Birmingham Community Healthcare NHS Trust v Ibrahim: High Court upholds Ramadan medication discrimination finding

The High Court has dismissed an appeal by an NHS trust against a finding that its prison medication policy unlawfully discriminated against a Muslim prisoner who fasted during Ramadan. In Birmingham Community Healthcare NHS Trust v Ibrahim [2026] EWHC 2468 (KB), Soole J upheld the county court's conclusion that the trust breached Article 14 of the European Convention on Human Rights, read with Articles 8 and 9.

The claim concerned Ramadan 2019 at HMP Birmingham, where the trust provides primary healthcare. Codeine could be dispensed only under supervision at a medication hatch whose opening hours fell within fasting hours, and could not be issued in possession because of its diversion risk. The claimant chose to fast and was given alternative pain relief. HHJ Najib rejected the Article 8 and 9 claims, found that no withdrawal symptoms had been suffered, and granted a declaration without damages. There was no cross-appeal on those points.

The trust's principal argument was that, because the claimant suffered no detriment, the treatment fell outside the ambit of Articles 8 and 9. Soole J disagreed. Ambit and interference must be kept distinct, he said, so a claimant need not establish a violation of the substantive right. Drawing on SC, A and B v Criminal Injuries Compensation Authority, Steinfeld and Smith v Lancashire Teaching Hospitals, he held that the test is whether the treatment has a more than merely tenuous connection to a core value of the Article, and that no adverse effect need be shown. Lord Bingham's approach in M had been overtaken. The submission that the rights were "secured" because effective alternative medication was supplied was, in his view, tantamount to merging the two concepts, while the contention that the difference in treatment must be "meaningful" looked beyond the first stage of the inquiry.

Security and the non-proliferation of opiates were accepted as legitimate aims. The dispute turned on whether resources were an aim the trust in fact pursued. The judge below found the trust's evidence on that point to be little more than assertion. No one had raised the issue with the prison authorities or higher management, and the claimant had been escorted to the hatch during lockdown on several nights of a later trial without any apparent need for extra staff. Soole J held that this finding was open to a judge who had seen the witnesses. The evidence did not reflect anyone's reasoning at the time, and the trust had therefore not acted with resources in mind.

He rejected the argument that the judge had excluded resources as a legitimate aim. The judge had cited Baroness Hale's observation in Coll that saving cost is a legitimate objective of public policy but that budgetary considerations cannot justify discrimination, and had accepted that resources could be weighed at the justification stage. Soole J agreed that "refusal" was not the apt word, since the evidence showed a failure to consider alternatives at all. That took the appeal no further, because a failure to consider an option cannot place a public body in a better position than a refusal. A passing reference to round-the-clock healthcare was not central to the reasoning.

The procedural challenge also failed. The trust argued that the alternative procedures identified in the judgement had been neither pleaded nor put to its witnesses. Soole J found that the gist of the alternative had been sufficiently identified in cross-examination, and that the trust had suffered no unfairness or prejudice. Where a trust had given no meaningful thought to the question, he added, it was in an inherently weak position on the margin of appreciation.

Proportionality did not strictly arise, but the findings on resources would have compelled the conclusion that the test was not met. The judge rejected the trust's floodgates and perversity arguments, stressing that the decision rested on the particular facts of the case.

Conrad Hallin, instructed by DAC Beachcroft LLP, appeared for the trust. Carl Buckley, instructed by Instalaw Solicitors, represented the claimant.