Judge criticises public bodies for operating in silos having only regard to own duties in disordered eating case

He said there had been a silo mentality among the bodies involved and a lack of common sense thinking appeared to have permitted a “disregard for the humanity” of those affected. Court orders had also been ignored.

AB is aged 17 and has restrictive intake self-harming behaviours and is refusing nutrition and hydration.

In June 2025, AB’s mother CD took her to the County Hospital in Hereford where she was admitted to the gastroenterology ward and discharged a week later.

She was readmitted two days later and given intravenous fluids and dextrose. With significant weight loss, and indications of starvation, the clinical evidence was that without an immediate dietetic feeding plan, AB was at risk of significant deterioration.

Later that month, Wye Valley NHS Trust sought interim declarations that AB lacked capacity to consent to medical treatment and that it was in her best interests to be artificially fed.

Some days after that the case reached McKendrick J, who declined Wye Valley's invitation to make such an interim declaration.

Instead, he said he made a narrower interim declaration, which was agreed by Wye Valley, the Official Solicitor and CD.

He said: “Despite this interim declaration paving the way for consideration of a best interest order in respect of artificial hydration and nutrition, delivered with force, if required, Wye Valley did not seek any such relief (despite the terms of their urgent application).”

The judge then made orders  One was against Powys Teaching Health Board whose community psychiatric team was responsible for AB. It ordered the board to report to the court on AB’s progress.

It was also ordered that Herefordshire and Worcestershire Health and Care NHS Trust should report on AB's capacity to consent to medical treatment by way of artificial hydration and nutrition and the use of force or restraint to deliver that.

Wye Valley was then ordered to give an update on AB's clinical presentation and devise a treatment plan which the court would be asked to authorise if AB was not detainable under the Mental Health Act 1983.

The judge said: “Wye Valley did not comply with this order.” Instead it emailed to say AB was now detained under the Mental Health Act and discharged from the trust to a unit under Cwm Taf Morgannwg University Health Board.

Disputes broke out between the NHS bodies concerned over their respective responsibilities and Powys County Council then also entered the case saying it would become involved when AB was discharged from hospital.

In July McKendrick J sought an update from a public body on AB's health, but “no health body was able to update me".

He said no public body, either in writing, or through counsel at the hearing, could tell me if it remained the case that AB had taken no hydration during the previous five days.

Mr Justice McKendrick accepted that Wye Valley's role had largely ended. However, "no other public body attended the hearing or wrote to update the court in respect of AB's health and welfare. It would appear none of these public bodies thought it necessary or appropriate to update the court on the life sustaining treatment of a child.

The Official Solicitor had no update beyond her knowledge that AB had not taken nutrition since 3 July 2025 and had not taken hydration since 5 July 2025.

“Understandably the Official Solicitor would require to seek updates from public bodies, given the parlous state of her client's health.”

The judge said: “Despite the involvement of five public bodies, despite two court orders and notwithstanding the fact this application was urgently issued..... seeking out of hours best interest orders, the court had no updated evidence on AB's capacity twelve days after the issue of these urgent proceedings.”

He said each public body’s reasoning was understandable to some extent, but went on to note: “There are a number of concerning features of this litigation which are individually and collectively caused by the public bodies (although I recognise the very limited role played by Powys County Council).”

The judge said there had been a failure to appreciate these proceedings began as an urgent out of hours application and had to be fitted into already very busy court lists.

“It is especially disappointing to note that orders made have been routinely ignored,” he said. “Nor have the Court of Protection rules been followed.”

He said it was surprising that two court orders to two public bodies made to ascertain the court's jurisdiction were not followed and concerning that Powys Health Board “felt the appropriate response was to email the parties letting them know the order would not be complied with, without considering a formal COP 9 to vary the order, as the original section 49 order provided for”.

The judge said it was “a matter of concern” that Cwm Taf did not update the court or instruct representatives to attend.

He concluded: “All in all, the failure of these public bodies to work together is perplexing. They each appear to operate in silos having only regard to their own duties, without any common sense approach to the life of a child, who requires them to work together to protect her.

“Overall, the approach taken by the public bodies has failed to properly respect Mrs CD and AB herself. The lack of common sense thinking appears to have permitted a disregard for the humanity of those involved.”

Communication between the relevant public bodies has been sufficiently poor such that McKendrick J said: “In the exercise of my quasi-inquisitorial jurisdiction, I cannot accede to Cwm Taf's submission that I stay or conclude these proceedings at the hearing. I do not have the necessary confidence to do so.”

Mark Smulian