On 8 September in the High Court, United Medical Associate Professionals (UMAPs) put its full case for judicial review of the decisions of 16 July 2025 to make, accept and implement the recommendations of the Leng Review before the High Court. Mr Justice Sheldon heard argument from the relevant parties and has reserved judgment, with his decision on whether the claim proceeds to a substantive hearing expected in the coming weeks.
For over a year, the Government, NHS England and Professor Leng have resisted this challenge on paper. They had to answer it yesterday, for the first time, before a judge in open court.
The claim is brought against NHS England, the Secretary of State for Health and Social Care and Professor Leng, with the British Medical Association (BMA) as an interested party. Mr Justice Sheldon reconsidered the application afresh following its refusal on paper on 16 July 2026.
Central to the argument was the Ministerial Submission – the advice on which the then Secretary of State, Wes Streeting, accepted all 18 recommendations of the Leng Review on the day it was published. It is the only substantive document the Government has disclosed. Neither the Secretary of State nor NHS England identified, at the time the decisions were taken, the statutory power under which they were taken.
We believe the Ministerial Submission is extremely revealing and extremely damning. It explicitly makes the link between the Leng Review and the Government’s dispute with resident doctors, referring to the Secretary of State’s “wider agenda with industrial relations, the 10 Year Plan and resident doctors”. Its very first page recommends that all 18 recommendations be accepted immediately. The Review was published on 16 July 2025: the Secretary of State accepted every recommendation that day while resident doctors were due to strike days later. Safety – the question Professor Leng was commissioned to answer – is mentioned only once in the body of the submission.
UMAPs’ case is that the Ministerial Submission shows that the urgency behind the Government’s decision was driven not by the safety of Associates, which the Leng Review itself could not find evidence to question, but the need to placate a hostile faction of resident doctors within the BMA on the eve of a strike.
Among the grounds argued before the court, UMAPs’ case is that:
- The Leng Review found no scientific evidence that Associates were unsafe. It then reversed the burden of proof, demanding “overwhelming” evidence that Associates were “always” safe – a test no healthcare profession could meet – and made no comparison with the alternative of the work being done by someone else, or not at all.
- Having discounted the objective evidence, the Leng Review relied on a dossier compiled by the BMA and on a survey for which the BMA had circulated a template response to doctors, and was therefore subject to gaming and bias.
- Professor Leng assured UMAPs that she was not consulting other organisations on her draft recommendations – but other members of her Core Stakeholder Group were in fact consulted, and the BMA has admitted receiving “high level minimum role requirements” for Associates before the Review was published.
- No impact assessment or cost-benefit analysis was carried out before recommendations altering thousands of NHS roles were implemented on the day of publication.
If permission is granted, the claim will proceed to a substantive hearing at which the evidence of all parties will be examined in open court, and UMAPs will press the Defendants to comply in full with their duty of candour and disclose the key documentation that shows exactly how these decisions were made.
UMAPs is represented by Patrick Green KC, Jack Castle, Thomas Mallon and Kate Gardiner, instructed by Sneha Nainwal and Katherine Burnett of Shakespeare Martineau.
Stephen Nash, General Secretary of UMAPs, said:
“We are proud of the case we put and confident in its strength.
This case is about holding to account those who have leveraged a dominant position within the NHS to shut out a group of workers who were trained to help patients. Our members have lost their jobs, have been pushed out of roles they trained and qualified for, and have been subjected to a hostile campaign of bullying and harassment by their medical colleagues aligned with the BMA doctor substitution committee rhetoric, both online and in the workplace. This has had a profoundly damaging impact on the Associate workforce, which is around 80% female and around half from Black, Asian and minority ethnic backgrounds.
We believe this has all been driven by the protectionist agenda of the doctor replacement committee within the BMA – through the pressure they are exerting on employers, royal medical colleges, and policy makers – and enabled by the Government’s capitulation to the union in an attempt to prevent further devastating industrial action by resident doctors.
Our members are entitled to know why the decisions affecting them were taken and who they were really taken for, and patients deserve to know why their access to care has been restricted during these past 14 months. Yesterday, those questions were finally asked out loud, before a judge. We look forward to the court’s decision, and to arguing this case in full at a substantive hearing.
Our message to NHS employers remains unchanged. The Leng Review and the NHSE/DHSC’s advice to adopt the Review’s recommendations carries no legal authority and is not a mandatory instruction. Its lawfulness is now before the High Court, and any Associate dismissed or restricted on the basis of it will be supported by UMAPs in any potential claims they wish to pursue before the employment tribunals.”
