Tribunal decisions

The decision

IN THE UPPER TRIBUNAL
IMMIGRATION AND ASYLUM CHAMBER
Case No: UI-2024-003669

First-tier Tribunal No: HU/63632/2023

THE IMMIGRATION ACTS

Decision & Reasons Issued:

16th June 2025

Before

UPPER TRIBUNAL JUDGE MAHMOOD
DEPUTY UPPER TRIBUNAL JUDGE SMEATON

Between

NOREEN AKHTAR ABBASI
Appellant
and

SECRETARY OF STATE FOR THE HOME DEPARTMENT
Respondent

Representation:
For the Appellant: Mr P Turner (counsel, instructed by Lee Valley solicitors)
For the Respondent: Mr M Parvar (senior home office presenting officer)

Heard at Field House on 12 May 2025

DECISION AND REASONS
INTRODUCTION
1. By a decision issued on 28 October 2024 (a copy of which is appended below) the decision of the First-tier Tribunal (‘FtT’) was set aside, subject to preserved findings. We now re-make the decision.
ANONYMITY
2. An anonymity order was previously made by the Upper Tribunal (‘UT’) on the basis that the appellant is a vulnerable person and these proceedings involve discussion of her confidential medical records. Having heard from the parties, we decided to discharge that order. In making that decision, we had regard to the UT’s Guidance Note 2002 no.2 Anonymity Orders and Hearings in Private.
3. Open justice requires, as a general rule, that the courts must conduct their business publicly unless this would result in injustice. Articles 2 and 3 ECHR are not engaged in this appeal. No other reasons have been identified which make it necessary to make an anonymity order.
RELEVANT BACKGROUND
4. The appellant is a national of Pakistan and is now aged 63.
5. She appeals under section 82(1)(b) of the Nationality, Immigration and Asylum Act 2002 (‘the NIAA 2002’) on the ground that the decision by the respondent dated 3 November 2023 to refuse her application for entry clearance as an Adult Dependent Relative (‘ADR’) is unlawful under section 6 of the Human Rights Act 1998 because it violates article 8 ECHR.
6. The sponsor is the appellant’s British national daughter, Miss Sadia Shabbir.
ISSUES
7. We discussed the issues with the parties at the outset of the hearing. The respondent conceded that, in light of the preserved findings of the FtT, paragraph 5.1 of Appendix ADR was no longer in issue. The respondent accepts that the appellant, as a result of age, illness or disability requires long term personal care to perform everyday tasks.
8. The respondent also accepts that the relationship and financial eligibility requirements of Appendix ADR are met.
9. The Principal Controversial Issues are, accordingly, as follows:
(1) Is the appellant unable to obtain the required level of care in Pakistan, even with the financial help of the sponsor because either:
(a) the care is not available and there is no person in that country who can reasonably provide it; or
(b) the care is not affordable?
(2) If the Immigration Rules are not met, would refusal of entry clearance result in unjustifiably harsh consequences for the appellant and her family?
10. The following findings from the FtT are preserved:
10.1. the appellant has been able to be regularly tested (paragraph 10 of the FtT decision)
10.2. the appellant has been a patient of Dr Nadeem Iqbal since 2022 (paragraph 11 of the FtT decision)
10.3. the appellant has been diagnosed with a range of medical complaints including dementia, diabetes mellitus, Parkinsonism, peripheral neuropathy and progressive neurological conditions that affect memory, cognitive function and daily living abilities. She experiences difficulties with memory recall, decision making and the orientation of time and place. In the opinion of Dr Iqbal, she requires constant supervision, support and assistance with daily living (paragraph 12 of the FtT decision)
10.4. Dr Qureshi, a specialist diabetes doctor, recommends that the appellant lives with her family in the UK as she requires constant supervision and assistance, although his report is not specific as to whether long term care is required to perform everyday tasks (paragraph 13 of the FtT decision)
10.5. The reports from Dr Iqbal and Dr Qureshi before the FtT are given significant weight (paragraph 14 of the FtT decision)
10.6. The sponsor provides real, committed and effective support beyond the normal emotional ties of family. Family life exists and refusal of entry clearance interferes with that family life such that article 8 ECHR is engaged (paragraph 20 of the FtT decision).
HEARING
11. The hearing was recorded and that recording shall stand as the record of proceedings.
12. We were provided with a consolidated bundle of 515 pages and a skeleton argument from the respondent dated 14 March 2025. We heard evidence from the sponsor, the appellant’s daughter, Miss S Shabbir and submissions from both representatives. At the end of the hearing, we indicated that our decision would be reserved.
APPLICABLE LAW
13. In human rights appeals the burden of proof is upon the appellant to show that there has been an interference with her human rights. The legal standard of proof is the balance of probabilities.
14. In considering whether refusal of entry clearance would place the respondent in breach of its obligations under article 8 ECHR, we must first consider whether the refusal of entry clearance is an interference with the appellant’s right to respect for her family or private life of such gravity as to potentially engage the operation of Article 8. In applications for entry clearance, we must consider the impact of refusal on the family unit as a whole and the rights of all those concerned, not only the rights of the sponsor and others in the UK (see Al-Hassan & Ors (Article 8 – entry clearance – KF (Syria)) ]2024] UKUT 00234 (IAC)
15. It is not in dispute here that family life exists and that the refusal of entry clearance interferes with that family life. Accordingly, we adopt the structure recommended by the Senior President of Tribunals in TZ (Pakistan) v SSHD [2018] EWCA Civ 1109, [2018] Imm. A. R. 1301; considering first whether the appellant meets the requirements of the Immigration Rules. If she does, that finding will be positively determinative of the appeal (paragraph 34 of TZ). The refusal of entry clearance will be disproportionate and there will be no need for further examination.
16. The appellant relies on Appendix ADR. The appellant argues that the care she requires cannot be reasonably provided to the required level in Pakistan. Mr Turner relies, in particular, on paragraph 59 of the decision of the Court of Appeal in R (on the application of) Britcits v SSHD [2017] EWCA Civ 368, [2017] 1 W.L.R. 334. That states,
“59. Second, as is apparent from the Rules and the Guidance, the focus is on whether the care required by the ADR applicant can be "reasonably" provided and to "the required level" in their home country. As Mr Sheldon confirmed in his oral submissions, the provision of care in the home country must be reasonable both from the perspective of the provider and the perspective of the applicant, and the standard of such care must be what is required for that particular applicant. It is possible that insufficient attention has been paid in the past to these considerations, which focus on what care is both necessary and reasonable for the applicant to receive in their home country. Those considerations include issues as to the accessibility and geographical location of the provision of care and the standard of care. They are capable of embracing emotional and psychological requirements verified by expert medical evidence. What is reasonable is, of course, to be objectively assessed.”
17. If the appellant does not meet the Immigration Rules, we must consider the issue of proportionality more generally, using the ‘balance sheet’ approach; setting out those factors that weigh in favour of immigration control – the ‘cons’ – against those factors that weigh in favour of family and private life – the ‘pros’ – and giving reasoned weight to each before giving a reasoned conclusion as to whether the ‘pros’ have outweighed the ‘cons’ such that the refusal of entry clearance is disproportionate. If it is, the appeal succeeds. If it is not, the appeal must be dismissed.
18. As was made clear in R (on the application of Agyarko) v SSHD [2017] UKSC 11, [2017] 1 W.L.R. 823, the purpose of the Immigration Rules is to enable decision makers to understand and apply the appropriate weight to be given to the public interest. That the appellant in an application for entry clearance does not meet the Immigration Rules is an adverse factor.
FINDINGS
Medical evidence
19. In reaching our decision, we have taken into account the medical evidence that was before the FtT and given it appropriate weight in accordance with the preserved findings.
20. In addition to the medical evidence before the FtT, the appellant relies on an updated letter from Dr Iqbal dated 10 December 2024. Mr Parvar invites us to place little weight on this letter. He notes that Dr Iqbal does not explain whether the letter was written upon request from the appellant or after a consultation or whether Dr Iqbal carried out any updated tests on the appellant to establish her medical state. He suggests that the letter is simply a repetition of what the appellant has said in her most recent witness statement.
21. We agree that it would have been better for Dr Iqbal to explain how he reached the conclusions in his letter and, in particular, whether he carried out an examination of the appellant and when. We also take into account that the letter is consistent with what he says in his first letter and that the FtT felt able to place ‘significant weight’ on that document (a finding which is preserved before us). The FtT accepted that Dr Iqbal had been treating the appellant since 2022. Dr Iqbal is therefore able to provide evidence on the appellant’s state of health. Further, the updated letter states that the appellant’s health deteriorated in October 2024 when she was suffering from malnutrition necessitating a visit from her son (Bahram Abbasi). This is supported by the evidence that Mr Abbasi travelled to Pakistan from the UK in October 2024 and remained there until December 2024. The sponsor confirmed in her oral evidence before us that the updated letter from Dr Iqbal was produced after Mr Abbasi took the appellant to see him.
22. Taking all of that evidence together, we do place weight on Dr Iqbal’s updated letter and have taken it into account when reaching our decision.
Family support
23. It is not in dispute that the appellant has committed support from her three adult children, all of whom live in the UK. They visit her whenever they stay in Pakistan for prolonged periods. The sponsor currently uses all of her annual leave to travel to Pakistan. Mr Abbasi is a taxi driver and takes extended periods of time away from work in order to stay with the appellant in Pakistan. Neither the sponsor nor Mr Abbasi are married and they do not have children. To that extent, they would appear to be able to devote more time to their mother than the appellant’s other daughter, Nadia Shabbir.
24. Ms N Shabbir has two young children. She said she visits the appellant when she can in the school holidays. She takes her children with her because her husband lives and works in Bahrain. The sponsor’s evidence on the position of her brother-in-law (and his ability to support the appellant) was not entirely satisfactory. Me Turner referred to it as bizarre. She said that her brother-in-law works seven days a week and that he has to book leave six months in advance so cannot easily provide additional support to the appellant notwithstanding that Bahrain is close to Pakistan by aeroplane. That seems an unusual employment situation, especially since it means that neither Ms N Shabbir nor her children see their father for at least 6 months. We conclude though that this evidence is not material to our decision. We proceed on the basis that Ms N Shabbir is able to visit her mother at least once a year when she goes to visit her husband and when her children see their father. We consider that it is likely that these visits by Ms N Shabbir could occur more frequently than the once a year which the sponsor claimed.
25. Mr Parvar invites us to find that the appellant has not given a credible account of the family support available to her in Pakistan and submits that we cannot be satisfied that she does not have siblings or other close family members there who can provide the support she requires. We therefore assess the evidence on this aspect.
26. We conclude that the evidence on behalf of the appellant in this respect has not been satisfactory. For example, the sponsor initially said that the appellant had no family or relatives in Pakistan, but then said that the appellant has a brother in Pakistan who has been in a mental health facility for a long time, as well as an extended family member, Aman Ullah.
27. We do not find that the failure to mention the appellant’s brother undermines the appellant’s credibility, as Mr Parvar submitted. If her brother has been in a mental health institute for some time, it is not surprising that the appellant did not see the need to mention him.
28. The presence of Mr Aman Ullah is not new evidence. He submitted a statement as part of the application. The sponsor’s evidence, however, was that he does not live near the appellant and cannot provide any assistance. We do not accept that. The sponsor has not told the truth about Mr Ullah’s ability to assist the appellant. According to his statement, he lives in Islamabad (as does the appellant). Further, in response to a question from us about money remittances and who arranges for the payment of rent and medicines, the sponsor said that Mr Ullah assists. In his statement, Mr Ullah says that he is available ‘as much as possible’ but that he has other commitments. Whilst we accept that Mr Ullah is not able to provide constant support to the appellant, the evidence is clear that he is a family member who lives reasonably close to the appellant, who is able to visit the appellant and who assists with many administrative tasks like shopping, paying bills and collecting medication.
29. Accordingly, when reaching our decision, we proceed on the basis that the appellant has one family member nearby in Pakistan who can provide regular, but perhaps not daily, support with administrative tasks and some emotional support. The appellant is otherwise reliant on her family members in the UK.

Issue (1) – availability of care
30. The medical evidence, as accepted by the FtT, establishes that the appellant requires long term personal care to perform everyday tasks.
31. The exact nature of the care the appellant requires could and should have been more fully explained in the medical evidence. Dr Iqbal, in his first letter, says simply that the appellant requires constant supervision, support and assistance with activities of daily living. No further detail is provided. Dr Qureshi also says that the appellant requires constant supervision. Dr Iqbal’s updated letter says that she requires care to ensure that she is adequately nourished.
32. The appellant’s first statement says that, without care, she often forgets to take her medication but that she also needs help with daily tasks such as cooking, climbing stairs and getting to hospital appointments. That is reflected in the sponsor’s witness statement.
33. Taking all of the evidence together (and the preserved findings at paragraphs 10.3 and 10.4 above) we find that, whilst the appellant does require assistance with everyday tasks in the home such as cooking, the key requirement for the purpose of this appeal is a need to be supervised. The appellant needs someone with her to remind her to take her medication, to attend her appointments and to eat and drink. That is appears linked with her diagnosis of dementia
34. We acknowledge Dr Iqbal’s opinion that the appellant’s wellbeing is significantly impacted when her family is not present and that, without their presence, she struggles to maintain adequate nutrition and displays signs of emotional distress. We also accept that the appellant’s health is likely to improve if she were to live with her family in the UK and that coming to the UK may well be the best option for her. That, however, is not the test that we must apply. We must decide whether the evidence establishes, on the balance of probabilities, that the care the appellant requires cannot be reasonably provided to the required level in Pakistan.
35. We do not accept, on the balance of probabilities, that the appellant will only take water if given to her by her children or that she does not trust anyone other than her children to assist her. If that were so, we would expect it to feature prominently in the updated letter from Dr Iqbal. We note the unsatisfactory evidence of the sponsor in respect of Mr Ullah’s assistance.
36. At present, the appellant is living alone in Pakistan with help from her relative Mr Ullah. The sponsor and her siblings are travelling to Pakistan and stay for prolonged periods of time in order to provide the appellant with practical and emotional support. There is no regular, paid care in place. We accept that that situation is not sustainable and that, as reflected in Dr Iqbal’s updated letter, it is not meeting the appellant’s needs.
37. Although the evidence does raise concerns about the reliability of previous at-home carers and the absence of residential care homes, the focus of the appellant’s claim to date has not been on the availability of paid care. Although there is evidence in the bundle that was before the FtT that specialised residential care in Pakistan is rare, in evidence before us, the sponsor suggested that the family have approached care homes and that they managed to find one where the appellant could go but that she refused to go there. We do not find this account credible. There is nothing in the documentary evidence to suggest that care homes have been approached or that a place has been found for the appellant. The appellant’s own witness statement says that she has considered going to a care home but that there are only very few good ones and that it is hard to find a place. That is inconsistent with the sponsor’s evidence. There is no reliable evidence before us to suggest that the sponsor or her siblings have visited residential care homes or had discussions with such care homes about whether the appellant’s physical and emotional care needs could be met in such a setting.
38. Even assuming that no residential care is available, there is no reliable evidence before us to suggest that the sponsor or her siblings have had discussions with any care providers who may be able to offer specialist dementia support. In the respondent’s review dated 15 May 2024, three providers are listed (with hyperlinks provided). At least one of those (PlanCare) appears to offer specialised dementia care at home including daily living assistance, medication management, hospital coordination, hospital transportation and tele-consultation. This appears to be the very care which the appellant requires.
39. We note too that the appellant lives in Islamabad and not in a rural or isolated area and that PlanCare offer services in Islamabad. Islamabad is the capital of Pakistan. The appellant and her representatives have been on notice of those proposed providers since at least May 2024, therefore for a year. The burden of proof remains on the appellant to explain why those providers, who are likely to be experienced in dealing with the difficulties Dementia causes such as a mistrust of strangers, cannot provide the reasonable care which the ADR rule requires us to consider.
40. Further, the evidence before us from Dr Iqbal does not go as far as saying that the care the appellant requires is not available in Pakistan, or that, even with such care, the appellant’s emotional and psychological care needs could not be met. His evidence is that the current situation (i.e. the appellant living alone with limited or non-existence paid at-home care and occasional visits from her family) is not meeting her needs and that she would benefit from living with her family.
41. There must be reliable evidence to demonstrate on the balance of probabilities, that such care does not exist or that the appellant’s care needs cannot reasaonbly be met with such care.
42. Insufficient evidence to the required balance of probabilities test has been adduced to show that the appellant’s physical, emotional and psychological needs could not be met by a combination of specialist care (residential or at-home), regular planned visits from the appellant’s children and support from Mr Ullah. There is no issue that the sponsor can meet the financial requirements and so it means that she can continue to fund the appellant’s care in Pakistan too. Even if she cannot do so on her own, she has the assistance of her siblings and Mr Ullah.
43. We remind ourselves of the issues which we set out at the start of our decision.
“Is the appellant unable to obtain the required level of care in Pakistan, even with the financial help of the sponsor because either:
(c) the care is not available and there is no person in that country who can reasonably provide it; or
(d) the care is not affordable?”
44. We conclude that it is clear that when looking at matters objectively as we are required to do, the appellant has not satisfied us that she is unable to obtain the required level of care in Pakistan with the financial help of the sponsor (and her siblings if required), or that the care is not available from care homes or from providers and with visits from the UK family who themselves have relatively recently settled in the UK. The appellant will objectively be able to attain both physical and emotional care.
45. There is, accordingly, insufficient evidence before us to reach a conclusion, on the balance of probabilities, that the care the appellant requires cannot reasonably be provided to the required level in Pakistan.
46. The appellant does not satisfy Appendix ADR of the Immigration Rules.
Issue (2) – unjustifiably harsh consequences
47. The failure of the appellant to meet the Immigration Rules is a significant factor which weighs against her in the proportionality assessment under article 8 ECHR.
48. Further, there is no evidence to suggest that the appellant speaks English (s.117B(2) of the NIAA 2002). This is also an adverse factor.
49. The respondent accepts that the appellant will be adequately maintained in the UK. This is a neutral factor (s.117B(3) of the NIAA 2002).
50. No other factors have been identified which would render refusal of entry clearance unjustifiably harsh. We acknowledge that the current situation is not easy, both for the appellant and her children (including the sponsor).
51. Caring for older parents is difficult. Heart-breaking decisions have to be made. We acknowledge the pain that separation causes and the heartache which was clearly evident from the sponsor. She genuinely wants to have her mother with her in the UK. Those factors, however, are not sufficient to demonstrate that refusal would be disproportionate. We are confident that in this case the sponsor, her sister and their brother have their mother’s best interests at the forefront and that they will continue to ensure that the best care as they are able to offer their mother is provided.
52. Arguments have been made previously in this claim about the best interests of the appellant’s grandchildren. No submissions were made on this before us and there was no suggestion that the appeal would turn on this issue. The appellant does not care for her grandchildren. Whilst they may well benefit from her presence in the UK, that is not a factor which is sufficiently significant to render refusal disproportionate in light of the findings above.
53. We note the difficulties which this case causes were outlined by Underhill LJ in (albeit a different case on the facts because the appellant in that case was already in the UK). In Mobeen v Secretary of State for the Home Department [2021] EWCA Civ 886 Underhill LJ said,
“78. I have every sympathy with the Appellant's wish, and that of her children, that she should be able to live permanently in this country now that she is widowed and all her children are settled here – and all the more so now that she has a grandchild. I do not find it difficult to accept that if she has to return to Pakistan she will miss them very much. But I am afraid that that is not the test. When people from overseas choose to make a life in the UK they are not entitled to expect that they will later be able to bring their parents to join them. The Government has decided as a matter of considered policy that that right should generally be restricted to cases satisfying the strict criteria set out in the sections denoted EC-DR and ILR-DR under Appendix FM to the Immigration Rules; and in Britcits this Court has found that policy to be legitimate.”
54. Whilst it plays no part in our decision, we note too that Ms N Shabbir states that her husband lives and works in Bharain and that he does not see her or their children except for after 6 monthly intervals as he works in Bahrain. That perhaps is indicative of how difficult family life decisions are already being made by this family in terms of their efforts to ensure they see each other in the best way possible across the continents. It reflects the difficult choices which have to be made.
55. We have sympathy for the situation that the appellant finds herself in. We conclude that the Immigration Rules are not met. We also conclude that refusal of entry clearance would not result in unjustifiably harsh consequences for the appellant or her family.

NOTICE OF DECISION
The decision of the First-tier Tribunal contained a material error of law.
We remake the decision. We dismiss the appellant’s appeal.

J. SMEATON

Deputy Judge of the Upper Tribunal
Immigration and Asylum Chamber

10 June 2025