Facts: In Wales, local health boards (LHBs) assessed the level of their payment for registered nursing care, in care homes, by reference to the tasks undertaken by registered nurses which only a registered nurse could perform, rather than by reference to all the tasks in fact undertaken by registered nurses, including the provision of personal care.

Judgment: the Court of Appeal (Laws and Lloyd Jones LJJ, Elias LJ dissenting) held that this approach was lawful because the language of section 49(2) of the Health and Social Care Act 2001 required a distinction to be drawn between the different services provided by nurses at a care home and indicated that the LHB was only required to pay for costs of services that only a registered nurse could perform.