22.14It should be noted the Official Solicitor does not operate an out of hours service, so on any application brought out of normal court hours the court will normally strive to make the most limited order possible until such point as the matter can be brought back with the Official Solicitor present. The same will also generally apply if the urgency of the application has meant that the Official Solicitor has been unable to attend,1For a good example of the court’s approach, see Nottinghamshire Healthcare NHS Trust v RC [2014] EWHC 1136 (COP) at para 19. although in the case of a decision that simply cannot wait, the court will make the decision on the spot.2See Newcastle-upon-Tyne Hospitals Foundation Trust v LM [2014] EWHC 454 (COP), [2015] 1 FCR 373.

22.15The general rule in medical treatment cases is that it is better to bring the application sooner rather than later so that all the necessary inquiries can be made and information obtained to allow the court to reach a proper conclusion as to where P’s best interests lie. It should be noted, however, that a somewhat unfortunate consequence of the decision in Aintree University Hospitals NHS Trust v James3[2013] UKSC 67, [2014] 1 AC 591, (2013) 16 CCLR 554. is a lack of clarity as to exactly when applications should be brought in respect of the withholding of life-sustaining treatment. Lady Hale, giving the judgment of the Supreme Court noted that, if an application is brought too early, then there is a risk that that the court may be unable to say that when the treatments are needed that they will not be in the best interests of the patient.4Para 47. The logical corollary of this is that some decisions may be delayed – and that a sudden clinical deterioration may then require an urgent application to be brought.5See further in this regard the article by Vikram Sachdeva, Alex Ruck Keene and Victoria Butler-Cole entitled ‘The MCA in the Supreme Court – Reflections on Aintree v James’ [2014] Eld LJ 54.