AC-2024-LON-001142 - [2025] EWHC 2015 (Admin)

The way in which this claim has been put has changed over the course of the proceedings. This was in part envisaged at the permission stage: in his order of 8 November 2024, Foxton J allowed that the claimants might seek to rely on amended grounds so as to be able to include reference to potentially relevant events that had occurred since the commencement of the proceedings. An amended statement of facts and grounds of claim was duly filed and served in January 2025, with detailed grounds of defence (for the CQC) and detailed grounds for contesting the claim (for IP1) being filed and served in February 2025.

In both the original and the amended claims, the grounds identified by the claimants were threefold: ground 1, regarding the CQC’s decision to register IP1in January 2024, where reference was made to both the provision of puberty blockers (“PBs”) and to the hormone treatment, with a clear focus on the safety of the provision of these treatments; ground 2, regarding what was said to be the CQC’s failure to consider exercising its power to impose a condition on IP1, so as to be satisfied that the treatment could be provided in a safe way; ground 3, relating to the assessment decision of December 2024, contending there was insufficient evidence to support a conclusion as to the safety and efficacy of the hormone treatment. In the skeleton argument for the hearing, and in the claimants’ oral submissions, however, not only has there been a clarification and re-ordering of the grounds of challenge (see below, where, in identifying the issues for determination, I have sought to reflect the claimants’ case as it was put before me), there has been a clear shift in focus, from the safety of the treatments provided by IP1 (albeit the claimants make clear this remains the relevant context for their challenge) to five particular issues relating to how IP1 operates, which are relied on as demonstrating that the decisions made by the CQC (or, in relation to the failure to impose a condition, the CQC’s omission) are irrational (as to process and/or outcome) and unlawful.

For the CQC it is complained that this represents a change to the claimants’ case that ought properly to be the subject of a formal (re-)amendment. For the claimants it is said that this is simply drawing out particular aspects of the claim that were (certainly since the earlier, permitted, amendment) already present; in any event, however, the claimants have made a formal application to re-amend their claim to expressly incorporate the points identified in their skeleton argument.

I do not consider it would be right to characterise the change in the way the claimants’ case is put as simply a shift in emphasis. The earlier iterations of the claim clearly focused on the particular treatments it was considered IP1 prescribed. The case as now advanced relies on five particular operational features of IP1 as demonstrating the irrationality (process/outcome) and/or unlawfulness of the impugned decisions. While some aspects of those five matters might be discernible from the amended statement of facts and grounds, as the case is now advanced, it could not be said that the earlier pleadings set out each ground of challenge with sufficient detail of each alleged breach of law/legal principle to enable the essential issues to be identified. As such, I agree with the CQC that a formal application to amend was required.

Turning then to the question whether that application should be allowed, neither the CQC nor IP1 sought to suggest that the proposed re-amended claim would give rise to any insurmountable prejudice or that this should lead to an adjournment of the hearing. Equally, although the claimants also made a late application to adduce further evidence, it was not argued that this must lead to a postponement so as to enable the CQC or IP1 to further investigate matters/have time to obtain evidence in rebuttal. Seeking to do justice to all sides, and in accordance with the overriding objective, I therefore allow the claimants’ applications to re-amend the statement of facts and grounds, and to adduce further evidence, also allowing applications by the CQC and IP1 to rely on the evidence they have submitted in response.