UK & Europe
We recently helped two NHS Trusts with an extremely difficult case, where the legal proceedings had to be more robust than usual.
X was a teenager in the care of the Local Authority (as a ‘looked after’ child). He had been detained on a section 2 of the Mental Health Act the previous year; the lengthy assessment had concluded that there was no psychiatric disorder which was amenable to treatment.
Whilst in a Children’s home he ran away often, and endangered his own health and life. He was violent to the staff; after assaulting a staff member, he was taken into the acute NHS Hospital by police. He did not have any acute medical needs and was ‘medically fit for discharge’ on the same day. However, in a situation that will be familiar to many of you, he could not be discharged, because the Local Authority said that:
The Local Authority continued to look for a placement, but the weeks ticked by. X was bored and understandably unhappy being detained in a room in the hospital. Although 1:1 carers were arranged to provide activities and distraction, he quickly began to abscond (multiple times each day), then to steal dangerous objects and to physically harm NHS staff and security. The acute NHS Trust escalated their concerns with the Local Authority at director level – but the response remained the same (no placement had accepted X). The NHS Trusts began to doubt that any ‘standard’ Children’s Home would accept X, given the level of risk he posed (of serious harm and of absconding). The Local Authority (LA) approach did not change.
When a staff member required emergency hospital treatment after being assaulted, and parents were concerned for the safety if their seriously unwell children in hospital, we advised the NHS Trusts that they should take robust action, to protect the safety of their staff and other patients.
The LA declined to apply to court. On our application, the High Court authorised the deprivation of liberty for X to be kept in hospital under extremely oppressive conditions, simply because it (like the Hospital) had no other immediately available option. We applied for the LA to take our place as the Applicant, which the court agreed with (commenting that the LA should have been the Applicant from the outset).
We also applied for an Order that by 4pm at the end of that week, the LA should be required to remove the child from the hospital. The LA did not consent to this part of the Order, however the NHS Trust in law, had no duty to the child, whilst the LA did have a duty to provide accommodation (under the Care Act). As a result, the Order was made, and the LA transferred the child into the community (he left without incident).
If you are having difficulty discharging a child who is ‘medically fit’, do give me a call (the first call is free of charge).
* details have been changed to avoid identification.