“My attempts to engage Louise have not been fruitful. We are little wiser about her wishes or perceptions, except that she would have liked to stay at The Arc. We may fairly assume that she has made relationships with the staff in the few months she has been there. The scale of her difficulties is significant. Her resistance is both odd and persistent. She has a range of well-practiced tactics to avoid cooperating. Her clinging to staff, seen during assessment, does not have a sense of anxiety about it however; it felt more like a ploy to remain in control.”
“The chief area of concern is Louise’s emotional, social and behavioural profile. Now in mid adolescence, she still has minimal relationships with other young people and certainly no mutual relationships yet. She needs firm-but-fair management. She had settled and functioned reasonably well in the relatively undemanding routines at The Arc, but with generally high (but not continuous) levels of input. The level of attention available is probably a factor in her having enjoyed her placement there. There are now signs that expectations of compliance are eliciting more resistance, as experienced elsewhere. Overall, her difficulties are developmental and are severe and complex. … I take a long-term view of her development. It is important to select the best and most flexible provision to meet her emerging needs until she is, say, 25 years of age, rather than make several changes over a few years, if that can be avoided. I recognise that it may be difficult to find such a placement.”
“Louise needs to: 55. develop better interpersonal skills, which she can use more consistently, with a wider range of people, including peers; 56. begin to learn to behave reciprocally and to accommodate reasonable demands from other people; 57. learn to negotiate her wants and needs by positive means; 58. learn to complete tasks that are within her capability, without supervision; 59. acquire more personal independence, for example planning a meal, shopping for food and preparing it; …”
“64. Louise’s combination of some degree of learning difficulty and emotional and behavioural difficulties including non-compliance will necessitate well organised, structured and consistent provision, throughout the year; 65. The ideal provision would be a single establishment with the flexibility to provide an individualised, holistic education and care, which would comprise: 66. integrated domestic and learning plans which form a ‘seamless garment’; 67. discernible objectives, planned, reviewed and revised on a regular basis; 68. access to on-site and off-site provision (such as local social education and further education facilities); 69. availability of therapeutic advice or input; and 70. the ability to link positively with Louise’s family. 71. If that cannot be found, then an establishment that could provide care and personal development (to a similar standard) all year, but had good links to competent educational provision externally, would be the only other option. I do not consider that a 38 week year, with 14 weeks at home, or in only marginally coordinated supplementary provision, would be desirable.”
“I spoke on the telephone today to M/s Brady, the term leader/keyworker. She described an assertive approach to their managing Louise – essentially a firm-but-fair one, which does not accept negative behaviour but does use praise for cooperative behaviour. If her behaviour is unreasonable then she has to accept the consequences, such as being ignored, when, for example Louise does not make eye contact, or answer a question. Humour is used sometimes to avoid a difficulty.”
“21. The main question, therefore, is should we trade close parental involvement for what is, potentially, the more restrictive environment i.e. Choose Hesley rather than Cintre. 22. Hesley would provide adequate care, but not the optimum social context. There would be very high staffing levels and significantly disabled fellow service users, which arguably would have the potential of restricting Louise’s environment. 23. Cintre, however, would provide both care and a more appropriate social context. It is likely that the educational needs that I was asked to identify, originally, would be more closely met. 24. Mr and Mrs Twomey’s wish, to remain in frequent contact with their immature daughter, who is 17 next month, is entirely understandable however. 25. Should Louise’s parents and indeed Louise herself reject the possibility of placement at Cintre a compromise would be necessary. In that event I could only suggest that Social Services should negotiate with Hesley a plan for Louise’s care and development which endeavours to advance Louise’s functioning in light of her relatively developed capabilities and potential. If that is not part of the process Louise, inevitably in my view, would become embedded at Hesley for the foreseeable future. Even with such plan, there is still the prospect of this young person (who attended mainstream schools, albeit with difficulty and was doing coursework for some elementary public examinations, and who then attended an anxious and pregnant schoolgirls’ unit) living with a significant disable population and not developing optimal independence and social skills. She would have, however, more parental support.”
“(1) Louise will not agree to go to Cintre, either to visit or on placement. Sharon Stafford tried to persuade Louise to visit Cintre at the end of November 2003, and advised that she could fly to Bristol. Louise refused and would not be persuaded. Louise is vehemently opposed to travelling to Cintre by air or rail. (2) There is currently no direct flight between Manchester and Bristol. Southwest Air has firm proposals to operate a direct service between Bristol and Manchester from March 2004, but it is not certain whether and for how long the route will operate. … (5) Since Terry Akerman visited Hesley, Hesley has opened new additional provision on site which is aimed at meeting the needs of children whose needs are similar to Louise’s. The report from Hesley had gone some way to addressing the reservations expressed by Terry Akerman in relation to Hesley.”
“Louise has repeated on many occasions that she is not part of the decision making process about her own future. It is not clear to me that this immature young woman has been supported to the point where she could contribute to an informed discussion about future placements. I have formed the impression moreover that it would no longer be fruitful to persist with that aim. I have expressed my view as to which setting would be likely to provide the more appropriate experience. I am sure that parental antipathy to a placement at Cintre will not change. They are adamant that Hesley is acceptable, Cintre not, because of distance. As a placement, Cintre is unlikely to work without parental support. Although Louise would have greater potential compared with the population at Hesley, that placement would not harm her at all and would be able to provide positive experiences. If they could maintain reasonably high expectations, Louise might have a greater chance of more independent living.”
“ Her impression of the hall where Louise would be living until she reached 18 was poor. • There are locked doors within and at the entrances to the building. • Carers were sat around on the floor within the building. • There was a smell of defecation • The rooms Sharon was shown had little evidence they had been personalised for the young people. Sharon had concerns also about the young people Louise would be living with. There would be four young people at Hesley who would from an appropriate peer group, however the majority of the other young people had complex needs and would not offer an appropriate peer group, as highlighted in Terry Akerman’s report. Mr and Mrs Twomey did not accept Sharon’s concerns. It was agreed that a meeting be arranged to include those invited to this meeting and also a representative to Hesley. Helen Smith advised that in addition to the issues raised by Sharon she would wish to discuss further with Hesley how they would meet Louise’s needs and in particular support her into an appropriate level of independence. Helen advised that Hesley had not yet provided a contract and this would need to be considered by the Contracts Officer and Legal Officer for the Council. Helen further advised that her understanding was that a placement would not be available at Hesley until late May at the earliest. Those present confirmed this.”
“Mrs Twomey and I have discussed the placement issue with Louise as far as possible after the visit. Louise has explained that she refuses to be placed at Insight because it is too small, she does not like the location, and there is nothing to do. Louise states that she wants to be placed at Hesley because she can go to the college there and also work in the shop. Louise also talks about the activities at Hesley including the on-site gym, fruit and vegetable gardening, swimming, off-site activities, the weekly disco, and the drama group which involves the local school. If a situation was engineered to get Louise to Insight for a placement there, there is a distinct possibility that she would abscond. Although Louise is a very vulnerable young woman, she may be able to find her own way home. Louise is determined that she will not be placed at Insight and I do not think it is possible for Mrs Twomey or I to persuade Louise to be placed at Insight. Louise’s views in relation to placement are completely entrenched.”
“All the planning put in place to encourage Louise to effectively participate in the decision making process has not been successful. Louise presents as a complex young woman who requires support and encouragement if she is to develop to her full potential. Currently Louise clearly states what she wants, but is unable to reason her needs or apparently to grasp the options. Louise’s refusal to take an active and informed part in the visits to identified placements and discussions highlight her lack of understanding and ability to make the decisions needed regarding all future planning. The Children Act and social work practice emphasise the need to work in ‘partnership’ with parents. However my recent contact with Mr and Mrs Twomey gave me a distinct sense that they were covertly hostile towards Social Services, if my sense is correct then this raises concerns regarding how this is making Louise feel and difficulties which professionals face when offering Louise the opportunity to reach some level of understanding. In conclusion it is my opinion that it is very important that Mr and Mrs Twomey should work in partnership with all professionals. Louise will be expected to feel fearful and therefore it is important that the adults in Louise’s life help her to come to terms with her current situation. It is my professional opinion that Louise would greatly benefit from living at Insight who would promote her personal development and her life chances.”
“In my experience, it was evident while Louise was at Focus Arc Centre that Louise is biddable. She often presents as reluctant to do things which are in her best interest; i.e. go out, wash, mix with others; however, she is soon talked around with a positive and consistent approach. Louise has expressed a view that she wants to go to Hesley and has consistently presented as not wanting to go to the Cintre Community and more recently to Insight. However, when Louise did visit Cintre, the feedback from Jackie Mears: the manager who assessed Louise as suitable for Cintre and who also showed Louise around the Cintre Centre, was that Louise presented very differently at Cintre to how she did during her visit to Louise at home. At home, Louise was reluctant to engage and quite distant, she was clearly curious though. At Cintre, Jackie reports that Louise was wary initially but later became quite animated and clearly enjoyed being there. Jackie stated that she was of the opinion that Louise would like to stay longer. … It is my opinion that Hesley could meet Louise’s needs however; I have previously outlined my reservations around this resource. It is my belief that Louise’s needs would best be met within a community based resource. This view has been reinforced by Judy Noble of Hesley College and Jackie Mears of Cintre Community, with whom I have discussed the merits of their respective placements. The view of Terry Ackerman, Psychologist, was clearly stated at the meeting of22nd July 2004 that he is of the opinion that Insight would best meet Louise’s needs. … I consider Insight to be the best placement to meet Louise’s long-term needs. These, the contents of my statement, are true.”
“My general comments about much of Mr Twomey’s statement is that it confirms an impression that while the court case is carrying on the flow of information to social services about what is happening with Louise is severely restricted so that information appears when it is needed for a court statement but not before. Social Services Officers have been asked to make contact through Mr and Mrs Twomey’s legal advisors and not contact Mr and Mrs Twomey direct. This therefore prevents Calderdale from carrying out its role in an effective way. The litigation focus (particularly in relation to Hesley) has been unhelpful to co working. It has I believe stood in the way of Louise being allowed to go to the type of establishment which would be best for her. The decision that Louise would best placed in a residential setting is partly because of the difficulties Mr and Mrs Twomey have had in coping with her (and given the pressures which Rebecca’s care imposes). I believe that part of the message of Mr Twomey’s statement is that it confirms that they need her to be supported, advised and cared for by people who have the right professional skills. This was evident in the progress made whilst Louise was at Focus Arc. Any move away from home requires that Mr and Mrs Twomey step back and allow others to take the necessary steps. As I have pointed out in my 27.7.04 statement I would propose to act on the basis of accepting their statement that they will not obstruct an appropriate placement. If they are now prepared to work outside of a litigation format and on a basis that they will implement qualified professional advice then I believe that with preparation a successful placement at Insight can be achieved. Mr Twomey has expressed his opinion that if placed at Insight there is a distinct possibility she could abscond. Based on all of the available information and professional advice I do not believe that his is a prediction which has any identifiable likelihood. I am not aware that this has ever been a feature of Louise’s behaviour or that any part of the records supports this as a strategy of Louise’s. Any risk aspects would anyway be at the heart of care planning. I cannot therefore support a view that this is a significant risk. I think Mr Twomey’s concern starts from the wrong point because it does not take account of the work that can be done with Louise if permission is given. Part of the exercise now for the professionals is to help Louise to take control of aspects of her life in a positive way. I have now had the opportunity to consider the Initial Assessment of Louise provided to me by Insight on the afternoon of 30th July. I would ask the Court to read the assessment. I am impressed by its contents. It is a detailed analysis of Louise’s needs and how Insight would seek to meet Louise’s needs and is in marked contrast to the very basis care plan provided by Hesley on which I have commented in earlier statements. The Insight assessment further reinforces my opinion that Insight is the most appropriate placement for Louise. This forward-looking plan is a great improvement on the limited goals which Louise had had through this year so far. I have had a summary of the basis on which the Insight option is said to be unlawful. My comment is that I believe that Louise’s wishes need to be and can be handled differently, that she does not have an understanding of what is involved and that with suitable preparation, professional support and parental cooperation a successful placement can be made. I do not believe that the outlined absconding option is at all likely. Louise’s education needs have moved on from last year. Her GCSE chances were stopped by the family discussion about non attending. Her educational needs are now as advised by Mr Ackerman and the Council is following his advice. At the meeting on 22nd July Mr Ackerman reported: “As far as the wider issue of personal development the unit has session plans/service plans. They individualise what would be available according to the service users needs and can provide college support or other support e.g. distance learning. The young man I spoke to was doing a course. In the long term Insight intends to get registered with the Learning and Skills Council to provide a learning environment but cannot guarantee as they are in the very early stages. Taking what is available currently there is a satisfactory living environment with planning and review in place and the opportunity to use the resources of the wider environment appropriately.”
“More formal educational goals should be planned with her/people who know her best as they will need to be personally meaningful to harness any natural motivation. Once the tasks arising from the goals have been identified they should be approached as for other task demands.”
“Insight provides a high standard of decoration and furnishing. The atmosphere at the Home is relaxed and friendly and the environment warm and comfortable. A thirteen-week assessment period is undertaken prior to admission. Detailed service user plans and risk assessments are in place. During the inspection, the service users consulted were highly complimentary about the care and support provided. The inspector observed a good rapport between service users and the staff team. Access to appropriate healthcare resources is available. No formal complaints have been received by the NCSC. Staffing levels are well above agreed requirements.”
“TA – Insight was a refreshing example of a good environment. The immediate impact was the quality and size of the living space and the wholesomeness. I talked at some length to the manager, Wendy Shepherd and went through documents looking at examples of service user plans. I talked to Alan Rudman, Psychiatric Nurse – Cognitive Behavioural Specialist. This inspired confidence in me in that they could provide an appropriate behavioural response. I since looked at the last unannounced inspection report which were mainly 3’s [standard met] and 4’s [standards exceeded] which is encouraging. I spoke to a service user, alone. He was positive about Insight and didn’t reveal any difficulties apart from another service user who could sometimes be challenging. In short it was a positive experience. I was encouraged that there would be an assessment period. Wendy Shepherd made the point that compatibility has to be an issue, therefore it is prudent to give someone a try out. I addition, I used the ultimate criterion of “if my daughter was going there how would I feel”? I would feel happy about it. I didn’t talk to the other staff for long as there was not enough time but informal conversation suggests they were pleasant. Therefore I would be fully confident if my offspring was there. As far as the wider issue of a user’s personal development is concerned, the unit has session plans/service plans. They individualise what would be available according to the service users needs and can provide support in college or other support e.g. for distance learning. The young man I spoke to was doing such a course. In the long term Insight intends to get registered with the Learning and Skills Council to provide a learning environment but cannot guarantee that as they are in the very early stages. Taking what is available currently, there is a satisfactory living environment with planning and review in place and the opportunity to use the resources of the wider environment appropriately.”
“JW Question: How would Insight meet Louise’s educational needs? TA Answer: Going back to my report, Louise has developmental needs in the broadest sense. The principle concerns must be in relation to her ability to act appropriately with people (learning to accept and express demands). An educational context is one in which one may learn and apply these skills. Until there are sufficiently established relationships Louise will find it hard to accept going on to a course in some way; she needs a gradual transition. It would be subject to her learning to reciprocate in a social sense. JW Question: How would they teach her to reciprocate? TA Answer: By modelling and providing positive options for a young person to take. In a sense from boiling down what everyone else learns in life and making it part of what happens in the unit. There is no specific programme, you have to take it in context. An experienced person will know how to take this forward. There will be elements of Louise being given specific targets and objectives. HS Question: Will Insight be able to? TA Answer: I have confidence. Staff have various degrees of experience but they receive supervision and have developmental programs in place.”
“In the case of a child to whom section 20(11) of the [Children Act 1989 ] applies (child aged 16 or over agreeing to be provided with accommodation) the arrangements shall so far as reasonably practicable be agreed by the responsible authority with the child before a placement is made and if that is not practicable as soon as reasonably practicable thereafter.”