Welfare evaluation
77I intend to use the framework of the welfare checklist, highlighting the factors I consider to be of most relevance. 78P’s wishes and feelings are clearly ascertainable, although she does not know that there is a possibility she may be removed from her mother’s care and so she has not been directly asked for her views. She loves her mother deeply and I have no doubt that she wants to remain living with her. Care from her mother and her maternal grandmother is all she has known throughout her life. P’s wishes and feelings must be evaluated in the light of her age and understanding. She is nine years old but has a degree of developmental delay. It is likely that she does not have capacity to appreciate the medium to longer term risks to her health and development. The weight I can give to her wishes is limited, but they are important as an indicator of how she may respond if the decision of the court is one that she does not understand or agree with.79P’s physical, emotional and educational needs. At a minimum, P has the needs of any nine year old. She needs a home where she lives with at least one adult with whom she can form a secure relationship and whom she can trust to meet her needs. She needs warmth and affection. She needs to have fun and be stimulated. She needs to have boundaries set for her. She needs to be a loved and valued member of the family where she lives and she needs to feel that she has permanence and belongs there.80P has existing and strong relationships with her family members. In particular, she has close relationships with her mother and her grandmother, with whom she has always lived, but she is also now developing a meaningful relationship with her father, with whom she has had fairly frequent virtual contact for about two years. She knows her younger half-sister, and a relationship with her is also developing. 81In my judgment, P has a particular and identifiable emotional need, wherever she is living, to retain her relationship with her mother, who has been her primary carer and attachment figure throughout her life. The impact on her of a significant reduction in her mother’s role in her life will be very significant, and she will experience this as a huge loss.82P has additional needs arising out of her Tyrosinemia Type II. She has quite complex medical needs. They require her carer to maintain a close overview of her blood levels, to liaise with Great Ormond Street, to make sure she takes her amino acid supplements and to monitor the food that she eats every single day. That task involves not just weighing the portions she is given and calculating protein limits, but also watching to ensure that she does not help herself to food, as children in most households are able to do, and as she has done before. The carer has to liaise with her school and with the parents of her friends whenever P is out of the home to ensure that those around her understand the seriousness of her condition and what has to be done to ensure her diet is correct. 83As P gets older, she will need support to take on more responsibility for this herself. A condition like hers can be very challenging for a teenager to manage, as the mother’s own history has demonstrated. Ordinarily, parenting a teenager involves allowing them to take some risks and to push boundaries. There is less scope for that with P because the risks to her, for example if she were to rebel against her treatment regime, are very high.84P’s educational needs are also enhanced due to her health condition and her developmental delay. She has an education, health and care plan which I have read with care. It is very detailed and was clearly prepared by professionals with a thorough understanding of her functioning. It would, in my view, be difficult to replicate in a different education system, especially if P is being taught in a language that is unfamiliar to her. I note, in particular, that P’s writing has been identified as a weakness, both in the EHCP and by the Guardian. She has no understanding of or ability to write in Arabic as yet and it is unclear to me whether she would be able to develop that skill at all. If she were to transition to an Arabic-speaking environment and educational setting, that would result, in my view, almost inevitably in significant educational setbacks. Whether she would be able to recover from these is very uncertain.85The effect of change: P has been described by her school as a friendly, happy child. Her mother also said that there is very little that makes her cross or upset and she is usually very cheerful. However, her EHCP highlights the impact of her developmental delay on her ability to relate to her peers and to form friendships and social relationships. It is harder for P to establish and maintain relationships and it requires more work, both on her part and from those around her.86Two of the options before the court involve very significant change. A move into foster care would be a huge change for P. The Guardian thought she would experience it as a shock. She thought that P would be significantly distressed at her separation from her mother. She would have to form relationships not only with new carers but with any other children in the placement. In my view, she would struggle to adjust and it is likely to take her a considerable period of time. 87A move to the father’s home country would also be a very significant change. This would involve not just a change of household routines but a new culture and language. It will take some time, in my judgment, before P becomes comfortable let alone fluent in Arabic. She is likely to learn more slowly than other children because of her delay. In the initial weeks and months, if not longer, it is likely that P would feel that she cannot communicate what she is experiencing adequately to those around her. The effect of this on P will be mitigated by her knowledge of her father and his family. I accept that she knows them and has begun to form relationships with them, but those relationships as yet are still developing and she will have no real memory of spending time with them face to face. In my view, this would also be a profound change and one which has the potential to cause P very significant upset and distress.88Both of these options would involve the sudden and significant loss of P’s mother’s day to day presence in her life. That, in my view, will be a huge change for her. She will miss her mother enormously. If she is in foster care, contact can mitigate that loss to an extent. If she is in the father’s home country, although virtual contact could take place and I am sure the mother would visit when she could, P is likely to feel that her mother is very far away. Their relationship is likely to be severely limited by the distance.89P’s age, sex, background and relevant characteristics. P’s parents are first cousins;their mothers are sisters. Both parents describe themselves as non-practising Muslims. P has lived all of her life in London, aside from two periods of between four and eight months when she was very young and spent time in the Middle East. The mother has also lived in the UK for most of her life and the language in which she and P communicate is English. Some Arabic is spoken in the home by the mother and maternal grandmother and P understands this to an extent but she cannot speak or write Arabic.90The harm that P has suffered or is at risk of suffering. If P’s Tyrosinemia Type II is not managed effectively, she will suffer very serious harm to her health and development. The evidence from Great Ormond Street is that increased tyrosine levels are associated with ocular changes, skin changes, such as painful lesions, poor growth and neurological symptoms. It is important to remember that because of the rarity of this condition the prognosis is unclear. In particular, Great Ormond Street say that it is difficult to predict the effect of P’s condition, especially if poorly controlled, on her future intellectual development.91Thus far, P has not experienced any ocular or skin symptoms, despite a history of periods of poor adherence to treatment leading to high tyrosine levels, and her physical growth, although she is small, is in line with her centiles. Her treating consultant is of the view that her academic delay could be the result of past poor metabolic control but it is probably more likely to be due to a range of different factors. Wherever P is living, it will be crucial that her condition remains well controlled and that the progress that has been made over the past eight or nine months is maintained. If not, P is likely to suffer significant physical harm and development impairment, due to her condition not being properly managed.92There are some risks to P arising out of the mother’s interactions with people she meets online. In my view, these risks are real but are less acute than those that relate to P’s medical condition. The mother is undoubtedly vulnerable, particularly where her own friendships are concerned, and that creates the potential for P to be exposed to unsafe adults. However, these risks can be mitigated, in my judgment, as P grows older by specific work done with her to improve her own understanding of how to keep herself safe online.93P’s prospects of reaching her educational potential will be affected if her education is disrupted, especially by a transition to a different educational system. That is particularly serious for P because she is so delayed. The Guardian explained to me that her reading and writing are well below age-related expectations.94P’s emotional and long-term psychological wellbeing will be significantly affected if her relationship with her mother is lost or substantially diminished. That will be even more the case if she is unable to form secure and supportive relationships with new carers. In the longer term, if her relationship with her mother also dwindles P may well be left adrift in the care system without a sense of belonging anywhere.95It will be obvious from this analysis that I consider the stakes in this case to be very high indeed and that there is a real and significant risk of P suffering harm whichever of the options before the court is preferred.96The capacity of P’s parents and other potential carers to meet her needs. The mother’s capacity to provide good enough care for P is a key issue in this case. In the past the mother has not met P’s needs to an acceptable standard. It is necessary to determine whether there is evidence on which the court can be satisfied that things have changed and that she will be able to meet P’s needs going forwards. 97It is accepted that since these proceedings were issued there have been improvements in the mother’s care of P. The blood spots have been consistently sent to Great Ormond Street and P’s levels have been within their target ranges. Ms Harold’s evidence is that the mother’s care of P overall has improved. The school and the family support worker evidence, which is more recent, indicates that P is now taking 90 per cent of her supplements at home and the school is supporting with the remainder. Overall, the evidence is that P’s medical condition is currently sufficiently well managed.98It is necessary to consider whether the care that the mother is currently providing overall is good enough. The Guardian makes the powerful point that P needs more than just a basic level of care because of her overall functioning and developmental delay. In particular, she needs to be given a high level of stimulation and supported to engage in activities and to form social relationships. The mother’s provision of stimulation has been inconsistent and it is clear from Ms Harold’s report that at least in the autumn, when that assessment was carried out, the mother’s preferred way of spending the weekend was to stay at home and watch videos or play online games. There is evidence that over the course of these proceedings she has taken P more frequently to see friends or to go out to the park, but my sense from the evidence is that she has needed considerable encouragement to do this. The mother has some close friends who may be able to support her but both have family and other commitments of their own.99The mother’s mental health has fluctuated. When her mental health is poor it affects her ability to care for P. In the past the mother has failed to take medication which has been prescribed for her. Her engagement with therapy is in its early stages. It is, however, true that the mother’s mental health has been stable throughout these proceedings, despite what must have been enormous stress for a considerable period of time.100I remind myself that my focus in this case must be the mother’s ability to meet P’s needs with support. The initial expectation of Ms Harold was that support could be found within the family network. That has not been possible. The mother’s relationship with her own mother has been volatile in the past, although the Guardian thought that it had shifted and become more amicable over the course of these proceedings. However, the maternal grandmother has a number of health difficulties herself and is not in a position to offer meaningful day to day input into P’s care.101I have found the local authority’s approach to this case to be flawed in that the expectation thus far has been that the aim must be to reduce and ultimately withdraw support. I am satisfied that that is not an appropriate or realistic approach to this case. In my view, support at approximately the current level (that is, four to six hours of family support worker support each week) is likely to be required indefinitely if the mother is to care for P in the long-term. There is not, in my judgment, evidence to support a suggestion made by Ms Koroma in her evidence that the mother would require twenty-four hour support every day. She does not need someone present in the home overseeing her throughout the day. What she needs is relatively frequent support and reminders to ensure that she is keeping appointments, managing P’s condition and keeping her safe and providing her with adequate levels of stimulation and support at home.102In my view, it is not unreasonable to expect the local authority to make support at that level available on an indefinite basis. It may, in fact, be possible for part of the cost to be funded by health services given the circumstances of this case and the origin of the need but, in any event, the local authority resources required would be very much less than those involved in a placement in long-term foster care.103I accept that the mother’s capacity and willingness to accept support in the future over a sustained and lengthy period is very uncertain. On the one hand, I recognise that she has been resistant to this in the past and that Dr Parsons suggests that an oppositional response may be part of her personality, although he coupled that observation with a caveat that the mother’s very low verbal ability must be taken into account and that it is important that the right skills are used in engaging with her. I recognise also that the mother has said, as recently as 9 May to the Guardian, that she does not think she needs ongoing local authority support and that she is looking forward to a time when social workers will no longer be involved in her life. The maternal grandmother, with whom the mother lives, does not see why professionals need to be involved and finds their presence in her home intrusive.104On the other hand, I have to take into account the nine month period in the latter part of these proceedings when the mother has worked well with family support workers, taken on board advice and made general improvements in P’s care. I have to recognise also the fact that the local authority’s approach throughout the three and a half years when they have worked with the mother has been that the aim should be to achieve independence and that the local authority should step away. As I have said, it is perhaps not surprising, in those circumstances, that this is the mother’s expectation also.105On this fundamental issue it is impossible to make a firm prediction. There is a real element of uncertainty about the mother’s capacity to sustain the working relationships that she has built up over the course of these proceedings. There are factors pointing in both directions. In my judgment, the prognosis is uncertain but it is not bleak.106The father has no direct hands-on experience in parenting a child of P’s age and, as yet, has only a limited relationship with P herself. Taking on the care of a child in those circumstances would be a challenge for any parent, although not insurmountable when the will is there on the part of the parent and when the child is reasonably receptive to establishing a relationship. I am satisfied that the father has the capacity to develop the skills that he would need to parent P. He is clearly determined and capable. I am sure that he could acquire the knowledge he needs to manage her condition. However, in order to care for her safely the father would need to establish a secure relationship with her very quickly from a standing start and progress is likely to be impeded by (a) P’s shock at the move and the loss of her mother; (b) the lack of a shared language in which they can communicate fully and freely, and (c) the complexity of her medical needs. I conclude that the task the father would be facing, if he were to take over P’s care now or in the foreseeable future, would be a formidable one.107It is important to consider what would need to happen in order for the father to be in a position to care for P. In my view, before this could be considered the father and P would need to spend extended periods of time together so that their relationship can develop and P can also get to know his wife and daughter. It would also be essential that the language barrier is overcome, either by P learning Arabic or, more likely, by the father improving his English. The Guardian observed in her final analysis that the father has not as yet taken any meaningful steps to learn English to a standard that would enable him to communicate fully with P but seemed to assume that if she came to live with him in his home country he would get an Arabic tutor for her. In my view, this is expecting too much of P and if the language barrier is to be broken down, the main work needs to be done by the father and not by her.108Unusually, in this case I need to consider, albeit in very general terms, the capacity of any prospective foster carers to meet P’s needs. In most cases the court will assume that a trained foster carer has the capacity to provide a good standard of care. In this case the situation is very much more complicated. Parenting a child with P’s condition requires much more than the usual type of care. It is not just a matter of learning the mechanics of weighing out food and supplying the amino acid supplements at the right time. Any new carer will face the much more difficult job of working to secure P’s trust so that they can overcome her resistance to the treatment regime, and creating a routine and robust systems in the household so that P’s strict diet can be maintained, despite the fact that others in the home, including any other foster children, will not be following it.109I would be hopeful that an experienced foster carer could develop the necessary skills but it is far from guaranteed that that would be successful and the task will be complicated by the fact that P is certain to be missing her mother desperately and the prospects of her resisting are high. Parenting P will, in my view, be a daunting task for all but the most experienced and dedicated foster carer and even such a person, assuming they could be found, might well not succeed.110The range of powers available to the court. The threshold criteria are met enabling me to make a care order as the local authority seeks. If I decide that P should remain in her mother’s care, the mother is willing to accept a supervision order. I have the power to adjourn, as the father asks me to do, if I think I need further evidence about his capacity to provide care for P. It would only be appropriate to do so, in my judgment, if I thought there was a realistic prospect of P being placed with her father in the foreseeable future. Proceedings cannot be adjourned indefinitely if there is no real chance of the father taking on P’s care within a reasonable period of time.111I have not been addressed on the possibility of a care order with P remaining at home. That is potentially an option available to me, although I accept that it is one that should generally be reserved for exceptional cases. 112If I do not agree with the local authority’s plan for contact, it is open to me to make an order under s.34 of the Children Act.