This information is copied from FROM WEDNESBURY UNREASONABLENESS TO
ACCOUNTABILITY FOR REASONABLENESS by DANIEL WEI L. WANG in The Cambridge Law Journal, Volume 76, Issue 3 November 2017 , pp. 642-670
cambridge.org/core/services...
In R v Cambridge Health Authority, ex p B [1995] 2 All ER 129, [1995] 1 WLR 898, the principle that a rationing decision will withstand judicial review simply if it is not absurd was replaced by the requirement that authorities take all the relevant considerations into account when limiting access to a health treatment. The decision should not be "so absurd or outrageous in their defiance of logic or morality that no reasonable person addressing the question would have come to the same conclusion". This is known as "Wednesbury unreasonableness".
When given 1) the research that is on this forum, 2) the BTAs own statement that they are not advocating a ban on liothyronine and 3) the NHS Guidance, the CCGs are very likely to be shown to be Wednesbury unreasonable.
In Fisher R. v North Derbyshire Health Authority, ex parte Fisher [1997] 8 Med L.R. 327.
a treatment for multiple sclerosis was denied by reasons of lack of funds and insufficient evidence of its efficacy and cost-effectiveness, in spite of an NHS circular asking health authorities to develop and implement arrangements to prescribe it. The High Court quashed the decision on the basis that the defendant authority had failed to give clear and rational reasons for not complying with the national policy and that it established a blanket ban that did not take into account the patient’s individual circumstances.
This is very similar to the position with liothyronine.
A blanket ban on a treatment was also the reason for quashing a decision in R. v North West Lancashire Health Authority, ex parte A, D and G [1999] All E.R. (D) 911 in which there was a challenge against a policy that gave gender reassignment surgery low priority for funding. Despite the local health authority policy mentioning that exceptional circumstances would be considered, the Court of Appeal found that the manner of considering these exceptional cases actually amounted to a blanket policy. The Court of Appeal also challenged the authorities’ scientific assessment by concluding that they had not engaged with the existing evidence that this treatment was effective.
The parallels with the CCGs and PrescQIPP misquoting the BTA statement about the alleged lack of evidence to support liothyronine therapy and not considering other valid scientific evidence.
The prohibition of a blanket ban and the duty of authorities to take into account the patients’ individual (and possibly exceptional) circumstances were reaffirmed in several subsequent cases in which decisions not to fund drugs for cancer for reasons of cost and lack of evidence were judged unlawful. In these cases courts accepted that a drug may not be funded for priority-setting reasons, but such a policy would only be accepted as rational if grounded on clear and rational reasons and envisaged exceptional circumstances. Moreover, the concept of exceptionality cannot be too narrow to the extent that no case would be exceptional.
In R v Swindon NHS Primary Care Trust, Secretary of State for Health, ex parte Rogers [2006] EWCA. Civ 392, the Court of Appeal quashed a policy not to fund Herceptin but in exceptional clinical circumstances, which had been upheld by the High Court, on the grounds that the circumstances that would make a case exceptional were not clear.
in most CCGs, there is not even an exception for certain cases, as the BTA, patient support groups and the NHS require.
In R. v Barking & Dagenham NHS PCT, ex parte Otley [2007] EWHC 1927 and R. v West Sussex Primary Care Trust, ex parte Ross [2008] EWHC B15, based on divergent expert opinions, the courts also challenged the health authorities’ analysis of the scientific evidence and their conclusion that the claimant’s case was not exceptional.
Neither PresQIPP nor the CCGs have adequately assessed divergent expert opinions, based mostly on misreading the BTA statement which in itself does not adequately adequately assess divergent expert opnion. However, the BTA have subsequently advocated the use of liothyronine.
In R. v Salford Primary Care Trust, ex parte Murphy [2008] EWHC 1908, even though none of the factors brought by the patient could make her case exceptional, the court quashed the decision on the grounds that authorities had evaluated each of the factors separately rather than holistically (“in the round”).
I hope that patients and patient groups take some confidence that our cause is good, there is case law to show that PrescQIPP and the CCGs are acting unlawfully and irrationally, and that there is a course of action open if the the dossier gets "filed". It may be that quoting the case law, providing the BTA NHS and our dossier in a letter or formal complaint to your CCG may be sufficient to initiate T3 therapy.
because you clearly have a broad and specific experience in such matters. I made my comments based on just one experience where I took a local health trust through their complaints procedure to deadlock so that the matter was referred to the ombudsman. After setting out the clinical and policy issues and some to-ing and fro-ing about the various positions Adopted by the Health Authority in response to my claim the ombudsman found in my favour, refunded more than £1000 of private healthcare costs and instructed the local trust to make provision for the matter at issue o others did not fall foul of their de facto policy. 
Scientific evidence for Hashimoto's?
Has your CCG said your doctor can't prescribe T3?
BTA and 'T3 does not cross the placenta'
