High Court judge approves unregistered placement for teenage girl with “nowhere else to go”

A Family Division judge has directed that a teenage girl at risk of suicide should be moved from hospital to a placement even though the latter is unregistered and the provider could be at risk of legal action by Ofsted.

The case before Mr Justice Poole concerned J, who was made the subject of an interim care order in July.

Manchester City Council had been unable to find any suitable accommodation for her and so she has been living in a hospital, even though she has no need for in-patient treatment and the environment was unsuitable.

The judge said: “All parties in this case agree that J needs to be placed somewhere else but such is the state of provision for children with complex needs in England and Wales that there has been nowhere else for J to go.”

She has autistic spectrum disorder and attention deficit hyperactivity disorder and can become aggressive having assaulted hospital staff, damaged property, absconded and self-harmed on multiple occasions.

Her mother considerers it impossible for J to return home because of concerns about her siblings’ safety.

In J, Re (Deprivation of Liberty: Hospital) [2022] EWFC 121 Poole J said: “Very sadly this case is not unique. J's plight highlights an ongoing problem that is blighting the lives of many children with complex needs whose behaviour presents very significant challenges to those who are caring for them."

He noted seven previous hearings found it was necessary, proportionate and in J’s best interests to authorise the deprivation of liberty in hospital as there has been no alternative and restrictions amounting to the deprivation of her liberty have been needed to keep her safe.

At previous hearings Poole J insisted on regular review hearings, had ordered the attendance of Manchester’s director of children's services, and directed details of the case be provided to the Secretary of State for Education and the Children's Commissioner, all of which he remarked had been “to no avail”.

He noted the court was told that as of 10 October there were 62 referrals for places in secure accommodation across the country and only one vacancy for a female.

Manchester later identified a private landlord with a property the council could rent where care could be provided.

This would allow J to leave the hospital but it would be an unregistered placement.

Manchester “anticipates that Ofsted may serve cease and desist notices on the provider and the property owner [which] highlight the risk of prosecution’.

Holgate J said a copy of his judgment should be sent to Ofsted as the proposed placement was unregistered and the provider - which offers agency care not the operation of children's homes - would not apply for registration.

“It would be extremely unfortunate if, after three months living in a hospital awaiting a placement, J's new placement were to break down because it remains unregistered, given that I am satisfied on the current evidence that it is an imperative necessity and in her best interests to move to the new placement even though it is not registered,” the judge said.

He said he struggled to see that J’s continued presence in the hospital was in her best interest even for a relatively short time, but the national lack of resources to accommodate children with complex needs meant this was the only possibility until the placement found by Manchester became available.

The court heard the proposed placement would cost some £9,600 per week against the £7,000 cost of J’s care in the hospital.

Turning to his decision to allow Manchester to be named, Holgate J said there was a strong public interest in knowing the identity of the local authority.

This was because it was accountable as a public body and it was in the public interest for it to be known that even as large an authority as Manchester struggled to find placements.

He was mindful of the risk of J being identify but said Manchester’s large population and profusion of hospitals made this a lower risk than in a small authority.

Mark Smulian