE and EDC”.
He was also satisfied that the cooperation and joint working required between the defendants was in place.
Judge Cooper took into account evidence that the family had paid for private ambulance transfers, that CDE and his family had not received respite care since the closure of the hospice service in December 2025, and that CDE’s mother had an ongoing need for an operation and had required mental health support.
However, he said the evidence did not establish an arguable case that these matters amounted to a breach of the defendants’ legal obligations.
He added: “In particular, it is clear that immediately after the closure of [the hospice service], it took all parties time to agree and put in place an alternative package of care but the evidence does not suggest that this time was unreasonably extended due to any breach of their statutory obligations by either Defendant.”
He refused permission for judicial review.
Lottie Winson