IN THE MATTER OF THE MENTAL CAPACITY ACT 2005
IN THE MATTER OF NB
B e f o r e :
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LONDON BOROUGH OF TOWER HAMLETS | Applicant | |
-and- | ||
VW | First Respondent | |
-and- | ||
(by her Litigation Friend, the Official Solicitor) | Second Respondent |
____________________
J. Anderson (instructed by TV Edwards Solicitors) for the First Respondent
S. Reeder (instructed by Steel & Shamash Solicitors) for the Second Respondent by
her Litigation Friend, the Official Solicitor
HEARING DATES: 21st and 22nd September 2015
The proceedings were heard in private.
This judgment is being handed down and delivered to the parties by e-mail on Friday
2nd October 2015. It consists of 15 pages and has been signed and dated by the judge.
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Crown Copyright ©
INTRODUCTION
a. to remain living at P House (where she has lived since 29th April 2015), at least while the protracted search for a long-term placement is pursued; ORb. to put in place (either for the long-term or as interim measure) a 'shared care' arrangement, whereby NB returns to live with her mother for 4 nights a week, and spends the other 3 nights a week at P House (or such other placement as may be identified in due course.)
MATTERS CONSIDERED
a. Filed on behalf of the Applicant:Position statements dated 24th February, 3rd July & 14th September 2015
Statement by Janet Eweka dated 28th March 2014
Statements by Nina Ezekiel dated 12th May, 12th August, 26th September
2014, 27th January, 20th March, 22nd April, 16th June and 4th September 2015
Statement by Bright Okeyere dated 27th January 2015
b. Filed on behalf of the First Respondent VW:
Position statements dated 26th February, 2nd July & 18th September 2015
Statements by VW dated 28th April 2014, 9th February, 27th March, 30th
June
c. Filed on behalf of the Second Respondent NB:
Position statements dated 24th February, 6th July, 1st & 17th September 2015
Statements by Janice Kaufman dated 24th February & 18th September 2015
Statement of the Official Solicitor dated 22nd April 2014
d. Expert assessments and reports
Dr Kabir, dated 6th January and 2nd April 2014
Dr. Hall, dated 8th May, 29th July & 1st September 2015
Dr Kabir & Dr Hall dated 14th August 2014
Niah Gaynair dated 13th June 2014
Dr Rippon dated 29th July 2014
Dr Fitch dated 18th August 2014
Dr. Sahni dated 21st August 2014 and 27th August 2014
Dr Ezeokwuka dated 26th August 2014
Laura Copsey OT dated 22nd April 2015
Keith McKinstrie ISW dated 19th December 2014 & 13th April 2014
Various e-mails, placement reports and follow-up assessments (in section E
of the hearing bundle)
e. Care Plans
Contained in section D of the hearing bundle, ranging in date from 14th April
2014 to 29th June 2015
f. Miscellaneous
Documents contained at sections F and G of the hearing bundle, including
incident reports and contact notes
Documents produced at the hearing, including:
NB's Support Plan dated 18th September 2015
a CQC report on O Gardens
VW's housing appeal application dated 14th August 2015
OT rehousing needs assessment report dated 28th August 2015
Where there are numbers in brackets in this written judgment, they are
references to pages in those files.
BACKGROUND
Before issue of these proceedings
a. In November 2013 it was reported that there had been a physicalaltercation between NB and her sister R.
b. In December 2013, security guards were involved with removing NB from a shopping centre when she became distressed on a family shopping trip.
c. Then in March 2014, VW brought a suitcase of NB's possessions to the Local Authority offices saying she wanted a break. When NB was delivered home from her day care centre she was not let in, and so was delivered instead to the Local Authority offices. After speaking to her mother on the phone, NB tried to run away, in the process hurting her head on a glass window. Both police and medical services were called. NB finally returned home some time after midnight. (C143)
From involvement of the Court
a. VW went to Jamaica between 30th May and 21st June, on a trip which had been arranged before the Court hearing but not disclosed to the Local Authority, the Official Solicitor or her own representatives. NB was provided with respite care at HITP whilst her mother was away but that placement unfortunately was characterised by incidents of verbal and physical abuse of staff.b. Shortly after NB had returned home, on 31st July 2014 there was an altercation when NB is said to have bitten her mother and tried to push her downstairs. NB was returned to the HITP again (E772), and the Local Authority sought urgent direction from the court.
a. final declarations that NB lacks capacity to litigate and to make decisions about where she should live, how she should be cared for and the contact she should have [with family members];b. an interim declaration that NB lacks capacity to consent to particular types of medication;
c. provisions to bring about NB's move to a supported living placement at LG;
d. directions for joint instruction of an independent social worker.
a. the planning for the return home had been inadequate and left too much of NB's timetable uncertain;b. there had been too little detail given on the support which would be provided to VW;
c. without the facilities and aids (in particular an autistic-friendly shower and a planner board) which had been provided at the previous placement but not to VW, the move home would be unsustainable;
d. On 29th April, VW's son H had moved back to live at the family home, sleeping in the room which NB regarded as 'hers', "too scared to go back" to his previous semi-independent placement;
e. "I do not believe that my home at …is suitable for NB, partly because of a lack of space."
a. the Applicant's position was that NB should continue to live at P House until an appropriate long-term placement could be identified, which was thought likely to be in July 2016 with the opening of a new in-borough facility;b. VW sought an immediate progression to a 'shared care' arrangement, whereby NB spent 4 nights at week at the family home, and 3 nights a week at P House, on a permanent or at least a trial basis;
c. The Official Solicitor's written position was that the assessment process directed in July had failed to be completed properly (and, this having been apparent at the round table meeting, the OS had delivered his position statement some 3 weeks ahead of the final hearing "in an attempt to galvanise the parties to focus on suitable available long term residence and care options") but that O Gardens still offered some immediate prospect of appropriate long-term placement. As a result of discussions between the parties and the late production of a CQC report, the O Gardens option was discounted. The Official Solicitor's orally-stated position when the hearing began was therefore that the Court has no suitable options before it to consider.
"1. whether there is shared care as a long-term solution;2. If not, whether pending a log-term placement there is shared care or NB
remains at P House in the interim;
3. In any event, whether the proceedings continue or not;
4. If proceedings continue, the directions to be made."
THE EVIDENCE
"the period NB and VW lived together was characterised by VW and NB refusing to engage with health and social care professionals other than in response to a crisis, arguments between NB and VW that could on occasion be violent, VW seeking respite care for NB and NB refusing to allow support workers to care for her as she considered this should be done by VW.It is my opinion, should NB return to the care of VW, their relationship is likely to revert to the same dynamics and patterns as previously, which were physically and emotionally harmful for both…" (E807)
"NB has a need for predictability and routine in her life. In my view a shared care arrangement will not provide this. The care and support she receives from VW and from carers in her placement will almost inevitably be different and inconsistent. "(E810)"A shared care arrangement would only have a chance of working in NB's best interests if all those caring and supporting NB agree how her needs should be met and are willing and able to abide by a protocol that prescribes their practice.
Previous experience implies VW would find it difficult to work cooperatively with health and social care professionals if she disagreed with what was proposed by either the local authority or the placement provider as to how her daughter should be cared for and supported.
Similarly a placement provider would be unwilling to compromise their practice if they considered what was proposed by VW was either not in NB's best interests or counter to their organisational principles or ethos." (E811)
a. "consider[ed] the suitability of [living at the family home] to be largely determined by the availability, or lack of availability, of any alternative potential placements for NB." (E862)b. "…in the absence of a viable alternative long-term placement … now consider[ed] it to be in NB's best interests to return to live with VW rather than a series of unplanned, short-term placements, should these be available." (E869)
c. maintained the opinion that "living with VW would not provide NB with the consistency and routine she requires in order to feel sufficiently safe and secure. This may lead to NB's behaviour becoming increasingly challenging to those around her and a further unplanned removal from home." (E869)
d. remained of the view that "there are a considerable number of disadvantages that outweigh any possible advantages of NB having her care and support shared between VW and a residential placement and this should not be considered." (E869)
informed, had "useful" input into the arrangements agreed between the parties on that occasion.
THE LAW
a. the decision of Peter Jackson J in A and B [2014] EWCOP 48, and in particular his reminder that the Act requires "a sensible decision" in the best interests of the protected person, not the pursuit of perfection; andb. the case of K v A Local Authority [2012] EWCA Civ 79, in respect of which it is common ground between the parties that the court must determine the best interest decision as required by Mental Capacity Act first; and then cross-check that decision against Article 8 requirements.
THE BALANCING EXERCISE
a. Goes some way to meeting NB's wishes: NB has not expressed a wish for shared care but the proposal would mean that NB spends significant periods of time with VW. Family relationships, which are very important to NB, could be maintained.b. Familiarity: NB is now familiar with both the family home and P House, so combining the two in her weekly routine would not require her to adjust to any new surroundings. She could continue with her known activities, such as Poetry in Wood. Three nights a week at P House amounts to a planned and stable arrangement which could be explained to NB in advance and which could potentially become part of her routine.
c. Continuity: NB would benefit from continuity of care by CLDS professionals with whom she is familiar.
d. Respite: NB and VW could use the P House placement for periods of respite support, so relieving some of the strain of VW providing sole care.
a. New domestic arrangements: the domestic arrangements at the family home have changed since NB last lived there. Her brother H now lives in the household, and NB's relationship with him is an unknown quantity. He has been using the room which NB regards as 'hers.' I accept Ms. Ezekiel's evidence that, if this were to continue, NB would find it very distressing. The alternative proposal is that H sleeps on a blow-up bed downstairs. I agree with the assertion of the Official Solicitor that this arrangement would be likely very quickly to leave the whole family living in cramped conditions, without the communal living space which NB is accustomed to and needs, with consequent strain and risk to NB's ability to cope.b. frequent transitions: the shared care proposal would require NB to leave her family setting every week. It is generally agreed that NB finds partings difficult. Mr Mckinstrie noted (E810) that NB would be likely to find shared care arrangements potentially confusing and disruptive, and find it difficult to leave the family. NB has refused respite before. It seems to me much more probable that she will resist separation from her mother and become distressed (as Ms. Ezekiel and Mr McKinstrie suggest) rather than accept it as an aspect of routine with a promise of return (as VW suggests).
c. inconsistent care: NB's special needs are such that she requires stability, consistency and routine. I accept the evidence of Mr. McKinstrie that a shared care arrangement, almost inevitably, means inconsistency -two different care regimes, each unlikely to change to match the other. Moreover, within the family home setting, VW has to date found it difficult to prioritise NB's needs and balance them with the needs of her other family members, leading to an experience of inconsistent support for NB.
d. sustainability: any shared care proposal depends to a high degree on the various parts of the arrangement being able to work together constructively. This particular proposal also depends heavily on VW being able to meet NB's needs during the 'home' period. Experience demonstrates that such demands have not been sustainable before. It is acknowledged that VW has done considerable work with psychological services in the duration of these proceedings, but her own evidence was that she had not found this helpful and she has effectively stopped going because she did not see any use to it. I can find no basis for confidence that the difficulties which were experienced last year would somehow not occur again. Consequently there is, I consider, a very high risk that the proposed shared care arrangement would not be sustainable, with emotional damage to NB as a consequence.
e. Not supportive of developing independence: Ms. Ezekiel considers that NB's fixed preference for her mother's exclusive attention would mean that the proposed shared care arrangement reduces NB's prospects of developing a more independent lifestyle. However hard VW may try, experience suggests that Ms Ezekiel is right because NB would be less likely to commit herself to a more independent approach.
a. Familiarity: NB has now lived at P House for some 5 months. There have been difficulties but the staff are now showing commitment to her and have demonstrated willingness to adopt strategies which tackle challenging behaviour and have reduced incidents. NB is now familiar with the layout and approach of the placement. She can continue familiar activities, such as Poetry in Wood.b. Proximity to family: It is said that P House is 36 minutes from the family home by public transport. This proximity makes possible the continuation of contact arrangements.
c. Other service users: the other two service users are young and verbal, and share some socialising opportunities and some interests with NB.
a. Lack of permanence: it is not suggested by any party that P House is a suitable placement for the long term. It does not meet all of the "McKinstrie specifications" (as identified in the order made on 15th May 2015 (B124). In particular, there is only one bathroom. Moreover, if NB stays beyond the current proceedings, she will lose the support of her current CDLS team because the placement is out-of-borough.b. Difficulties experienced: there have been several incidents of challenging behaviour from NB. The staff group is new and still stabilising. In response to difficulties, staff have called police (which exacerbates NB's anxiety) and have previously given notice that the placement will be terminated.
c. Peer group: the other service users at P House are male, and do not share all of NB's interests or her cultural heritage.
d. NB's wishes: NB does not wish to stay at P House.
e. Health concerns: VW has expressed concerns that NB is not being given a healthy diet at P House, has put on weight and is at risk of developing diabetes (C646).
CONCLUSIONS
a. In April this year, there was an urgent need to move from the known quantity of LG without any other placement having been tried. In those circumstances, shared care seemed to offer relative stability and security. In a situation of very limited options, it seemed to provide "the least worse" option.b. Now the position is different. VW's domestic situation is more complicated – as she herself recognised when explaining why she subsequently resiled from the shared care agreement before it could be put into effect. It was her own considered conclusion (C530) that the shared care would in fact have broken down. On the other hand, the available alternative is less uncertain. NB has now tried, and is showing positive signs of settling at P House, so there is a known quantity against which a return home can be compared.
So I am satisfied that, although a shared care arrangement was considered appropriate a few months ago, the court can properly take a different view today.
NEXT STEPS
been received by the Court. Unless it is filed by 4pm on 7th October, I propose to list the matter for a brief attended directions hearing.
District Judge C.H.J. Hilder
Note 1 1 A COP1 application dated 3rd April 2014 was subsequently filed (B72)
[Back] Note 2 Attached to this order is the unissued draft order prepared after the hearing on 23rd April – B128.
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