The Secretary of State is not obliged to meet every demand for health services and can achieve only what is possible with the resources available.

Judicial review was sought regarding a PCT’s decision not to fund Avastin for treatment of cancer. Five cycles of treatment had been purchased privately, with significant success. The Court of Appeal held that the PCT’s decision was irrational and unlawful.

Unless decision-makers seek to justify their decision on lack of resources, they must consider properly whether treatment could be successful.

The PCT had a policy to fund Herceptin (treatment for breast cancer) in ‘exceptional’ circumstances only.

The decision was unlawful because the PCT had not defined the circumstances that could represent ‘exceptional’. Since the PCT had not referred to cost as a relevant factor, it could not rely on resource constraints as a reason for denial of treatment.