A vulnerable and suicidal teenage girl came within three hours of being forced out of a secure mental health hospital last week when the country’s top family judge stepped in to beg the NHS to extend its deadline on her discharge for a second time.
At an emergency hearing on 7 May, the judge was told that 14-year-old “Becky” had spent over 15 months locked away in a paediatric mental health facility on a deprivation of liberty order, after trying to jump off a bridge on the M6 motorway.
The North Staffordshire NHS Trust which runs the facility said Becky did not need mental health care and that being locked in a hospital room – always intended as an emergency stopgap – was itself causing her harm.
Her court-appointed guardian was also concerned that her human rights were being breached. “The veneer of lawfulness [of this placement] has gone,” the court was told.
The law is clear that local authorities are responsible for the children they have taken into care. And having accommodated Becky since March last year, the North Staffordshire trust decided it must give notice on the placement, stating she had to be out by 30 April. At an earlier hearing on 29 April, it told the court Becky’s care had cost the NHS £2.3 million, as well as diverting “extremely limited and precious resources” from mentally ill young people who badly needed them. Now, the trust said, “it needs to end”.
Tortoise has been following Becky’s story for over a year, and in a hearing last week to determine what we can publish on her case, which would usually not be reportable, Sir Andrew McFarlane, president of the family division of the high court, described the public interest in knowing about her story as being “at the highest level”.
Sir Andrew quizzed Staffordshire Council, which is responsible for Becky’s care, on where she would go if the hospital insisted she leave the next day.
“I have nowhere she could go,” said Tracy Lakin, counsel for the local authority.
“You have to put her somewhere,’ said McFarlane. “It’s a complete dereliction of duty by the local authority.”
An eight day extension was agreed by the NHS, and on 7 May, everyone was back in court. There was still nowhere definite for Becky to go. And so McFarlane had to plead with the NHS Trust for another few days’ grace. Reluctantly, the trust acceded to a further 48 hours.
On 9 May, Becky was moved to her new placement, a residential home outside her home county.
24 hours later – at the time of writing – the council’s plan has collapsed. Becky absconded within hours, her mother says, and ran out into the middle of a road. She has attacked transport staff, the police were called, the residential home refused to take her back, and as of Friday afternoon Becky was sitting in a local hospital as a ‘place of safety.’ A short while later, her mother informed Tortoise that Becky was being transported back to Staffordshire, to different premises that the local authority had informed the court just three days earlier were unsuitable.
“I feel sick with worry,” her mother messaged. “I think we’ll be back in court within the week.”
Over the past 15 months and more, Becky and her family have been plunged into a crisis engulfing children’s social care in which children taken into care who have the most acute and urgent behavioural and emotional needs are the very hardest to place.
Figures reported last month in The Observer showed that in 2022-23, councils placed 706 children, the majority of them under the age of 16, in their care in homes that were not registered with Ofsted, and so subject to no regulatory oversight. Many, like Becky, are among the most vulnerable and troubled children in the country.
Over the period Becky has been locked in a hospital room she has made several attempts to kill herself. There have also been multiple incidents of self harm and serious assaults on staff, including one just a few days ago.
Hours before the hospital’s 12-noon discharge deadline on 7 May, it became clear that Staffordshire Council had spent the week scrambling in vain to find somewhere suitable for her to go. After over a year of repeated failures to find anywhere willing to take her, its social work team contacted 646 children’s residential care homes in a desperate attempt to find one with the required space, expertise and experience. Just two providers stepped up.
But to McFarlane’s evident concern, it emerged that the home preferred by the council was run by an unregulated provider which was unable at that point to provide evidence that its staff were properly trained in restraint techniques. The council also had to tell the judge that despite repeated requests the home’s managers had not provided certificates to show it was suitably insured.
It also became apparent, to the dismay of Becky’s mother, that her daughter was being regularly sedated by hospital staff with Lorazepam – a drug used to control anxiety – and Promethezine, an antihistamine that can be used as a sedative, without her knowledge or consent. Neither had the local authority, which shares parental responsibility, been asked to give permission for the child to be, as her guardian put it, “chemically restrained”.
An assessment by the trust’s medical staff that the 14-year-old was competent to consent to being medicated was not investigated at this emergency hearing, but concern was voiced by McFarlane as to whether given her emotional difficulties, Becky could weigh information and assess long term risk in the manner required for a determination of competence to be lawful.
And so despite the tight oversight of Becky’s case at multiple hearings in front of the most senior judges in the country, there was confusion as to whether the NHS trust was lawfully administering medication to a child, contrary to the express refusal of a judge at earlier hearings.
A severe shortage of specialist children’s homes means that private providers have moved into what has become a profit-driven market in caring for vulnerable children. The dearth of beds is so dire that private providers can pick and choose which children they are willing to take, leaving council social workers spending hours daily trying to match scores of vulnerable children to what is often fewer than a handful of specialist beds across the country.
Some of these residential care homes are inspected and regulated by Ofsted. Many are not. Councils, which now run few such homes themselves, are left with little to no choice, and must place children in facilities where standards are known to be sub-optimal and hope for the best.
As in Becky’s case, this can be a vain hope with catastrophic results. Who will take Becky now?
Judges have repeatedly appealed to the Secretary of State for Education to step in, but central government has refused to take responsibility for a growing crisis in secure care which is causing both immediate and long-term harm for Becky and other children like her. Becky’s deterioration in state care, and the harm it has caused her, is symptomatic of a crisis that has become a national scandal.
Additional reporting from Phoebe Davis.
aLSO, in the sensemaker
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