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Judge raps NHS England and mental health trusts over failure to provide medium secure bed for 15-year-old girl

A Family Division judge has strongly criticised NHS England and two NHS mental health trusts over the failure to accommodate a 15-year-old girl ‘M’ with complex needs through a medium secure tier 4 bed.

In North Yorkshire County Council v M & Ors (Medium Secure Bed) [2021] EWHC 2171 (Fam) Mr Justice Macdonald said: “It will not be lost on those reading this judgment that the High Court is in this case, in effect, being required to adopt the role of mediator, or at least facilitator, between NHS England and two NHS mental health trusts, in order to procure medium secure tier 4 provision that the NHS is responsible for providing and for a child who has twice been assessed as being in urgent need of that provision.” [judge's emphasis]

He joined to the action the two mental health trusts and the Secretary of State for Health and Social Care, which `”represents the best opportunity to break the impasse in this case and, finally, to secure for M the medium secure provision she has been assessed as urgently needing”.

North Yorkshire County Council has sought to make M a ward of court, and an order authorising the deprivation of her liberty. It also asked for an injunction prohibiting Leeds City Council from discharging M from her current placement.

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The judge said M had highly complex needs and a significant offending history. She was in a secure children's home, but had been assessed as requiring a tier 4 bed in a medium secure unit.

This followed a period in which M's conduct had become increasingly dangerous, regularly presenting a risk of harm to herself and to others with occasions when prolonged restraint was necessary.

Macdonald J noted that across England only three services admitted young females into medium security beds.

North Yorkshire searched for a suitable placement and NHS England committed to fund additional mental health support in the interim.

But this was unsuccessful and Leeds agreed M could remain at he current placement for a short period but said it could not meet her identified clinical needs after that.

All parties agreed that a discharge into the community would place M at risk of serious self-harm, including a risk to life.

The judge said that although only three units could admit M it had come to light that between them they had 10 empty beds, but despite M’s assessed and urgent need for a medium secure tier 4 bed, “each of those units has to date refused to admit M”.

He added that this refusal “has been maintained even in the face of NHS England making clear that it will provide whatever support is needed in order to address any difficulties arising from accommodating M in the beds that are currently empty”.

Macdonald J said he would join the two trusts to the proceedings “in order that the court can investigate properly why those NHS trusts are refusing to admit…a vulnerable young person who has been twice assessed to require Tier 4 provision”.

He said the court would direct statements from the directors of the trusts “requiring an explanation in detail as to what obstacles to M's admission to one of the empty beds are said to exist and how those obstacles may be overcome”.

Joining the Secretary of State to the action would mean “discussion can take place at the highest level regarding the provision…that M has twice been assessed to require and in order that the Secretary of State can confirm whether he is willing to direct the relevant NHS trusts to make such provision for M”.

The judge concluded: “It is difficult to see how it can be sustainable for the two NHS mental health trusts who have between them 10 empty medium secure tier 4 beds to refuse to admit a vulnerable young person who has twice been assessed as requiring such provision, absent very cogent reasons, particularly in circumstances where NHS England is willing to make good any current difficulties in utilising those empty beds with whatever resources are required.”

Mark Smulian

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