London Borough of Lewisham v SL & Anor

This matter concerns an application by the London Borough of Lewisham (‘the local authority’) for orders in the Court of Protection regarding SL, a 30 year old woman. The local authority is represented by Katharine Hampshire. SL lacks capacity to conduct these proceedings and is represented through her litigation friend, the Official Solicitor, who is represented by Alexis Hearnden. The other party is DL, SL’s mother, who is represented pro bono by Grainne Mellon and Sebastian Elgueta. The court is enormously grateful for them taking this case on. DL, the other parties and the court have greatly benefitted from their expertise and skill.

There is a large measure of agreement between the parties. It is agreed SL should remain living with her parents with the current level of support. DL and SL seek a pause of at least six months in assessing SL for and introducing SL to new placements due to the level of stress it is causing SL. Until the hearing started the local authority did not support that position but reflected on that as the oral evidence was given and now agree they would not introduce alternative placements to SL for a period of six months.

I heard oral evidence from GF, the allocated social worker, DL, SL’s mother, and Mr Caulfield, jointly instructed Independent Social Worker.

SL lives with her parents, DL and TL. She developed epilepsy in 2010 and it presents with a combination of absences, myoclonic jerks, and nocturnal motor fits. She experiences clusters of seizures and uncontrolled seizures. Although SL takes multiple anti-epileptic medications, her epilepsy remains poorly controlled. SL was diagnosed with atypical autism in 2011 by the CAMHS Neurodevelopmental Team.

In May 2011 SL was assessed as functioning within the mild to moderate range of intellectual impairment and moved to a specialist autism school in 2012. In early 2023 SL was diagnosed as having sleep apnoea. She was unable to tolerate using a CPAP machine and in May 2025 her tonsils and adenoids were removed (a first line treatment for sleep apnoea).

SL is a user of crack cocaine which has driven her significant history of absconding. She is extremely vulnerable when she absconds, and is classed by the police as a ‘high risk’ missing person. The absconding behaviour began in 2014 when she was 18 years old and has in recent years significantly increased (2021 - 27; 2022 – 47; 2023/2024 – 46 and so far this year – 9). When she absconds SL is exposed to significant risks of physical, emotional and sexual harm. There have been repeated allegations of serious sexual harm made to the police regarding SL and in June 2024 she had to be put in an induced coma for 18 days having absconded taken cocaine and suffered a seizure. SL has a care package at her parents’ home that provides a significant level of care, including 1:1 from 8pm – 8am.

When these proceedings commenced in June 2022 DL was unrepresented and the local authority application sought authorisation of SL’s deprivation of liberty at home due to concerns about SL’s absconding. DL had also requested respite care..

In late 2022/early 2023 Dr Rippon undertook a capacity assessment and concluded in February 2023 that SL lacked capacity to conduct the proceedings, make decision about residence, care and support, contact with others and consent to sexual relations.

In May 2023 the proceedings were allocated to a T3 judge. In Dr Rippon’s capacity assessment in November 2023 she concluded SL had capacity to have sexual relations and make decisions about contact with others.

In January and March 2024 SL had further hospital admissions regarding injuries sustained relating to her absconding.

In April 2024 the local authority considered SL should move from her parent’s home to a supported living placement, MC. This was supported by the Official Solicitor.

Between April – July 2024 a transition plan was proposed, starting with SL having respite care at MC following a familiarisation process with the staff from MC with SL. This plan did not proceed as planned as DL cancelled the service at the first visit and then SL had a hospital admission requiring her to be put in an induced coma for 18 days due to suffering seizures having absconded and taken class A drugs.

In July 2024 the local authority applied for urgent authorisation for SL to move from hospital to MC. In the end that could not take place as MC withdrew their offer of the placement. The local authority agreed to an additional care package to support a transition plan to MC and transition visits took place in August 2024 but SL refused to engage or visits were cancelled. In September 2024 SL absconded from MC when out in the community with her care worker. In early November 2024 SL further absconded from MC whilst on a respite stay.

In January 2025 the court ordered a further assessment from Dr Rippon and permission was given to instruct the Independent Social Worker, Mr Caulfield. In March 2025 MC withdrew its offer of a placement for respite or permanent care due to SL’s behaviour and the impact on the other residents at MC.

The matter was listed for a contested hearing in May 2025, that had to be adjourned as SL was admitted to hospital for her tonsils and adenoids to be removed. It was re-listed for a contested hearing on 20 – 22 October 2025, then adjourned again to this hearing on 20 and 21 November 2025.

Between May to October 2025 further appointments with SL were not attended (save for one at home with the allocated worker with Community Connections on 26 September 2025) and she continued to abscond at a high level and place herself at high risk of harm. In August 2025 SL was missing for four days and was taken to hospital after a phone call from a man who claimed a cupboard had fallen on her. Hospital staff did not believe that account, they suspected sexual assault and the man was arrested.

By the end of August 2025 the local authority had contacted 21 supported living providers, all had either declined to offer a place or had no suitable vacancy.

SL was discharged from hospital in early September 2025. She has enrolled at college and attends three times a week supported by her carers. SL met with Dr S and Ms A on 3 October 2025 and she now attends for therapeutic support.

SL absconded on 7 October 2025 whilst with her care workers on the way to college. She returned on 9 October 2025.

SL attended the hearing in October, listened to the oral evidence and was able to express her wishes directly to the court.

The current social worker, GF, has been allocated since 2023. She has filed detailed written evidence since then. In her most recent statements she confirms there are no concrete proposals for an alternative placement for the court to consider. In her statement she recognises the ‘need for a tailored respite solution that meets the needs of SL whilst providing meaningful relief to DL and TL in their caring roles’. She confirms the local authority will ‘fund the support provided by staff to SL during any respite arrangement. Associated costs such as food, travel and other incidentals would not be covered..’ She continues ‘The local authority will continue to assess available respite services, including revisiting the suitability of [named provider] and other providers…[the local authority] do not agree to explore whether respite could be organised with SL’s usual workers at an Airbnb or Caravan park to enable DL and TL to stay at home and receive respite from their caring role’ due to the level of risks involved, for example SL absconding in an area unfamiliar to her and the level of risk she would be exposed to in an unregulated environment, particularly in relation to absconding and to her health. GF outlined that the local authority provided a respite placement at MC where the arrangement consisted of short stays with the aim of transitioning to it being permanent placement. GF notes that despite the accommodation being available and funded over an extended time SL only went there on 7 occasions. SL presented with very challenging behaviour when she was at the placement. GF considers any day trips need to be risk assessed due to SL’s history of absconding.

GF has outlined the update on the support SL is receiving from the drug support organisation CGL. They undertook an assessment with SL in September 2025. CGL advised consideration of a professional meeting with the Mental Health Learning Disability Service run by South London and Maudsley Hospital and the Neurology Team at Guys and St Thomas NHS Foundation Trust to support care planning. GF reports that DL expressed to them that she feels that as she and her husband get older, SL may need to move to a residential care setting, and she is keen to ensure SL is familiar with such settings. CGL have provided harm minimization and advised that the CGL MDT will consider options for further support to be informed by discussions with CGL commissioners. They have agreed to offer a programme of harm minimisation relapse prevention for six weeks which started in October 2025. In addition SL will have a CGL keyworker who will review SL regularly for support, risk assessments and management, breath alcohol and urine drug screens and monitoring of mood and mental state. CGL requested SL’s GP for regular review of SL’s physical and mental health and further management as the GP deems appropriate. They have requested a recent summary of SL’s GP records and correspondence from SL’s neurology and mental health treatment providers and have confirmed that SL and her carers are aware of crisis options in the event of any deterioration in SL’s mental or physical health.

To date the local authority have looked for suitable placements through their arranging care team. To date they have been looking for ‘core and cluster type supported living placements and residential placements. SL requires ground floor accommodation or accommodation with a lift, because of risk of falls from seizures’. They have searched for services supporting people with autism, learning disability, challenging behaviours and staff who have experience of managing epilepsy. They have looked at areas close to where SL lives now. In her written statement GF states the local authority view is that SL is still likely to abscond whether she is near or far from her current home. They consider there may be a reduced risk of absconding if the area is not familiar to SL and state they would consider placement further away if SL liked it, visits with DL remained possible and the service was appropriate.

Although the local authority’s initial position was that there should be no pause in assessing SL for and introducing SL to new placements they have now reflected on the oral evidence and agree to a pause for six months.

GF summarised SL’s current care plan and Mr Caulfied notes in his report the provision of care and support is to:

There are two care providers, one that provides overnight care for 12 hours from 8pm to 8am and an additional seven hours 1:1 support at the weekend.

Another care provider provides 1:1 daytime support during the week for 25 hours to enable SL to access college or community activities safely. This support includes attending community education classes (SL is currently attending 3 days a week) and other social activities. This level of support is agreed to be proportionate and in SL’s best interests in supporting her physical and mental health, ensuring she takes her medication and helps her become more independent in managing her health and her personal care. The aim is to provide a more stable regime for SL and reduce the need for emergency services being called. It also seeks to reduce SL’s exploitation by others, help reduce her isolation and support her developing safer friendships. This care package will be reviewed annually. As regards deprivation of liberty exit doors are locked at all times for SL’s safety, access to the garden is via the support worker who will accompany SL into the garden and SL will be supervised 1:1 when she is in the community.

GF outlines in her most recent statement that the local authority is willing to provide direct payments to enable DL to make arrangements for respite at the rate it would cost the local authority to commission. GF outlines that this could include selecting a personal assistant or identifying someone known and familiar to SL. This arrangement has not been accepted by the family but GF confirms the local authority will continue to consult with DL about this option. SL will be engaged in this process by showing her photos or videos of the placement and visiting it. If SL expresses interest a transition plan will be developed in collaboration with her current support team, the family and the proposed provider. GF makes it clear that if required and the risks of harm remain high the local authority will keep under review whether to make an application to the Court of Protection with identified options, this would only be in the event of disagreement as to SL transitioning into an identified proposed placement that the local authority considers would meet SL’s best interests.

As regards the local authority plan going forward regarding the selection of placements after the pause for six months GF states the placements will be introduced in a ‘staged and person centred manner’ identifying potential placements based on SL’s care and support needs. The placements will first be visited by the social worker and then the provider will be invited to visit SL and DL to carry out their assessment to confirm whether they will be able to support SL.

In her written and oral evidence DL recognised that SL will need to live away from home in the long term due to DL’s and TL’s ages and health, together with the demands placed on them of SL living at home. She supports SL spreading her wings. Pending a suitable alternative placement being found DL considers it is in SL’s best interests to remain living with her parents with the current package of support. According to DL the difficulties she has found is that there has been no real filter applied by the local authority before looking at suitable placements, with the consequent stress that has caused to her and SL. That is not accepted by the local authority who feel there is an element of DL finding fault rather than looking at solutions. DL feels very strongly that there is less risk of SL absconding if she is occupied. DL secured SL attending XY, a community organisation that involved SL working with others and learning about gardening and other activities which SL enjoyed and benefitted from. SL has set out the interests she has and there is liaison, including with the care organisation that supports SL during the day, with Community Connections, which is the part of the local authority that assist in this type of community support. Currently XY consider the risks of having SL are too high but there is little evidence that looks at exploring ways round that. DL’s evidence was that if SL is engaged and occupied the risks of absconding reduce.

In her final statement DL makes the point that three years after first requesting respite there are still no arrangements in place. She considers the local authority evidence fails to actively look for solutions stating ‘I feel like the LA have not really tried to solve this problem rather just list why they can’t help’. Whilst she recognises there was an incident between SL and the staff at MC, DL considers whilst recognising its seriousness that was an isolated incident, it is not a consistent feature of SL’s general presentation and DL fears a more balanced picture is not being considered by the local authority. DL considers the risks caused by SL’s absconding needs to be considered holistically, the risks analysed in the context of being in an area known to SL and one that is not and the steps that can be taken to manage the risks. DL makes the point that TL is now 80 years old and is reluctant to leave the home. As DL says ‘It is a difficult situation for me. I don’t want to burn out and would like some respite. While we have carers some of the time now, I am still working a lot with [SL].’ DL’s evidence regarding direct payments was that nobody could be found to make that system work.

Mr Caulfield’s main report is dated 6 May 2025. It is a comprehensive report and should be read by anyone involved in SL’s care, either directly or indirectly. He met with SL on 28 April 2025. SL described what she enjoyed doing in the home and the community and was able to describe places she would like to visit and other activities she would like to do. She said she wanted to do volunteering, she had done that at XY and wanted to return there. SL acknowledged she needed to learn more about taking her medication and her personal hygiene and wanting to be more independent. When Mr Caulfield showed SL on his laptop examples of the type of placement he was asking SL about she was able to discuss those with him as well as her drug use, absconding and the serious risks she was exposed to.

In Mr Caulfield’s discussion with one of SL’s support workers she explained how long the process had been. She had been working with SL for some time before they left the home, then it was only with DL before SL would go out with the support worker on her own. As she observed ‘with SL it is a long process, things take time, because SL takes a lot of time to build trust and to get to know somebody. So, this is why I think the thing with [MC] is not so easy, because SL doesn’t know them like she knows us’. The support worker reported ‘SL needs consistency, so for instance, she’s going to [MC] and because of how they run, they don’t have consistent staff. But it would be good if they had one consistent staff when she comes on…’. In Mr Caulfield’s discussions with the psychologist who has worked with SL she stated that they didn’t ‘want to keep SL in a situation where she has so many restrictions, we want to support her develop her understanding, that she can have choices and she can make unwise decisions, if she is able to learn about some of the ways to keep herself safe. A ‘core and cluster’ model would be a model we could support her in’. She considers that in order for SL to ‘move on’ her family would need to commit to allowing SL to do so, continuing ‘I don’t think SL knows what she wants, this is all she has ever known. I don’t think the family are in a position to make a decision, they do it in a crisis, they say they don’t want SL to be there anymore and say they can’t carry on but I don’t think they recognise how restrictive it is or that respite was meant to be a temporary measure to support risk assessment and management but it’s been going on now for 3 years’. She made the following suggestion if SL remained at home ‘a positive change would be if the family were to agree to another provider going in with younger staff, removing the 1:1 support at night, as this is restrictive and was only supposed to be a temporary measure, that would change the environment. Environmental change has the potential to be positive but it all depends on what the family will be supportive of but I don’t think anything will change in the family home, in my view they won’t support any positive risk taking or changes’. It is her view that SL is someone who has the potential to be doing more with her life than she currently is and with less restrictions, providing SL and her family ‘buy in’ to change.

Mr Caulfield discussed the various options for SL with DL. One option discussed was whether the current carers could be involved in any placement, such as a core and cluster type, would DL support that as it would combine SL having her own accommodation but knowing the staff already. DL agreed that would be more successful for SL and also agreed with the suggestion of support staff known to SL being involved in any transition. However, DL did state that she is happy for SL to remain living at home. In his discussion with TL he informed Mr Caulfield that he would support respite taking place if SL remained at home and he and DL went out for the day or for 24 hours.

Mr Caulfield recommends there is greater involvement in ‘occupation, especially that which she has the opportunity to develop prosocial relationships outside of care staff and her family’ and ‘greater consideration is given to including SL in activities and occupation which align with her interests and may not be specialist in nature…volunteering in animal care, music groups and broader volunteering activities’. This would give more opportunities for SL to develop her confidence. Whilst Mr Caulfield considers SL places great emphasis on her family she also wishes to have more independence. He recognises, however, the need in the short term for restrictions due to the high level of risk SL is exposed to if she absconds. He highlights his discussion with SL support worker with her current carers and the supportive relationship she has been able to establish with SL. Whilst SL acknowledges the risks she is exposed to if she absconds and appears to be ‘impulsive and opportunistic, which markedly increases the risks to her…such absconding and associated substance misuse results in significant consequences for SL and the focus of any care package at this juncture must be providing a stable base, whereby such risks can be ameliorated and investigations and treatment surrounding her physical health can be undertaken.’ He continues that whilst he shares the concerns expressed by the psychologist regarding the enmeshed nature of SL’s relationship with her parents and also has a degree of concern as to how SL’s autonomy can be promoted further in the home environment, he did not consider a forcible move would resolve the issues and considers it would increase the risks. Having carefully analysed the considerations he concludes in his report that it is in SL’s best interests to remain living at home with the package of support. He also considers that respite with SL based in the family home is more likely to be successful due to the continuity of carers. Longer term he is satisfied that is it likely to be in SL’s best interests to live independently of her parents but it will need to be managed carefully and ideally in accordance with SL’s wishes and feelings. He considers ’a systemic approach in respect of SL’s care is likely to bring around greater change than the current approaches utilised, with greater emphasis placed upon working alongside the family as a whole’ thereby recognising the reality that SL’s family are the most important factor in SL’s life.

There is no issue in this case that SL lacks capacity to make the relevant decisions in accordance with ss1 – 3 Mental Capacity Act 2005 (‘MCA 2005’).

Consequently, the focus has been on whether the proposed residence and care is in her best interests in accordance with MCA 2005:

“1 The principles

(5)

An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

(6)

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

4 Best interests

(1)

In determining for the purposes of this Act what is in a person's best interests, the person making the determination must not make it merely on the basis of—

(a)

the person's age or appearance, or

(b)

a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests.

(2)

The person making the determination must consider all the relevant circumstances and, in particular, take the following steps.

(3)

He must consider–

(a)

whether it is likely that the person will at some time have capacity in relation to the matter in question, and

(b)

if it appears likely that he will, when that is likely to be.

(4)

He must, so far as reasonably practicable, permit and encourage the person to participate, or to improve his ability to participate, as fully as possible in any act done for him and any decision affecting him.

…

(6)

He must consider, so far as is reasonably ascertainable–

(a)

the person's past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity),

(b)

the beliefs and values that would be likely to influence his decision if he had capacity, and

(c)

the other factors that he would be likely to consider if he were able to do so.

(7)

He must take into account, if it is practicable and appropriate to consult them, the views of–

(a)

anyone named by the person as someone to be consulted on the matter in question or on matters of that kind,

(b)

anyone engaged in caring for the person or interested in his welfare

…

as to what would be in the person's best interests and, in particular, as to the matters mentioned in subsection (6).

…

(10)

“Life-sustaining treatment” means treatment which in the view of a person providing health care for the person concerned is necessary to sustain life.

(11)

"Relevant circumstances" are those—

(a)

of which the person making the determination is aware, and

(b)

which it would be reasonable to regard as relevant.”

SL’s best interests need to be considered within the statutory framework of the MCA 2005 and the MCA 2005 Code of Practice.

The relevant caselaw on best interests can be summarised as follows. In assessing best interests it encompasses medical, emotional, psychological and social issues. In the context of proposed medical treatment Baroness Hale in Aintree University Hospitals NHS Foundation Trust v James and others [2013] UKSC 67 at [39] and [45] stated decision makers must look at welfare [39] ‘…in the widest sense, not just medical but social and psychological; they must consider the nature of the medical treatment in question…they must try and put themselves in the place of the individual patient and ask what his attitude to the treatment is or would likely to be; and they must consult others who are looking after him or interested in his welfare, in particular for their view of what his attitude would be’. [45] ‘…The purpose of the best interests test is to consider matters from the patient’s point of view. That is not to say that his wishes must prevail, any more than those of a fully capable patient must prevail. We cannot always have what we want. Nor will it always be possible to ascertain what an incapable patient’s wishes are. Even if it is possible to determine what his views were in the past, they might well have changed in the light of the stresses and strains of his current predicament.’

All parties provided detailed position statements at the start of the hearing. By the time the evidence concluded there were no significant issues between the parties.

There is only one option on the table, for SL to remain living at home with the care package that is already in place. All parties agreed the proceedings should be concluded. There was broad agreement about the plan going forward.

These long running proceedings have been delayed by the evidential developments between hearings which has had the consequence each time of de-railing the careful plans that had been put in place at earlier hearings.

Some of the evidential developments have included accounts of the very serious risks SL is placed at when she absconds, and the damaging consequences for her of those events. Due to these events attempts to arrange respite care or any transition to SL being cared for away from home have not been successful. The evidential reality now is there is only one option for SL, for her to remain living at home with the comprehensive package of care that is in place. No party disagrees with that and Mr Caulfield supports it as being in SL’s best interests.

Whilst the longer term plan is to carry on looking for alternative placements the parties agree there should be a six month pause in assessing SL for and introducing SL to new placements. This will enable the family to have a break and for SL to have the best opportunity to build on the early signs of recent stability.

It is recognised there remains risks to SL by her continuing to live at home. The care package that is in place ameliorates those risks and that continued placement, at least in the short to medium term, is supported by the evidence, including of the jointly instructed Independent Social Worker, whose evidence I accept.

I agree that the even with the risks of further absconding that have been identified, in the short to medium term SL remaining living at home with her current care package is in her best interests for the reasons identified in Mr Caulfield’s report. It accords with her wishes, and she remains in a familiar environment with carers who are well known to her. It is recognised the strain this places on DL and TL and a respite package has still not been finalised. That should be prioritised. There remains the ongoing concern that SL appears over dependent on her family. Social work support and planning requires more focus on supporting SL becoming more independent and practical steps taken so she can engage with people who are closer to her own age.

Whilst there is this large measure of agreement the evidence has demonstrated, in my judgment, an element of drift in the care planning for SL. The court recognises it has been a dynamic situation that has been difficult to manage. However, with the conclusion of these proceedings and the care package relatively stable the court expects there to be a renewed focus and proactive planning by the local authority in the following areas:

It is hoped that with this revised approach regarding SL’s care and the search for future placements together within a period of relatively stability with SL engaging in college, the support from CGL and receiving therapeutic support SL’s wider and longer term best interests will be met. The courts concern is that without this foundation work being undertaken SL’s current placement will remain under pressure, fragile and at risk of an emergency breakdown.