At every level, judges of the family court have to resolve sometimes unimaginable situations – acts in the “never ending carnival of human misery.” The intensity of such cases is nearly always increased where the children involved are very unwell, and the patchwork of emotions that underpin how we as people think and act grows, and becomes more confusing. That confusion can manifest in a number of ways and often puts a great deal of strain on the relationships between the child’s parents and the professionals working around the child. This relatively recent case was one such example of where the relationships had broken down. 

What was the case about? 

W is a 12 year old boy. W has a very high level of need because of a genetic defect: he has epilepsy and a swallowing disorder, uses a wheelchair at all times and, at times, self-harms to the point where he loses consciousness. He does this by holding his breath; this has sometimes caused his body to be starved of oxygen. This need must be met by one-to-one care at all times during the day, and two-to-one care for moving and handling W. He also needs a gastronomy feeding tube. 

A private company was responsible for giving W the care he needed. Relationships between the care company and the parents became strained, however. The care company reported that the parents were doing a number of things to sabotage them, including:

  • Insisting on oversight of how carers were trained, and making decisions about which carers were giving care to W;
  • Alleging serious misconduct on behalf of a paediatric nurse and demanded that she be de-registered; 
  • Not co-operating with a review of W’s care package;
  • Refusing to allow the care staff to call an ambulance for a period of time following a hypoxic episode, which caused W to remain dangerously desaturated for ten minutes. 

As a result, Lancashire County Council (LCC) brought care proceedings, asking the Court for a care order for W in Spring 2021. LCC contended that W was suffering significant harm because of the “resistance and combative interference” of the parents. 

What happened in the case? 

Mr Justice Hayden heard the case. He directed that a psychologist be instructed to assess the family and, importantly, how they interacted with professionals. A highly respected and renowned psychologist, Dr Kate Hellin, was instructed. The judge expected to receive a thorough and considered report. He did not quite expect to receive “a report that so comprehensively captured the dynamic of this kind of conflict. It is, in my judgement, a landmark report, the analysis of which requires wider dissemination. Today, this interim hearing, which it was anticipated would be contested, has resolved, by agreement of the parties.” 

Dr Hellin noted that the parents “live with ongoing intense chronic and acute stress, day-to-day anxiety about his survival, the uncertainty regarding his future and their limited sense of control, at times, in the face of complex commissioning and care/medical delivery systems.” The way they responded was “a psychologically healthy way of responding to adversity.” 

What Dr Hellin’s assessment did not do was try to play the blame game. Rather, Dr Hellin made constructive reccommendations.

Dr Hellin’s reccomendations

Dr Hellin’s recommendations were summarised by their barristers, Lorraine Cavanagh QC and Kerri O’Neill. This was quoted fully in the judgment and I cannot improve on it by way of summary: 

  • “There are certain features of the system around [W] which make it more, rather than less, likely that problems will arise in it. First, it is a very complicated system.
  • Second, the stakes are very high. Ultimately, this is about keeping a child alive and ensuring his best possible quality of life.
  • Third, commissioners face what many would consider to be impossible decisions about resource allocation.
  • Fourth, care work is intrinsically stressful, and the pressures on health professionals and care staff have been vastly increased by the Covid-19 pandemic.
  • These factors all affect the emotional climate of the system around [W] and the relationships between those components of the system.
  • The system around [W] has become sensitised and inflamed. Feelings have run high and perspectives have become polarised and entrenched.
  • [M] and [F], individual professional staff and their organisations have become stuck in polarised beliefs about each other.
  • It has become difficult for the parents and for professionals to respond moderately in ways that sooth rather than exacerbate the dynamic tensions between the different parts of the system.
  • I hope it will be apparent that this analysis does not apportion blame.
  • The family, commissioners and health and social care providers are all affected by the dynamic context in which they are trying to do their best.
  • Rather than looking to change the parents, I recommend a systemic intervention drawn from organisational psychology, psychodynamic psychotherapy, group analysis and systems theory.
  • The intervention would assist all agencies and the parents to understand the dynamic processes that have led to the current difficulties, to step back from mutual blame and recrimination, to establish working practices which will contain and diminish sensitivities and optimise collaboration between the different parts of the system. 
  • I recommend that an organisational or a systemic supervisor/consultant is employed to work with the system and facilitate systemic meetings within which the aims set out in the paragraph above would be addressed.
  • The involvement of the Court has radically shifted the dynamics of this system.
  • The involvement of their legal representatives and of the Court, a neutral authority, has diluted the emotional intensity of the polarised “them and us” dynamic which previously existed between the parents and the health/care providers.”

Impact of the case

In spite of Mr Justice Hayden remarking that the report should be shared, I am not aware that it has been. The report does indeed sound like a ‘landmark’ assessment that would assist all professionals and lay parties who encounter these kinds of cases. I hope very much that a redacted and suitably anonymised version of Dr Hellin’s report is published if it is possible.

This case is also a reminder to everybody involved in these cases to tread carefully when assessing the family and professional dynamics. The expertise required to cut through the difficult situation that presented the Court was considerable, and it is a good illustration of how expert evidence in family cases can help the Court. In such cases, professionals should be keen to ask for an expert view and not attempt to impose a face value analysis of how they find parents in these situations.

Finally, it should be said that a collaborative approach seemed far more effective than any instrument the Court could have used beyond this. This should weigh heavy on the local authority lawyers when advising a local authority on how to deal with these cases.

The link to the judgment, W (A Child), Re [2021] EWHC 2844 (Fam) (25 October 2021), is here. It is extremely well written and accessible and makes for very interesting reading. 

Feature Pic: RCJ4 image by piqsels with thanks

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