A County Council v A Mother & Ors

In care proceedings, serious allegations must be proved on the balance of probabilities. The cogency required depends on the seriousness of the allegation, but does not impose the criminal standard of proof. Fact-finding must consider the whole evidential and social context, not medical opinion in isolation. Expert evidence assists the court but does not bind it; the court must evaluate the reasons, logic, consistency and independence of the opinions. Labels such as Munchausen’s Syndrome by Proxy and Fabricated and Induced Illness are descriptions of behaviour, not recognised diseases, and must not replace precise findings of fact and risk assessment.

The local authority sought care orders concerning three children. The proceedings were split, with factual findings to inform later welfare decisions. The principal allegations concerned fabricated or induced illness, including falsified diabetes evidence, exaggerated symptoms, inappropriate medication, and the promotion of an illness identity in one child. The mother denied deliberate fabrication and disputed that the statutory threshold was met. The court had to determine which medical and behavioural presentations were genuine, which had been exaggerated or induced, and the significance of the mother’s conduct for the children’s future care and risk.

1. The court made findings of fact for the purpose of determining the threshold and informing the later welfare hearing. The applicable standard was the balance of probabilities. Serious allegations require evidence of appropriate cogency, but the local authority was not required to satisfy the criminal standard: [1996] AC 563; [2003] 2 WLR 1075; [2004] 2 FLR 263.
2. Fact-finding must be based on all available material and assessed in context. Medical and scientific evidence is important but is not determinative in isolation. The court may choose between expert opinions and must evaluate the reasons, internal consistency, logic, accuracy, independence and response to cross-examination of each expert. Uncontradicted expert evidence does not bind the court: [1990] 1 Med LR 117; [2002] 2 FLR 599.
3. The court found that the child had experienced genuine epilepsy, intermittent ataxic symptoms, developmental delay, behavioural difficulties and stress incontinence. The mother had nevertheless fabricated or tampered with diabetes testing, exaggerated aspects of the medical history and had probably administered medication carelessly, contributing to some symptoms. The court rejected an approach that treated every earlier presentation as fabricated merely because a later fabrication was established.
4. “Munchausen’s Syndrome by Proxy” and “Fabricated and Induced Illness” are child-protection descriptions of alleged conduct, not medical or psychiatric diseases. They cannot substitute for findings about fabrication, exaggeration, omission, induction, harm and risk. The label should be used, if at all, only as a factual description and should not be used to reopen earlier findings merely because the label was attached.
5. The judgment also emphasised the need for senior, strategic and genuinely multidisciplinary working between health, social care, education and criminal justice professionals. The children’s welfare and the analysis of evidence should not be controlled by a single professional perspective.

First instance judgment. The court made factual findings in split care proceedings and adjourned submissions on the statutory threshold and the children’s future care arrangements.