Westminster City Council v H

I am concerned in this case with H, who is only weeks away from his 16th birthday. On the 16^th March 2017 I handed down a judgment in which I analysed the basis upon which the ‘threshold criteria’ were met pursuant to s31 (2), Children Act 1989. The Judgment is in the public domain, reported at [2017] EWHC 518 (Fam). On the 26^th April 2017 I heard submissions in relation to a planned move for H to MCU. The evidence pointed overwhelmingly to such a move being in H’s best interests. It needs to be emphasised that H is at the centre of this process. The proceedings are driven by an imperative both to identify and promote his welfare needs.

The Judgment of the 16^th March is detailed. There were 40 lever arch files of medical records which were the subject of comprehensive submissions by counsel and which required to be addressed fully. In the final paragraph of that judgment, I set out, in unambiguous terms, my conclusions in relation to the evidence.

I found, firstly, that the parents had misreported and exaggerated H's medical symptoms. I concluded that this had led not only to his emotional harm but to his physical harm. In consequence, particularly of the exaggerated gastrointestinal pain, there was the unnecessary insertion and thereafter the prolonged use of a Hickman line, which exposed H not merely to the risk of short-term infection, but to the risk of liver failure in the long term. It perhaps requires to be underlined that in consequence of his parents' actions H's life was placed in peril.

I went on to find that the mother, through bullying and bombastic behaviour, had intimidated medical professionals and others to the extent that she confused and undermined their confidence in their own professional judgement. In the hospital it generated a febrile atmosphere in which there was an elevated risk of clinical error, I found this compromised H's safety.

In particular, and this requires perhaps to be emphasised too, in April 2016, on the most compelling of evidence, I found that both parents had, on separate occasions, tampered with H's TPN pump. The effect of this, though it did not immediately threaten H’s health was, again, to cause confusion and alarm on the ward and jeopardise professional objectivity.

The father has both directly and passively acquiesced in the mother's distorted perspective of H's health and medical needs. The mother presented H to the world as dying, in extremely alarming e-mails. Moreover, on the evidence, she inculcated in H himself, a view that he was dying. The parents' actions led to prolonged stays in hospital, the consequence of which was that H has been robbed of much of his childhood and teenage years.

This is of course a desperate situation made all the more depressing by the fact that H has an outstanding, lively, irrepressible intellect and a keen and zany sense of humour. It is a tragedy that these talents have not been allowed to flourish and grow as they ought to have been. I reiterate, in order that the point is not lost in the detail of my judgment, the harm caused to H by his parents, protracted over many years, exposed him to significant harm at the most serious end of the spectrum, ultimately risking his life.

To begin to disentangle both the physical and emotional impact upon H of these years is a very significant challenge and, despite proactive intervention, the local authority have struggled to find a unit which they considered to be suitable. Initially, all that was available was ‘Unit A’ which I shall not name as there are other vulnerable young people living there. From the very beginning nobody thought that it was a facility that would be sufficiently equipped either to assess or evaluate the complex panoply of H's needs.

During the course of the substantive hearing it emerged that H, whilst not eating food, was buying sweets and enjoying them. I caused it to be checked with the doctors whether H could eat orally now and I have been told that he can. Staff at Unit A did not have the medical qualifications to make such an assessment. The social services have been advised that H should be tempted by foods that he is interested in and encouraged, in consultation with a dietician, to try to eat. This has not yet been achieved. Again, this is not part of the training or experience of those who work at Unit A.

H has been provided with education, which he plainly enjoys and is stimulated by. He amuses himself intellectually and socially by his extensive use of social media. It is his ‘lifeline’, as he has told me directly, and he is bitterly resentful of it being taken from him, even for the few weeks of the assessment contemplated in the unit.

H has a stoma. It is in my judgment indicative of the extent to which the parent’s own agenda overwhelms the social services capacity to focus on H’s needs that we simply do not yet know whether the stoma is reversible. H now wants to know the answer to this and it will be one easily resolvable issue now that he has moved to the MCU.

The mother, for complex reasons, has a powerful and deep-seated resistance to the Great Ormond Street Hospital (MCU). As I explained in my judgment of 26^th April, when I sanctioned H's removal, this plan was designed to facilitate a proper assessment of H’s identified needs, both physical and psychological. Furthermore, there were no alternative options available. I exhorted both parents to support H in that move because he was understandably apprehensive, picking up, I find, chiefly on his mother's own anxieties. I should record that from what I have read, and indeed from what I have heard today, the father has made some efforts, which will not have been easy for him, to encourage H in the move. If I may say so, I am very pleased to see it.

Earlier this week I received a request, to visit H myself. This is still a relatively unusual course, particularly where the young person is a party to the proceedings having been assessed by his very experienced legal team to be competent to instruct them. However, with the agreement of all the advocates, I visited H at the unit. It was very plain that H was anxious, to say the least, about going to Great Ormond Street. I spent, it is recorded, fractionally more than an hour with him. I add my voice to the many others. I found him delightful, stimulating and very good company, with a wide range of interests. His central preoccupation was, of course, his access to the outside world via the Internet. The restrictions contemplated are very hard for him to bear. I am entirely satisfied that they are necessary, not least because they are the route by which H can communicate with his mother, who is, as I have said, so extremely resistant to this assessment and to the MCU. Moreover, because the assessment itself is multidisciplinary and wide ranging it requires to be undertaken in a calm and cooperative atmosphere and for H this will likely be more constructive away from the endless stimulation that the Internet brings.

The case came before me on 17 May. There were some important issues to address, which need not be read into this judgment. They are private to H's life and circumstances. Later that afternoon, voluntarily (my emphasis) and not without some hesitation, H was able to go to the MCU and did not resist. A private ambulance which had previously been engaged on a number of days and abandoned, was booked for 17 May and waited whilst I spoke to H. The schedule was pushed further and further back and in consequence there was not time at the hospital for the contact to take place, as had been envisaged, between h and his parents. But H had asked me if I would hand his mobile telephone to his father so that he could be assured that his contacts, et cetera, were not lost. I gave him that assurance.

I was informed during the course of the hearing, by the local authority, that it suspected that a reporter from The Daily Mail had visited H in ‘Unit A’ on 8^th May. That reporter, I was told, was thought to be a Ms Sue Reid, though the visitor book bore an inscription that a Susan Odette Brown, recorded as ‘a friend’, had visited that day. I indicated to the local authority that they should make inquiries to establish such facts as they could. In pursuance of that, they drafted the following questions which were relayed to The Daily Mail. They are succinct questions and they are responded to with equal clarity. They require to be set out:

These questions had in mind the protection afforded to young people and particularly to those who are vulnerable, by the Codes of Practice (2016), Independent Press Standards Organisation (IPSO). It is convenient that the relevant guidance be set out here:

“Clause 8 protects patients in hospitals and similar institutions from intrusion. It requires journalists to identify themselves and to obtain permission from a responsible executive to enter non-public areas. The clause applies to all editorial staff, including photographers.

The clause covers the newsgathering process, so the Code can be breached even if nothing is published. The clause also requires that, when making inquiries about individuals in hospitals and similar institutions, editors need to be mindful of the general restrictions in Clause 2 of the Code on intruding into privacy.

The code purposefully set a strong objective to safeguard children. The following requires emphasis :