University College London Hospitals NHS Foundation Trust v GH & Ors [2026] EWHC 1064 (Fam)
[2026] EWHC 1064 (Fam)Case No FD26P00110
IN THE HIGH COURT OF JUSTICE
FAMILY DIVISION
IN THE MATTER OF THE INHERENT JURISDICTION
AND IN THE MATTER OF GH (A CHILD) BORN in 2010
Venue Royal Courts of Justice, Strand, London, WC2A 2LLDate 4 March 2026
Before
MR JUSTICE KEEHAN
Between
UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUSTApplicantGHFirst RespondentJKSecond RespondentESSEX COUNTY COUNCILThird RespondentVikram Sachdeva KC (instructed by Browne Jacobson LLP) for ApplicantChristopher Osborne (instructed by Cafcass Legal) for First RespondentMartha Gray (instructed by Watson Ramsbottom Solicitors) for Second RespondentJames Holmes (instructed by Essex County Council) for Third Respondent (on 19 February)Victoria Burgess (instructed by Essex County Council) for Third Respondent (on 26 February)Hearing Hearing dates: 19 and 26 February 2026JUDGMENTThis judgment was handed down remotely at 10.30am on 9 March 2026 by circulation to the parties or their representatives by e-mail and by release to The National Archiveson 6 May 2026..............................This judgment was delivered in private. The judge has given leave for this version of the judgment to be published on condition that (irrespective of what is contained in the judgment) in any published version of the judgment the anonymity of the children and members of their family must be strictly preserved. All persons, including representatives of the media and legal bloggers, must ensure that this condition is strictly complied with. Failure to do so may be a contempt of court.
Introduction
[1]This is an application brought by University College London Hospitals NHS Foundation Trust (“the Trust”) under the inherent jurisdiction of the High Court in relation to the medical treatment of GH, a 15-year-old child who suffers from relapsed B-cell acute lymphoblastic leukaemia (“B-ALL”).[2]The Trust applied for declarations that it is lawful and in GH’s best interests for specified investigations and treatment to proceed, including treatment by way of CAR-T cell therapy. Without such treatment, the unchallenged medical evidence was that GH would die within a short period of time. With the proposed treatment, she has an estimated 30–40% chance of cure.[3]GH was represented through her Children’s Guardian. Her mother, JK, is the second respondent. Essex County Council is the third respondent.[4]The application concerns life-sustaining medical treatment for GH who has, at different times, expressed resistance to further invasive treatment and whose mother has held reservations rooted in religious, cultural, and personal belief. The court is required to determine whether it should exercise its inherent jurisdiction in circumstances where the consequence of non-intervention is death.[5]At the hearing on 19 February 2026 the mother opposed the application made by the Trust. The children’s guardian proposed a staged approach to the issue of the court approving the proposed course of treatment. In the event I was invited, with the agreement of all parties, to adjourn the hearing for a short period to enable(i) further bone marrow testing to be undertaken to establish whether GH had suffered a relapse and(ii) an assessment to be undertaken to determine whether GH was Gillick competent. Accordingly, the hearing was re-listed on 26 February.[6]The bone marrow testing confirmed that GH had suffered a significant relapse. A consultant child and adolescent psychiatrist, concluded that it was not evident that GH explicitly or obviously lacked Gillick competence.[7]In light of the bone marrow test results the mother did not oppose the declarations sought by the Trust in respect of GH’s proposed treatment plan and GH agreed, not without some understandable reservations, to undergo the treatment.[8]An issue was raised on behalf of the mother as to whether, in these circumstances, the court should make declarations as to best interests and to approve the treatment plan. The trust submitted that because of the past history it was necessary and appropriate for the court to make a best interests decision in case GH changed her mind and withdrew her consent.[9]In any event, I was invited by the mother to give a judgment which would provide a base line in respect of any future application to discharge or revise a best interests decision in the event that GH withdrew her consent.
Background
[10]GH was born on in 2010. She was previously healthy.[11]In September 2024, while visiting her father abroad, GH developed fever, weight loss and anorexia. In October 2024, while in a foreign jurisdiction, blood tests identified leukaemia.[12]She returned to the United Kingdom in November 2024 and was admitted to Broomfield Hospital. Following further admissions and investigations, she was transferred to UCLH on 30 November 2024, where she was diagnosed with B-ALL.[13]Chemotherapy commenced on 9 December 2024. Safeguarding concerns arose, and Essex County Council became involved.[14]In January and February 2025, following the commencement of first-line chemotherapy, the court authorised treatment under the inherent jurisdiction and concluded those proceedings by a final order dated 7 February 2025. Thereafter, GH completed first-line treatment and entered maintenance therapy.[15]Sadly, on 2 December 2025, GH suffered an isolated bone marrow relapse. Relapse induction chemotherapy commenced on 9 December 2025. The early response was encouraging. However, after 31 December 2025, no further treatment was administered.[16]Throughout January 2026, there were missed appointments, refusals of procedures (including central venous access), and failure to return to hospital for planned treatment. The medical evidence was clear that this interruption materially worsened GH’s prognosis.[17]On 13 February 2026, the Trust issued the present application. A Transparency Order was made. On 19 February 2026, by consent, I authorised a bone marrow aspiration, directed a structured assessment of Gillick competence, and required a further independent haematology opinion. The matter was adjourned for those steps to be completed.
Law
[18]The legal principles to be applied in this case are agreed by the parties. The court has a protective inherent jurisdiction over children, which is highly likely to be exercised where a child is seeking to refuse treatment which will in all probability lead to the death of the child or to severe permanent injury despite the child having contrary views: In re W (A Minor) (Medical Treatment: Court’s Jurisdiction) [1993] Fam 64 (esp at 81H–82A; 83B; 88F; 89G–H; 91E–F; 92D; 93C–E; 93H; 94B–E) ; E v Northern Care Alliance NHS Foundation Trust [2022] Fam 130 ([44]–[60] and [57] ).[19]I was referred to and have taken account of the decision of the Court of Appeal in O v. P & Another [2024] EWCA Civ 1577.
Medical Evidence
[20]GH’s treating consultant haematologist, is a leading national and international expert in cellular therapy, including chimeric antigen receptor (‘CAR’) T cell therapy and the management of haematological malignances.[21]In her first report she concluded by noting that the consensus of the clinical team treating GH was that it was unquestionably in her best interests to receive chemotherapy in accordance with the CLCN UKALL 2019 interim guidelines, namely the CAR T cell therapy. It was the only available and viable treatment for GH’s condition. The alternative would be GH’s death in a matter of weeks or months.[22]Having considered the recent test results, GH’s treating consultant advised the court that “There is now an increasing urgency to proceed with the proposed treatment plan to a) prevent GH from becoming unwell due to progression of her leukaemia and b) enable us to collect sufficient T cells. T cells are normal blood cells which are collected and used to manufacture the CAR T cells. As leukaemia progresses, the bone marrow is unable to make normal blood cells efficiently and the circulating number of T cells falls. An adequate number of circulating T cells is an important factor in determining whether an adequate harvest and CAR T cell manufacture is possible.”.[23]Dr. YX, a consultant haematologist at Great Ormond Street Hopsital, was asked to give an independent second opinion. In his report he concluded that “there is no diagnostic or therapeutic dilemma in this case. GH has a very early relapse of acute lymphoblastic leukaemia. Kyrmiah offers a 30-40% chance of cure with likely minimal long-term side-effects. Although not perfect, it has truly revolutionised the approach to relapsed ALL and gives patients such as GH a very real chance of an entirely normal life. I would very strongly recommend that she proceeds as soon as practicable. We discussed that the main problem is lack of persistence of the CART and that we now endeavour to do everything possible to help this problem. Securing a good harvest of T-cells before the leukaemia returns to the blood is one such step. Ideally, one would have liked to have harvested last week. Finally, I did mention that perhaps these repetitive discussion are not helping GH. I got the impression that she has the capacity to and has made a decision and from the family outwards, we should now support her in that process”.[24]The medical evidence was not challenged. I have no hesitation in accepting the opinions of GH’s treating consultant and of Dr. YX.
Analysis
[25]The mother and GH have in recent months questioned, and doubted, whether GH had suffered a relapse and/or whether she required any further medical treatment. The mother had been keen to explore other options for the treatment of GH’s cancer, including alternative therapies available abroad.[26]However, since the recent further test results were explained to them by the clinicians, they now both accept that there is no option other than for GH to undergo the treatment plan advised by GH’s treating consultant, which is strongly supported by Dr YX.[27]This has been a frightening and very difficult time for GH. She knows the treatment plan will, at times, be painful and difficult for her. Once the harvesting of the cells has been completed and they have been prepared she will have to spend a prolonged period of weeks as an inpatient at hospital. She quite understandably has her doubts and reservations. Nevertheless, she knows and understands that the only alternative to this treatment plan is her death. She was clear in the views that she expressed to her guardian that she very much wants to live and to live a normal, happy and fulfilling life. She has, therefore, agreed to undergo the cell replacement therapy treatment.[28]The mother wished for there to be some provision to revise or revisit the order giving approval to the treatment plan if GH changed her mind. It is, of course, open to the mother and/or GH to make an application to the court in respect of any order I make on this application.[29]There are two important points to make. First, the medical evidence and the opinions of GH’s treating consultant and Dr YX are clear and unequivocal. The treatment plan is GH’s only possible course to achieve a cure and long-term recovery from her cancer. Once embarked upon it is essential that it proceeds without any interruption. In these circumstances, it is entirely right and appropriate that the court approves the treatment as being in GH’s best interests, not least to endorse and support her decision to proceed with the treatment. Second, it is imperative that everyone involved with GH gives her the support and encouragement she needs to enable her to embark upon the treatment plan and to engage with her treating clinicians so that she may successfully complete the treatment.[30]At the request of all parties, I wrote a letter to GH explaining why the court considered it to be in her best interests to undergo the cell replacement therapy and to endorse her decision to consent to the treatment.
Conclusion
[31]Accordingly, I will make the declarations and best interest decisions sought by the Trust to enable the agreed treatment plan to be implemented.[32]GH has made a clear decision to embark upon this treatment regime. She was right to do so and I wish her well.[33]I am very grateful to GH’s treating consultant, Dr YX and to counsel for all of the parties for the assistance they have given to the court.