Amy (Scope of Fact Finding), Re

In this judgment I answer the question raised by the parties: Is there a need for a fact-finding hearing in order to fairly and properly determine these proceedings? Both applicant local authority (“the LA”) and child’s guardian (“the CG”) answer this question in the affirmative. They seek directions for the appointment of appropriate experts and a timetable towards fact finding. In contrast the child’s mother, Ella, answers the question in the negative and seeks for this case to continue on its existing timetable towards IRH on 4 July 2025.

In coming to a decision, I have considered the papers contained within the hearing bundle, supplementary bundle and Coroner’s Inquest bundle; the skeleton arguments filed on behalf of each party, and the high quality and focused oral submissions made by respective counsel at the listed hearing. I have borne all of this information in mind in reaching my decision whether or not I directly reference it within this judgment. This is a case management decision of sufficient significance to warrant a considered determination. I indicated I would reserve judgment and provide a written explanation of my decision as I now do.

It is likely this judgment will be published. The names used in this judgment are not the real names of any of the individuals touched by the judgment. It should not be assumed the gender of the children follow the genders implied by the names. I have taken care to avoid identifying details without removing information key to understanding. In my view this is a paradigm case for publication having regard to the need for transparency. I note I made a Transparency Order in this case at the first interim care hearing.

The relevant background to this case can be summarised relatively briefly. At the start of this year Ella gave birth to Amy. Ella is [ ] years of age. In 2018 when she was herself a child and had just turned [ ] she had a child, Peter. Very sadly, Peter died at about 5 months of age in late 2018. The circumstances of Peter’s death constitute the dispute before me. The parties disagree as to whether the circumstances surrounding, and the likely cause of Peter’s death need to be determined, and particularly does Ella bear responsibility for this death, it not being suggested any other individual might fall into a pool of potential perpetrators.

In 2018, and at the time of Peter’s death, Ella was subject to a care order and was living with a family member. Ella had been assessed in a residential unit. The case concerns included drug use, her decision making and her ability to meet and prioritise Peter’s needs. One month prior to Peter’s death Ella left the unit and moved into the family home. Ella’s assessment was negative but the family member had a positive connected person assessment. In the following month Peter was found unresponsive. Despite best efforts Peter could not be saved and died the next day. Following Peter’s death there was a police investigation and later a coronial inquest. The police investigation commenced in 2020 and concluded in late 2022 with no further action being taken against Ella. The coronial inquest concluded with an Open Verdict with cause of death being given as a Head Injury. I have also seen the contents of a Serious Case Review undertaken following Peter’s death.

Following Amy’s birth, the LA had concerns for the care Amy might receive. The concerns related to ongoing issues around drug use on the part of Ella and the impact the same might have on her parenting together with concerns around her mental health needs. They issued proceedings following Amy’s birth. Their initial application did not include detail as to Peter’s death being relied upon and as a result I refused an urgent care hearing. The LA then submitted an updated interim threshold adding the concern arising out of this feature and the issue was reconsidered and listed. At that interim hearing those acting for Ella raised criticism of the failure of the LA to engage in any meaningful pre-proceedings work notwithstanding Ella’s (and their) early encouragement of the same.

I heard the interim care hearing on 23 January 2025. I made an interim care order with a plan of residential assessment. That assessment has now concluded with a final report. I heard the CMH on 10 February 2025 and I gave parallel directions (a) through to the IRH noted above, and (b) in relation to further consideration of fact finding. As to the general case management it appears that all directions have been complied with (drug testing with equivocal results as to cannabis); a psychiatric assessment of Ella, and the parenting assessment as above) or will shortly be completed (connected person assessments of two family members). Those directions are now approaching the point of filing of final evidence followed by IRH. As to the fact-finding case management the process has shifted somewhat during the proceedings. At the CMH it was the guardian who was seeking the instruction of a paediatric neurosurgeon to advise as the circumstances surrounding Peter’s death. This was sought to inform the question of whether a fact-finding hearing should be sought not as part of directions towards a fact-finding hearing. The LA indicated their support for this course of action which was opposed by Ella. I sought and was authorised to hear this issue sitting as a s9 Judge, gave directions and listed the same for hearing on 18 March 2025. On 18 March 2025, the parties appeared before me and the position shifted. The LA indicated they wished to proceed with fact-finding without the need for a preliminary report from the expert. They sought case management directions towards fact-finding albeit they were not in a position to ask the Court to give directions at the hearing in the absence of appropriate Part 25 applications or information. The CG fell in line with this. Ella’s position was that a fact-finding hearing was not required. I fixed a hearing to determine this dispute.

The question as to whether a Court should hold a fact-finding hearing is a matter of case management. There is no doubt the Court has the case management power to refuse a fact-finding hearing. The task for the Court when considering the need for fact-finding within public law proceedings is as to whether it is ‘right and necessary’ to conduct the hearing. In seeking the answer, I reference the following authorities:

I have regard to the Overriding Objective found in Part 1 Family Procedure Rules 2010. Pursuant to this the Court must deal with a case justly, having regard to any welfare issues involved. Dealing with a case justly includes, as far as is practicable:

In Oxfordshire McFarlane J. identified the following list of matters as being relevant to any decision as to the need for a fact-finding hearing:

In H-D-H the Court of Appeal observed (Peter Jackson LJ):

In H-W the Court of Appeal (Baker LJ.) added:

I was also referred to recent Guidance from the President of the Family Division relating to the need for a refocus on the underlying principles of the PLO including making cases smaller and reinforcing the requirement, not aspiration, of achieving completion of cases within 26 weeks. The observations of Peter Jackson LJ. in H-D-Hat [14] address this point notwithstanding time has moved on.

I remind myself of the observations from H-D-H:

I tackle many of the submissions made under this heading at [27-37] below. I also deal with the impact of investigating the matter on the welfare of the child elsewhere within this judgment.

The LA raise points as to the legitimate interest Amy has in having this issue answered. It points to the likely impact on Amy were there to be an ultimate placement for adoption without this being determined and question how this might make Amy feel. I do not follow this logic. Were Amy placed for adoption without this issue having been resolved then by definition the basis for placement would of itself be sufficient to mean nothing else would do. In such circumstances I struggle to see why Amy would be looking back to question why a fact-finding had not been undertaken, given it would not have contributed to the finding that nothing else would do. For the avoidance of doubt the LA do not submit that adoption is more likely simply as a result of there being no fact-finding. It is difficult to see how such an argument could be maintained.

They also question the impact on Amy were this not to be determined only for Amy to later come to harm in Ella’s care. I do not consider this a weighty point. Whilst this cannot be ruled out as a possibility it is equally balanced by the likelihood of Amy questioning a removal from Ella based upon events that occurred in Ella’s own childhood. Unless the LA are setting this in the context of Amy being ‘shaken’ as a speculative potential then it is difficult to view this point as being anything other than highly speculative. It would in my assessment require a much higher prospect of the eventuality to justify the costs and delay mentioned elsewhere in this judgment. I can see circumstances such as seen in H-Was making out such a point. It is easier to posit a subsequently sexually abused child questioning why an allegation of sexual abuse was not investigated to spare them the ordeal they suffered than to apply it to the facts before me.

It is suggested Amy has an interest in knowing the truth of what happened to Peter. Whilst this has a degree of weight in any assessment I do not consider it carries such force on the facts of this case. Realistically, were a finding to be pursued and made and were ultimately Amy to remain with Ella then I am confident the narrative in the home would not be that of the fact finding. If Amy were removed from Ella then, see elsewhere in this judgment, that would likely arise from other factors. In such circumstances I question why Amy’s welfare would require Amy to understand what the Court had determined happened to Peter. I also doubt the relative importance to Amy of knowing throughout childhood what the Court made of Ella’s actions when she was herself a child and self-evidently on any case at a very different time in her life.

This is a troubling aspect of the application. The parties agree about that whilst disagreeing as to the weight that should attach to the point when determining whether a fact-finding process should be undertaken. The case is now in week 17 with the evidence gathered permitting the LA to prepare and file its final evidence. The IRH date remains valid and is set within the PLO timetable. If fact-finding proceeds there will be a very lengthy delay to the case. I was told that the proposed paediatric neurosurgeon would not be able to report to November 2025, unless instructed at a higher rate, with no certainty that such a rate would be approved by the Legal aid Agency. This would then potentially be followed by a report from an instructed Paediatrician, an experts’ meeting and then fact-finding. It was suggested a 10-day listing would be required. Pulling together these threads one would likely expect a fact-finding hearing to be listed into 2026 and there is the potential at least of the case being delayed for close to a year by the time of an eventual post-fact-finding IRH.

There are factors that might reduce this period but there are also other complicating points. I made clear that were this to proceed before me without other complications then I could offer dates in September 2025. However, this does not address the actual expert availability or the complications and delay that may additionally arise from the fact that neither proposed expert works within LAA rates. There is a potential for the parties to have to proceed under the schema set in the recent case of Re K & Re S (Legal Aid: Experts Fees) [2025] EWFC 100 with the possibility of real delay from the same. Further, whilst I have authority to manage this case, the question of determining an actual finding if it is pursued has not been released to me at this time. It may be an effective fact-finding would need be heard in the High Court with potential additional delay.

By its very nature this is harmful to Amy. The provisions of the PLO and section 1(2) of the Children Act are a constant reminder that delay is inimical to the welfare of a child. Here the delay would be very significant and plainly damaging. In addition, as I address below one must be mindful of the impact of the delay on others and Ella in particular. One should not lose sight of the potential for the proceedings at some point to become so overwhelming in their own right that they impact on Ella in a manner which would not have arisen but for the proceedings continuing. It would be a matter of real concern were Amy’s prospect of placement with Ella reduced or lost as a result of delay in the proceedings undermining the care being given by her. Whilst proceedings are of their very nature a stressor which provides information as to the capacity of a parent to manage stress that is not a rationale for continuing the same unduly to further test a parent.

Yet some issues are so significant and so requiring of determination that delay, and even significant delay, has to be countenanced. It is difficult to conceive of circumstances in which a question of fact-finding that needed to be answered to ensure the child was safe would not be pursued simply because of delay. In cases such as H-Wone can see the Court of Appeal recognising this tension but accepting that notwithstanding the impact of delay a factual matrix needs to be obtained. In such cases the duty is on the Court to keep this delay to the minimum and manage the consequences of the delay in a child focused manner. In my assessment the extent of ‘acceptable’ delay will be correlated with the seriousness of the matter under consideration. The more serious the allegation, the more serious will be the implications for the child of it not being determined and the more extensive may be the accepted delay to enable clarity.

My conclusion is that this point will carry some weight in any assessment and in a balanced case may tip the decision but is unlikely to shift a conclusion which is firmly balanced in favour of fact finding. In this case the delay would be significant and so I judge the grounds for fact-finding must be clear and compelling. In this regard my analysis is closer to the logic of the LA analysis, however I address elsewhere the question of necessity of the fact-finding which is what permits the LA analysis to accept the significant likely delay.

A fact-finding of this nature will be a costly matter. A number of experts will be appointed, senior counsel will be instructed and a significant time estimate is likely. The Part 25 applications reference a neurosurgeon and paediatrician but the LA also seek to rely upon the expert witnesses who reported within the coronial process. I accept that many if not all of these will likely need to be examined. I consider a time estimate of around 10 days is not obviously excessive. This is valuable Court time that will be lost to other court users for whom their case is as important, if not more important, than the case before me. Yet this is the consequence of many fact-finding hearings of this nature. In my experience in nearly all ‘shaking cases’ there are around 4 expert witnesses and whilst all may not be required for live evidence the case will normally extend into a second week. Further, this is a category of work which justifies senior counsel with the additional expense this brings. It is difficult to assess at this point whether the time since the event in question and the impact this has on evidence will shorten or extend any hearing. In my assessment as with the delay point this consideration and the acceptability of high cost will be correlated with the seriousness of the allegation and the necessity for it to be determined before the life of the family can properly move on. But, I do not consider this is a point which pushes me against fact-finding if the same is justified on an objective basis in its own right.

The point is made that any finding may have broader relevance. Consideration will often be had to other children whose welfare may be assessed in the knowledge of a finding. Of course, time does not stand still and Ella may go on to have further children. The LA make the separate point that it is in the public interest to ascertain what happened to Peter. The CG has provided a detailed review of the evidence on which the LA rely. I accept the basic proposition that the LA has provided the foundation of a case to put before the Court. This could not be said to be a fanciful or spurious allegation. It has a meaningful foundation. One can see this foundation clearly set within the coronial review. I bear this in mind and reflect upon this point elsewhere within the analysis. Ella addresses points which fit within this heading but also fit elsewhere (i.e. necessity) and I consider those points in the other sections.

I accept the principled points noted above. But at this point in time there are no other children of relevance in respect of whom any finding would have immediate relevance. This is not a case where third parties are caught by the allegation and need closure. Further, were Ella to have children in the future then the need for determination to inform their care planning would plainly be no greater than the need Amy has for the same. Were I to determine Amy did not require this determination then it is difficult to understand on what basis a child in the future would. Finally, whilst I pay appropriate regard to the public interest in ascertaining what happened to Peter I also reflect on the fact of the police investigation and the conclusion of the same and the coronial process. I am not of the view the public interest is as engaged as suggested in the arguments.

On the facts of this case these two points are so closely entwined so as to justify treating them together. In my assessment the conclusions that are drawn with respect to these categories will lie at the heart of my conclusions and will likely point me in the direction I should take. By its very description, a conclusion that something is necessary will mean a fact-finding will likely follow. A finding which would or be likely to identify an existing and continuing risk of a material/significant nature and, which without fact-finding determination, could not be properly brought into the process of risk assessment, will in my assessment almost always require adjudication by way of fact-finding hearing. To fail to do so would mean any care planning would be structured without regard to the risk leaving the subject child at risk of harm. In such a case the care planning would be materially changed from what it would otherwise have been had a finding not been made, as per H-W:

The question for me in this analysis is as to whether the care planning for Amy would in fact or in all likelihood be materially different by reason of the Court finding that some 7 years previously and whilst herself a child Ella acted in a manner which led to the death of Peter? The LA submits there is current evidence of Ella acting impulsively and this supports the argument for fact-finding for the reasons I set out below. I acknowledge there is a challenge to this argument but for the purpose of this analysis I intend to proceed on the basis that this argument is established.

The LA argue the fact-finding issue will cause the Court to consider historic circumstances in which Ella may well have acted in an impulsive manner in the moment and without consideration or regard for Peter’s welfare. The LA argue this characteristic or quality of impulsivity is a continuing feature of the Ella’s life and presentation and as such there is a need to examine the circumstances in which this has played out in the past and the consequences with regards to Peter. In making this argument the LA join the dots between 2018 and 2025 with the end of this process being a submission that the Court has to fact-find to determine the parameters of the risk that can both theoretically flow from and will in fact have been shown to flow from Ella’s poor impulse control.

But is this confused thinking as submitted on behalf of Ella? Does this approach wrongly look at the outcome of the identified risk rather than the risk itself? Is the risk under consideration the impulsive behaviour not the suggested ‘shaking’ and is any risk assessment the means and route towards managing the same rather than a focus on preventing a further risk of ‘shaking’. In this context is it relevant indeed helpful to become fixated on how circumstances might play out in the event of an impulsive action? By its very nature, the outcome of the same is bound to be unpredictable and variable and a likely function of the surrounding circumstances at the time of any action. In what way does it materially help care planning to reach a conclusion on what happened in one situation of impulsive action or loss of control many years before? Surely the relevant point is that a impulse-related safety issue might arise rather than focus on what the likely outcome will be in such a case. Indeed, it may be that to focus on an individually identified outcome might distract from the broader and perhaps more likely risks flowing from impulsivity. Ella’s submission is to acknowledge that a finding of impulsivity by its nature requires risk assessment when considering care of a young child but that the format of the risk assessment and the resultant care planning does not require the clear definition of the outcome or outcomes that might follow from the same.

The distinction with the circumstances in H-W assist in making this point. In H-W the risk was of sexual abuse. The Court needed to know whether a person had acted in a sexually abusive manner towardsa child before anyone could assess whether the same person could protect the child against sexual abuse. The risk and the outcome (allegation) were closely associated and thus the finding was required. Here the outcome is one of a number of outcomes that constitute the category ‘what could happen’ if the risk (impulsive behaviour) materialised. Safety planning requires consideration of the category of risk rather than a close focus on a single example within the category. In reality if an outcome occurs there is no reason to believe it will be the same outcome.

It is important to note that this analysis has reflected the submissions in the case around a likely finding of a ‘shaking’ (more formally a rapid acceleration/deceleration mechanism) event occurring during a loss of control in an impulsive moment without proper consideration and reflection. This is why the LA focuses on the point as to poor impulse control. Of course, a ‘shaking’ event might be associated with a more malicious act conducted in bad faith which could include actions with a sadistic or similar motivation. Plainly that would fall far outside of the category of impulsive behaviour referenced above. However, it seems clear to me that no party in this case envisages the likely pursuit, let alone finding of such a nature. Given the passage of time and the available information (considered by both Police and Coroner) there really is scant basis for proceeding on the basis that the Court might reach a conclusion of such a character. There are very strong grounds for holding that any finding in this case would likely recognise the event as being one of temporary loss of control.

I recognise it is not for this Court to attempt a mini trial on the evidence available as one does not know what the totality of evidence would be should a fact finding be undertaken. I have proceeded above on the basis that a finding were made but within a likely context of a loss of control in the moment rather than a more sustained or malicious action. I do not consider this to amount to a quasi-mini trial given it appears to reflect entirely the issues of risk before me by those seeking a fact-finding and also gives regards to the real challenges in a detailed assessment beyond that which we already know of events which occurred such a time ago. It is most likely the evidence received will closely follow that which was laid down in subequent years.

I have stepped back and reflected on this point with care. I consider it is likely to rest centrally within any conclusions I reach. I have taken the view that it is better to proceed on the assumption the LA will make out a case of Ella being responsible for the matters alleged although I have caveated that in the manner set out above. It is only by doing this that I have been able to properly assess the impact the same will have on care planning and risk assessment. In doing so I have struggled to identify why the care planning and risk assessment will materially change as a result of this finding being made. I made this enquiry of the LA. Reference was made as to the potential for an adoptive outcome and I questioned as to how the LA’s case, which would not otherwise support adoption, could become one of adoption as a result of a finding as to events occurring almost certainly in mere seconds, many years ago when Ella was herself a child. For my part I remain unable to conceive of circumstances that would permit this marked change of direction. Whilst the case put before the Court might be for placement I cannot see that this will have been set by any fact-finding.

I accept that for those working with Ella in the future or those planning their ability to work with Ella in the future, that an answer to questions of this sort are bound to be helpful. By definition such a conclusion will provide a Court based determination on balance of probability. But I do not understand why those working in such a setting would be unable to bring into their care and safety planning the prospect of a range of risk outcomes including that which would be subject to fact-finding. I consider, and agree with those acting for Ella, that the risk planning is focused on what it is that causes risk (here impulsivity). The question of how that might play out should not be limited only to those outcomes which have been established to have previously arisen as a result. Any such risk planning would be short sighted in the extreme. Rather the risk planning would take a broader approach in its evaluation of the best way to manage risk. Put simply it is most unlikely any care planning would be structured simply to guard against a future risk of ‘shaking’ given any future risk would on balance likely arise in a different way. But risk planning would be able to have regard to risks including loss of control and conduct towards the child, including by ‘shaking’ without such a finding being made.

An obvious question was as to how the current assessment has been able to conclude (as it has) without this issue being determined. I consider the LA did not have an answer to this and I judge this is the case because there is no answer that sits comfortably with the argument of need for fact-finding. The LA did reference points in the assessment which note the fact the issue had not been determined but the assessment did not restrict its ability to provide a conclusion without the same being determined.

There is significant strength in the point that any assessment of current risk and the planning to mitigate the same is bound to be focused on and assisted by the existing evidence of current care informed by other available expert evidence, available network support and other present matters than it would be by the circumstances pertaining at the time of Peter’s death. Ella makes the point that as at 17 April 2025 she was being told the professional view was that she was to return into the community supported by her family. Whilst, positioning has changed due to perceived difficulties arising since, it is very hard to reconcile this planning with the continuing need for the Court to undertake fact-finding to inform safety planning and risk assessment. Viewed in this way there is a fundamental question as to the extent to which any fact-finding will in fact take the case forward.

The parties have focused on the impact the process will have on Ella irrespective of the ultimate finding made by the Court. Peter’s death has profoundly impacted Ella. I do not lose sight of the fact she was already fragile at that time as a result of her life experiences. She has subsequently experienced both the police investigation and the coronial process. It must be the case that the delays associated with the same (extending for some 4 years) will have made it very difficult for her to move on in any emotional sense. To now have to relive all of this through fact-finding, and to do so with the back drop of the threat of losing care of Amy will impact her at a very significant level. But, to an extent this is an inevitable consequence of any fact finding of a serious nature. Such a process will bring to any participating parent many of the emotions set out above. Yet this is not a justification for not holding a fact-finding where one is necessary. In making this point I do not seek to diminish the impact of these events on Ella. In such circumstances the Court should manage the case with care and in a humane and sensitive fashion. It would expect the representatives to condition their approach to reflect these issues. This would not remove the impact but it would be hoped to mitigate it. Still, the point can be made as to the utility of taking such an approach with such an obvious impact unless it can be shown to be truly necessary. In my assessment this feature is one that requires the Court and those parties seeking fact-finding, to reflect with care when reaching their conclusions. But if the conclusion is that fact-finding is necessary to safeguard the welfare of the child of for some other pressing reason then this factor is likely to impact on the management of the fact-finding rather than the holding of a fact-finding in principle.

In this case the LA benefits from the fact its evidence has been captured and preserved in the expert evidence for and from the coronial process. This would be supplemented by the further expert evidence which would itself be based on the preserved artefacts or existing records. In that regard the passage of time may not have a material impact. It may therefore be thought the LA can have a fair hearing. However, this is not without challenges. One of the coronial experts has subsequently been subject to criticism in the High Court and is unwilling to take on the role of an expert in this case. This witness has a central role in any conclusions reached both as to his own opinion but in shaping the opinion of another expert who was somewhat equivocal as to the ability to identify cause of death. Those acting for Ella highlight the importance of the witness and point to the limited written account available to support his conclusions. They would wish to robustly challenge his evidence which might have a profound impact on the evidence more generally. But he will have to be summonsed and would not be a willing witness. He could not be converted into a Part 25 witness and could not play a role in any experts meeting or be subjected to Part 25 questions. It is a matter of speculation as to how this will in fact play out. It is a concern uncertainty exists in regard to such an important witness. There is also some doubt as to the extent of historic material that might be available for further or additional expert assessment. Should the Paediatrician for example suggest the need for genetic testing then it is unclear whether the material is actually available to complete this process. I can only question what the consequence for the fact-finding process would be were this to be the case – i.e. a reasoned area of possible doubt that could not be addressed.

Finally, one needs to contrast the crystallised nature of the LA evidence in contrast to that available to Ella. As noted, we are 7 years on and memories will have faded or been consciously put to one side. Ella was at the time a child herself and suffered bereavement as a result. It is a legitimate point to make that she may have compartmentalised her recollection of these events and they may no longer be reliably available. The same might be said for witnesses within her family that she may wish to call. The Court is always required to have regard to the wide canvas surrounding the events but to what extent will this consideration be hampered by the passage of time? In analysing this point I bear in mind there will be some preserved accounts found within any police investigation. But I note this was not undertaken immediately following Peter’s death and it is difficult to quantify the extent to which this may fill the gap left by the points noted above. The danger as far as a fair hearing is concerned is that the LA bringing the case may be unhampered by the passage of the time whereas Ella facing the allegation is. I do not agree this point is addressed by the fact Ella will have highly experienced counsel or through special measures whilst I accept both of these points will be of assistance. No amount of special measures or quality representative can address gaps in the evidence caused by the impact of the passage of time. In this regard I note the submission of the CG that:

The CG references Ella’s sense that she is being judged on the basis of what happened to Peter without any finding having been made. This argues the CG supports a fact-finding being pursued to put the question to bed. Ella argues the justice of the case points against fact-finding. This aspect of the assessment does allow me to stand back and reflect on the overriding objective of dealing with the case justly. I can reflect on other avenues that might have been taken or may still be taken. I can reflect on whether without this fact-finding the true gravity of the case can be understood. I note the interests of justice have been considered in the coronial process and the criminal process. We are now 7 years on and it may be questionable as to whether any decision reached by me would cause a reappraisal of the charging decision. I also bear in mind that the allegation in this case does not relate to Amy and as such there is not a separate interest in this being resolved for Amy’s benefit so that Amy can understand what happened.

In summary the LA argues; (a) the degree of risk posed to Amy is of a different order if Ella caused the death of Peter; (b) the nature of the risk posed to Amy is different if Ella caused the death of Peter; (c) an assessment of whether Ella is able to provide safe and good enough care to Amy can only be meaningfully conducted from a perspective of clarity about this significant disputed fact; (d) an assessment of whether Ella’s parenting capacity is amenable to support and services or protective measures can also only be meaningfully conducted from a perspective of clarity about this significant disputed fact; (e) the police did not proceed to a prosecution. The coroner’s verdict was that Peter died as a result of a head injury but it was not the coroner’s function to identify a perpetrator. The reality is that none of the investigations which have gone before have demonstrated conclusively, or even on the balance of probabilities, that Ella did not cause Peter’s death (my emphasis); (f) this is an unsatisfactory and unsafe premise for the agencies tasked with child protection. This issue is going to continue to impact upon Ella, any child she may bear or have the care of and any household in which she resides where there are children.

For reasons which can be found within my detailed analysis above I do not agree with the points made and I have reached the conclusion, after a careful review, that there is no need for a fact finding hearing in this case. In reaching this conclusion I have placed particular focus on the following:

Having reached these conclusions, I confirm the proceedings will now proceed on the timetable set towards IRH.

In the light of these findings, I need not address the Part 25 applications. I will now forward this decision to the advocates. It can be shared with both lay and professional client. I would ask for any typographical corrections, requests for clarification and additional redactions no later than 4pm on 23 May 2025. This judgment will be handed down at the hearing listed at 2pm on 28 May 2025.