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England and Wales High Court (Family Division) Decisions
You are here: BAILII >> Databases >> England and Wales High Court (Family Division) Decisions >> T (A child), Re  EWHC 220 (Fam) (07 February 2020)
Cite as:  EWHC 220 (Fam)
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Strand, London, WC2A 2LL
B e f o r e :
| London Borough of Tower Hamlets
|- and -
|- and -
|- and -
|T (a child)
(by the Child's Guardian)
Mr Michael Bailey (instructed by Lillywhite Williams & Co) for the Mother
Father acting in person
Ms Nina Hansen (Freemans Solicitors) for the Child
Hearing date: 5th February 2020
Crown Copyright ©
Mr Justice Hayden :
'AND UPON the court giving a preliminary provisional indication that the contested issue of the administrations of vaccinations to the child would require to be determined by the court in the course of a discrete application seeking permission to invoke the court's inherent jurisdiction.'
"33. In this case the court is concerned with the issue of vaccinations in the context of children who are the subject of care orders and thus the dispute is between the local authority sharing parental responsibility for the child and the parent with parental responsibility. In the circumstances where SL is in the care of the local authority, by virtue of s 9(1) of the Children Act 1989 the local authority cannot apply for a specific issue order with respect to the issue of vaccination. Further, given the gravity of the issue in dispute, it is not appropriate for the local authority simply to give its consent to immunisation pursuant to the provisions of s 33(3) of the Children Act 1989 on the basis of its shared parental responsibility for SL under the interim care order (see A Local Authority v SB, AB & MB)  2 FLR 1203 and Re Jake (Withholding Medical Treatment)  EWHC 2442 (Fam))."
"Whatever its strict rights may be, a local authority will usually be ill advised to rely upon its parental responsibility under section 33(3)(a) of the 1989 Act as entitling it to authorise medical treatment opposed by parents who also have parental responsibility: see Barnet London Borough Council v AL and others  EWHC 125 (Fam),  4 WLR 53, para 32, and the discussion in Re C (Children: Power to Choose Forenames)  EWCA Civ 374,  1 FLR 487, paras 92-95."
"90. Whilst I may not necessarily agree with the precise way that jurisdictional issues have been approached or expressed in these very difficult cases, what is clear is that there is a cohort of cases where the common theme is that a party (whether it be a local authority or, often, an NHS Trust) has sought to bring an issue before the court, believing it to be of too great a magnitude to be determined without the guidance of the court, and without all those with parental responsibility having an opportunity to express their view as a part of the decision making process.
91. Most commonly, examples are found in the so called 'medical treatment' cases where, either an NHS Trust seeks a declaration from the court that they would not be acting unlawfully in pursuing or desisting from a form of treatment notwithstanding the parent's refusal to consent, or alternatively, a local authority seeks to invoke the inherent jurisdiction of the court and thereby to submit to the court's jurisdiction notwithstanding that care proceedings may have been open to them."
"All these cases depend on their own facts and render generalisations – tempting though they may be to the legal or social analyst – wholly out of place. It can only be said safely that there is a scale, at one end of which lies the clear case where parental opposition to medical intervention is prompted by scruple or dogma of a kind which is patently irreconcilable with principles of child health and welfare widely accepted by the generality of mankind; and that at the other end lie highly problematic cases where there is genuine scope for a difference of view between parent and judge. In both situations it is the duty of the judge to allow the court's own opinion to prevail in the perceived paramount interests of the child concerned, but in cases at the latter end of the scale, there must be a likelihood (though never of course a certainty) that the greater the scope for genuine debate between one view and another the stronger will be the inclination of the court to be influenced by a reflection that in the last analysis the best interests of every child include an expectation that difficult decisions affecting the length and quality of its life will be taken for it by the parent to whom its care has been entrusted by nature."
"(1) Where a care order is made with respect to a child it shall be the duty of the local authority designated by the order to receive the child into their care and to keep him in their care while the order remains in force. […]
(3) While a care order is in force with respect to a child, the local authority designated by the order shall–
(a) have parental responsibility for the child; and
(b) have the power (subject to the following provisions of this section) to determine the extent to which
(i) a parent, guardian or special guardian of the child; or (ii) a person who by virtue of section 4A has parental responsibility for the child, may meet his parental responsibility for him.
(4) The authority may not exercise the power in subsection (3)(b) unless they are satisfied that it is necessary to do so in order to safeguard or promote the child's welfare.
"(3) It shall be the duty of a local authority looking after any child–
(a) to safeguard and promote his welfare; and
(b) to make such use of services available for children cared for by their own parents as appears to the authority reasonable in his case. […]
(4) Before making any decision with respect to a child whom they are looking after, or proposing to look after, a local authority shall, so far as is reasonably practicable, ascertain the wishes and feelings of–
(a )the child;
(b) his parents;
(c) any person who is not a parent of his but who has parental responsibility for him; and
(d) any other person whose wishes and feelings the authority consider to be relevant, regarding the matter to be decided
(5) In making any such decision a local authority shall give due consideration–
(a) having regard to his age and understanding, to such wishes and feelings of the child as they have been able to ascertain;
(b) to such wishes and feelings of any person mentioned in subsection (4)(b) to (d) as they have been able to ascertain; and
(c) to the child's religious persuasion, racial origin and cultural and linguistic background."
"1. Diptheria is a contagious bacterial infection affecting the nose and throat and sometimes the skin. It is potentially fatal but rare now in the UK due to the success of the vaccination programme. There is a small risk of catching it when travelling in some parts of the world.
2. Tetanus is a rare but serious bacterial infection caused by the release of toxins when bacteria infect an open wound. The toxins cause muscle spasms and lockjaw which are potentially fatal. Tetanus is rare in the UK due to vaccination and is not contagious but the bacteria is present in soil and manure.
3. Polio is a viral infection that in a small number of cases can affect nerves in the spine and base of the brain causing paralysis. It is rare now due to effective vaccination.
4. Whooping Cough is a bacterial infection that can cause dehydration, breathing difficulties, pneumonia and fits. It can be fatal particularly in babies under 6 months of age. In older children it may cause hernias, nose bleeds and sore ribs. Whooping cough is contagious and the pattern of outbreaks occur in a 4 yearly cycle.
5. Haemophilus Influenzae is a contagious bacterial infection that causes meningitis, sepsis, pneumonia, pericarditis, epiglottitis, septic arthritis, cellulitis, and osteomyelitis. The infection is now rare due to the vaccination programme that started in 1992 but many children who have this infection become very ill. One in twenty with this type of meningitis will die and those who survive have long term problems such as hearing loss, seizures and learning disabilities.
6. Hepatitis B is a viral infection which can cause hepatitis (liver inflammation). The infection is less common in the UK than other parts of the world but some groups are at increased risk including people from high risk countries, people who inject drugs and people who have unprotected sex with multiple partners. Hepatitis symptoms usually pass within one to three months but some infected people will go on to get chronic hepatitis infection which may cause liver cirrhosis, liver failure and liver cancer later in life.
7. Menigitis B is a contagious bacterial infection that is a common cause of meningitis in the UK. It is estimated that one in ten cases of meningitis in the UK is fatal. One person in every 2 or 3 who survive have one or more permanent problems as a result of infection. These include hearing loss, epilepsy, learning difficulties, visual loss, loss of limbs, arthritis, kidney problems and co-ordination difficulties.
8. Pneumococcus is a contagious bacterial infection which can cause pneumonia, septicaemia (blood poisoning) and meningitis. Some infections are fatal and the consequences for children who survive are similar to that for meningitis.
9. Measles is a highly infectious viral infection that may cause pneumonia and encephalitis (brain inflammation). In rare cases it may cause death. Due to fall in the uptake of MMR vaccination it has become more common in the UK with 991 cases confirmed in 2018.
10. Mumps is an infectious viral infection that can be complicated by meningitis, encephalitis, hearing loss, pancreatitis, swollen testicles and swollen ovaries
11. Rubella is an infectious viral infection that can cause a flu-like illness and rash. If contracted by a non-immune pregnant woman it can cause miscarriage and severe birth defects.
12. Meningitis C is a contagious bacterial infection that is a less common cause of meningitis in the UK but has similar consequences for people infected with other types of bacterial meningitis."
"1. 6-in1 vaccine is a single injection which protects against diphtheria, hepatitis B, Haemophilus influenza, polio, tetanus, and whooping cough. It is inactivated which means it does not contain live organisms. Very common side effects (more than one in ten) include high temperature, pain and swelling at the injection site, loss of appetite, tiredness, crying, irritability and restlessness. Common side effects (up to one in ten) include diarrhoea, vomiting, high fever and a hard lump at the injection site. Uncommon side effects (up to one in a hundred) include respiratory tract infection, sleepiness, cough and large swelling on the injected limb. Rare side effects (up to one in a thousand) include rash, bronchitis, swollen glands, thrombocytopenia (low platelet count causing bruising/ bleeding) and in premature babies an increased risk of apnoea (pauses in breathing). Swelling of the face, lips mouth and tongue may also occur (angioedema).
2. Meningitis B vaccine may cause a fever that peaks around 6 hours after vaccination. Because of this it is recommended to give paracetamol after the injection. Other common side effects include pain, swelling and redness of the injection site, vomiting with or without diarrhoea , crying and irritability. These side effects occur in up to one in ten people. Uncommon side effects include high fever, seizures, dry skin and paleness which may affect up to one in a hundred people. Rarely (up to one in a thousand people) it ca cause Kawasaki disease – prolonged fever, with swollen lymph glands, peeling skin red eyes and skin rash – which requires specific treatment. Very rarely the vaccination can cause an allergic reaction which if severe would need treatment for anaphylaxis.
3. Pneumococcal vaccine may cause mild side effects including fever, decreased appetite, irritability, drowsiness and redness or swelling at the injection site. Rare side effects include allergic skin reactions and a high fever leading to febrile seizures.
4. Haemophilus influenza/meningitis C vaccine commonly causes fever, pain or redness at the injection site, irritability, loss of appetite and drowsiness. Uncommonly (up to one in a hundred doses) it may cause high fever, rash, vomiting, diarrhoea and skin allergies. Rare side effects (up to one in a thousand doses) may include abdominal pain, feeling unwell and sleeplessness. Severe allergic reactions occur in less than one in ten thousand people who are vaccinated.
5. MMR vaccine is a combination of attenuated live measles, mumps and rubella viruses. About a week to eleven days after injection some children get a mild form of measles which includes fever, rash, loss of appetite and being unwell for two to three days. About one in fifty children develop a mild form of mumps three to four weeks after the injection which includes swelling of the salivary glands in the cheeks and lasts for a day or two. Rare side effects include a small rash of bruise like spots about two weeks after vaccination which is known as idiopathic thrombocytopenic purpura (ITP) and is due to a decrease of platelets (which aid blood clotting). This occurs around one in twenty four thousand doses. This side effect usually gets better without treatment and there is a greater risk developing this side effect from the natural virus infections. Seizures occurring around six to eleven days after vaccination occur in around one in every thousand doses and again it is less likely to develop this complication from vaccination than from natural virus infection. Very rarely severe allergic reactions may occur after vaccination. More complex conditions such as Stevens-Johnson syndrome (inflammation of fatty tissue, skin rashes and ulceration of eyes , skin and mouth) and Guillan-Barre syndrome (a neurological condition causing muscle weakness) have been reported after vaccination but are so rare that the risk cannot be accurately calculated."
"(i) X (22) was in pain for many years after receiving the Gardasil vaccination (HPV), and also led to her being hospitalised for a week. No diagnosis was ever made and still suffers pain today. She was also given 5 doses due to a nurse telling us it was perfectly fine to have extra doses. The recommended dose is 3.
(ii) After receiving vaccinations Y's (11) development was delayed which has led to him having to receive growth hormone replacement. It was ruled out that his condition was genetic and to this day it remains a mystery as to why this has happened.
(iii) U (18), F's son, was in good health growing up but now has a condition called Russell-Silver syndrome (SRS-a congenital condition). This was diagnosed when he was 8 years old;
(iv) V (16), F's son, began fitting a week after having the first set of MMR vaccinations. He was subsequently diagnosed with West syndrome (severe epilepsy). V's IRO has informed the parents that V no longer has this condition and no other diagnoses have been made. Currently, V is in a wheelchair, cannot walk, talk, or do anything for himself. He wears nappies 24/7 and self-harms by punching and biting himself. He is said to have a developmental age of a 6 month-old baby.
(v) Research (undisclosed for the purposes of this Position Statement) indicates that a. some vaccinations contain aborted human foetus matter and b. some vaccines contain other ingredients that the mother objects to.
(vi) If T is to have vaccinations then the mother would want these to be given separately as research (undisclosed for the purpose of this Position Statement) shows that multiple vaccines at the same time shock the system and some children go on to develop autism and other conditions. The mother believes that it is safer for T to be given vaccinations separately.
(vii) T is now 10 months old and is in very good health. Apart from a few colds (in foster care) he has not had any childhood illnesses in spite of not being vaccinated and has a strong immune system. Research (undisclosed for the purposes of this Position Statement) shows that babies and children who have a good healthy balanced diet with the correct nutrition build a healthy immune system and do not need to be injected with viruses and heavy metals.
(viii) The Local Authority once informed M than T had contracted measles, but to date this has never been confirmed. If this was in fact the case then M will say that this shows that T's immune system naturally fought of the virus and his immune system is strong."
"2. Growth and development. T was born with moderately low birth weight (between 2 and 2.5kg) which is probably due to maternal smoking in early pregnancy. Low birth weight can be associated with poor growth and delayed development although he has shown good catch-up growth since birth and his development is within normal limits at present. However, his growth and development need ongoing monitoring and recognition of any problems such as decreased growth velocity, motor delay or speech and language delay should prompt early referral for assessment."
"5. Sibling medical history. There is a significant sibling history of growth and developmental problems but these do not affect all his siblings and the conditions that his half siblings have often arise spontaneously rather than having a strong genetic link. T does not have a particular risk of developing these conditions."
"3. Maternal addiction. T's mother has a history of alcohol dependence and alcohol was also abused by maternal grandparents. There is no indication that she drank alcohol during her pregnancy with T and he does not show any signs of Foetal Alcohol Syndrome. However, children of parents with addiction problems have an increased genetic risk of developing addiction themselves and this risk is independent of environmental factors. It is important that adoptive parents are able to raise this sensitive issue with him when he is older and that they are aware of the risks of peer pressure and experimentation with addictive substances during adolescence.
4. Maternal depression. Children of parents who have a history of depression have an increased risk of developing depression themselves. Depression is extremely common and is experienced by around 10% of people in a lifetime. The chances of developing depression rise to around 26% with a parental history. Depression is often a secondary reaction to adverse events and being brought up in an emotionally secure environment with supportive relationships will help to build resilience and mitigate some of the risk."
"6. Change in care settings. T's mother had a complicated pregnancy and spent some time in prison during this period. His care setting was subject to change in the first few weeks. It is likely that he has been exposed to greater than usual levels of cortisol (the 'stress hormone') during this period. Prolonged exposure can be associated with difficulties in cognitive development and behaviour although the risk of this is mitigated by placement in a supportive and secure environment."
"1. Immunisation. T is not currently vaccinated against a range of preventable childhood illnesses detailed in the text. This makes him vulnerable if he is exposed to these infections and he should be vaccinated as soon as possible. There is no medical contraindication for this to be done."
"T requires a safe, consistent and emotionally stable family environment free from the risks posed by neglect, addiction and exposure to domestic violence in order to thrive and develop to fulfil his potential. It is important that he has equitable access to all aspects of child health including vaccination against preventable illnesses, health promotion, and monitoring of his growth and development."