Q, Re (A child) (Skull Fracture: Proportionality)

These are care proceedings concerning Q (aged 7 years) following the death of his sibling R in 2024. R was two years and two months old at the time of his death.

The mother is PW, and the father is CS. Q is in foster care subject to an interim care order.

The Local Authority, Sandwell Metropolitan Borough Council (“the LA”) were represented by Matthew Maynard. PW was represented by Louise Higgins, CS was represented by Nicola Brown, and the Guardian was represented by Elisabeth Richards. Just before the hearing PW decided to dispense with Ms Higgins’ services. It appeared that PW was going to have to represent herself, so I gave her time to read the LA’s Opening Note. However, very helpfully, PW’s instructing solicitor Rachel Vickers offered to represent her, albeit remotely by video link. Given the limited matters in issue at the hearing I determined that this would appropriately protect the PW’s interests.

The case was concluded at the Issues Resolution Hearing (“IRH”). Agreement was largely reached on threshold, with the LA withdrawing the allegation that the parents inflicted a skull fracture and associated injuries suffered by R, as explained below.

I decided it was appropriate to give a short judgment, despite the high level of agreement, because I had determined at an earlier hearing, with the full support of the LA, that it would not be proportionate or necessary to undertake a fact finding hearing into the circumstances of R’s death. However, should any Family Court (or equivalent) have to consider those circumstances for any future decision making, it may be useful for the reasons for the order being made in this case to be explained.

The parents have an older child — L. L was the subject of care proceedings commencing in 2011. She was made the subject of a care order and placed in foster care. Her foster carers were subsequently granted a Special Guardianship Order. The parents do not have contact with L. The advocates’ case summary details that L presented with a number of serious medical complications. The parents are recorded as struggling with substance misuse, domestic abuse and a dysfunctional lifestyle. The threshold criteria were found in those proceedings. L suffered significant harm.

The parents’ relationship continued and Q was born in 2017. While still unborn, he was placed on a child-in-need plan. Two months before his birth, a child protection plan was agreed in August 2017. He remained subject to child protection planning until May 2018, when he was stepped down to child in need.

This LA became aware of the family again in December 2020 following a referral from another local authority. A single assessment was undertaken. Q was identified as a child in need between April 2021 and April 2022, and again from September 2022 (when, along with R, both children were deemed children in need), concluding in January 2023. R was born in 2022. He suffered from a medical condition and was non-ambulant. The family was open to health services throughout 2024, but no referrals were made to the LA.

The health visiting and other clinical documentation provide a history of poor parental engagement and missed appointments, which was also a feature of the proceedings involving L. Although the health visiting service recorded on 1 May 2024 that it would follow up on home conditions, it is not immediately clear from the available documentation what, if anything, was done. Indeed, it appears that neither child received home visits in the months leading up to September 2024. I return to this issue at the end of this judgment.

In September 2024, emergency services received a 999 call from PW. R was reported to have stopped breathing. The Ambulance Service was dispatched and arrived on the scene. PW was performing CPR in the public hallway of the block of flats where the family lived. R received extensive paramedic assistance at the scene. The police arrived. PW initially refused to allow them entry, which is perhaps unsurprising given the state of the property. The home conditions, including the children’s bedroom, can only be described as utterly squalid. The most fitting description comes from the police documentation:

“Officers who had attended the home address describe the premises as filthy and verminous, there is hoarding and clutter throughout the premises, signs of alcohol use with empty bottles of alcohol in every room including the bathroom. There was no bedding on the beds, which were seen to be dirty covered on what appears to be faeces and old decaying food. There does not appear to be a clear area where R would be able sleep safely and hygienically. It was noted that there were methadone bottles about the premises, one of which was on the floor and accessible to the children.”

I have watched the bodyworn video footage taken by the Police and the state of the flat is appalling, even by the standards of many of the cases that come before this Court.

R was taken to hospital. Despite the clinical team’s efforts, R’s condition did not improve. He died when life support was withdrawn.

The parents were arrested and interviewed. They were released under bail conditions and continue to remain on bail. The investigation remains live and the Police made an application for a large number of the documents in these proceedings to be released to them, which I acceded to.

The first hearing in these proceedings took place on 23 September 2024. Subsequently, additional disclosure was received from the police and the experts involved in the ongoing criminal investigation. I need do no more than broadly summarise the medical evidence. Professor Freemont (Osteoarticular Pathologist) concludes:

Dr Malcomson (Consultant Paediatric and Perinatal Pathologist) concludes:

Both experts raise the possibility that additional evidence from a neuropathologist could inform their conclusions. Toxicology results are also now available, indicating that no substances were identified in R’s blood sample. Various substances were detected in both parental samples. It was hoped that Dr Du Plessis's neuropathological report would have been available however it remains outstanding.

Neither parent has provided an explanation for R's injuries. R was non-ambulant and confined to a wheelchair. This makes the absence of an explanation from the parents particularly forensically significant.

The Police have informed the LA that the following additional experts are to be engaged and their opinions are pending:

In the light of these timings, and the need for stability and certainty for Q going forward, I determined that it was not necessary or proportionate to hold a fact finding hearing.

By the time of the IRH CS filed his final evidence and final threshold response, both dated 16 May 2025. PW has not filed or served any final evidence or a response to threshold. It was apparent that her solicitors had struggled to obtain instructions.

The LA threshold document sets out a series of allegations which can be categorised as follows:

CS acknowledges that the threshold for the making of public law orders is met. In his response document, he does not contest the medical evidence regarding the abrasions to R’s head, his intracranial injuries, and intraocular injuries. He denies inflicting any injury on R and claims he has no knowledge of PW doing so. He accepts the pleading as to neglect entirely, except he asserts that he was not responsible for either the methadone bottle or the “spice” found in the bedroom. He denies having poor parental engagement with professional services. He acknowledges long-standing substance misuse issues as they pertain to him. He accepts that the threshold was met in the previous proceedings, although he denies some of the details. The existence of that threshold is self-evident. He denies any failure to protect.

PW has not responded to threshold. However on the basis of Ms Vicker’s submissions on instructions, PW does not deny the fact of any of the injuries nor the state of the property. She accepts that threshold is crossed. She accepted historic alcohol use and that she had been on a methadone script. However, she denied any current substance abuse. I note that PW failed to comply with the order for drug testing. I do not make any inferences from that, but it is a matter of record which is relevant for any future determinations.

The LA submits that the existence of a skull fracture in a non-ambulant child, with no history provided by the parents that could account for such an injury, must amount to significant harm attributable to the care given to the child and not being care that it would be reasonable for a parent to give. I agree. However, R got the injuries, in these circumstances they must amount to significant harm.

The digital forensic analysis has revealed several forensically significant web searches conducted by PW in the days and weeks leading up to R’s death, including:

These phone records are a matter of record/fact. I take the view it is appropriate to set them out in this judgment even though PW did not give oral evidence and was not questioned about them. She has not made a statement in the proceedings seeking to set them into any context.

Both parents sought assessments to care. PW’s parenting assessment concludes negatively. PW failed to engage with the assessment and attended only three virtual sessions with the assessor. She withdrew from the assessment in February, asserting that her decision was linked to the Court's unwillingness to await the outcome of the criminal proceedings. PW’s attendance at contact has been poor, in the last two months being less than 50% attendance, although a small part of this may be attributable to the LA having to cancel contact. Importantly, I am told that PW has on a number of occasions failed to inform the LA when she could not attend contact, this has led to Q being upset and then dysregulated. I note that PW’s contact when it has happened has been positive and Q generally has enjoyed it.

CS managed to engage with the entirety of the parenting assessment. The outcome is negative, underscoring his longstanding substance issues, emotional and mental health, not to mention the circumstances surrounding R’s death. CS accepts this conclusion and acknowledges that he is unable to care for Q.

CS’s attendance at contact has been good, and his contact is reported to be a positive experience for Q. CS has been much better than PW at informing the LA when he cannot attend.

No kinship carers have been positively assessed.

The LA seek a final care order and the reasonably confident hope is that Q can stay with his current carers. Q is doing extremely well with those foster carers, with whom he has developed a strong bond. He is doing well at school, and the reports are that he is a much happier and more settled child than he was when he first came into foster care.

The only outstanding issue is contact. At the moment each parent has contact twice a week at a contact centre. The reports are that the Q enjoys contact, save when one of his parents fails to attend. He speaks positively about his parents, knows who they are and seems to look forward to seeing them.

The LA proposes a reduction in parental contact post-final order. The intention is to reduce contact down to once monthly, but to try to move it into the community so that it can take place more naturally.

In summary, the following sets out the position of the parties:

Threshold is undoubtedly crossed. I make the findings sought by the LA. R’s injuries are a matter of medical record and are not disputed. It is highly relevant that they happened to a non-ambulant child and therefore, whatever happened, he suffered significant harm, which must be attributable in some way to his carers.

The state of the premises was appalling and totally unfit for any child, let alone one suffering from a disability. The findings of neglect are therefore made out, simply from watching the bodyworn video.

The parents’ failure to engage with professionals is manifest from the health visitors statement and the chronology. On the face of it this is more attributable to PW, as she is the parent who seems to have taken responsibility for R’s appointments. CS appears to have taken little or no responsibility for engaging with professionals in the children’s care.

In respect of the substance misuse, this is accepted by CS. PW accepts historic alcohol misuse and being on a methadone script. She denies any present substance misuse but has refused to attend for drug testing, without giving any reason. Although I do not draw any adverse inference from this, it is yet another example of her refusing to engage with the process and with professionals and if these facts ever have to be revisited, that is a matter which will need very careful consideration.

The 2012 proceedings are a matter of record.

In respect of welfare there is no dispute that a care order should be made. I am delighted that Q is doing so well in foster care.

On contact, Q does seem to enjoy contact and it is largely positive for him. But both parents have struggled to manage the level of contact twice a week, and in any event that is too much contact for a long-term arrangement in foster care.

However, I accept Ms Brown’s submissions that this is a slightly unusual case in that the carers are supportive of contact and are very focused on what will help Q, and there is clear evidence of Q enjoying contact. It is important for Q’s identity, and so that he knows that he is loved by his parents that contact works well. The LA have agreed to keep the level of contact under close review and to retain an open mind as to whether it could be increased if that is in Q’s interests, having discussed it with the carers. I also think it would be good if the contact could move to the community, particularly during the summer months. It is critical that whatever contact is offered the parents prioritise getting to that contact.

I therefore accept the LA’s proposals for contact, but urge them to keep it under close review in discussion with the foster carers.