Capacity at the crossroads of mental health and cancer investigation

The recent decision in Powys Teaching Health Board & Anor v NT & Anor offers important guidance on capacity assessments and the need for timely applications in cases of serious medical treatment.

Background

The case centres around NT, a 41-year-old man with diagnoses of treatment resistant paranoid schizophrenia and attention deficit hyperactivity disorder. Detained under the Mental Health Act 1983, he had been living in an inpatient rehabilitation service since September 2023, although he had a long history of involvement from mental health services.

In March 2025, clinicians discovered that NT was suffering from a possible tumour on his bladder. However, NT rejected the diagnosis, insisting that he didn’t have any physical ailments and that God had cured him.

Clinicians were optimistic that with surgery, NT could make a full recovery. Several attempts were made to engage NT between March and October 2025, with NT repeatedly giving, and then withdrawing, his consent to the procedure. 

Capacity

NT’s prognosis prompted a capacity assessment, which was carried out to determine whether NT had capacity to consent to the recommended procedure. During this assessment, NT agreed to undergo the surgery, and the assessor concluded that he did have capacity. However, the court criticised this capacity assessment, considering it to be ‘superficial’ and noting its lack of analysis of NT’s past refusals and its failure to address the reasonable foreseeable consequences beyond a rather cursory statement that ‘the procedure and its purpose was explained to him’.

Fortunately, a further capacity assessment was carried out in August 2025. This time, the assessors considered that NT lacked capacity.

By the time of the hearing, all parties agreed that NT lacked capacity both to make a decision regarding the proposed treatment and to conduct the proceedings. Capacity was therefore not an issue in these proceedings. 

Delay

The court was concerned by the several months of delay in filing the application after clinicians discovered NT’s condition. The delay was attributed to a change to NT’s medication made in August 2025, as well as the need for liaison between various health bodies. There was also concern about NT’s relationship with his caregivers if he underwent the procedure in spite of his objections.

The decision

Shortly before the hearing, NT requested a private scan, and agreed that should it also show a tumour, he would consent to the procedure. A relative funded this scan, and NT consequently agreed to the procedure, although it was noted that he had changed his mind in the past. 

Perhaps unsurprisingly, the court determined that it was in NT’s best interests to receive the proposed treatment.

The judge took into account the evidence of NT’s wishes and feelings and his mother’s views, as well as considering the medical evidence. The court noted that clear and consistent communication regarding the procedure and future treatment would likely reduce NT’s anxiety. 

Comment

This case serves as a useful reminder to not delay bringing an application to court if there are disagreements between the clinicians and P when serious medical conditions are suspected. The judge recommended that a clear timetable for submitting an application to the court be agreed at the best interests meeting. In practice, this is likely to require a thorough understanding of the severity of P’s condition, with clear and realistic steps for an appropriately swift resolution. It also highlights the importance of robust capacity assessments that consider P’s history and reasonable foreseeable consequences.  

Do contact Neil Ward if you’d like to discuss any of the issues raised here or require support on a Court of Protection matter. To learn more about our mental capacity and deprivation of liberty work, please visit our webpage here.