NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST v M

Where a child who lacks capacity requires urgent medical treatment, the court may authorise deprivation of liberty and the use of physical or chemical restraint when these measures are necessary and proportionate to secure treatment in the child’s best interests. Any restraint must be the least possible level required at the relevant stage and proportionate to the circumstances. A detailed, tiered care plan should ordinarily govern how the child is persuaded to attend hospital and how distress or refusal is managed. The court may also authorise restraint for conveyance to and from hospital where that is necessary and proportionate.

The applicant NHS Trust sought declarations that it was lawful and in M’s best interests to deprive him of his liberty while receiving inpatient treatment and to convey him to and from hospital. M, aged 13, had serious medical conditions requiring urgent treatment, including removal of an unusable port-a-cath, administration of medication, airway investigations and dental treatment.

M had significant behavioural difficulties and had previously required physical holds in hospital. No party argued that he was Gillick competent to decide whether to undergo the proposed treatment. The central issue was whether the proposed deprivation of liberty, physical restraint and chemical restraint were lawful, necessary and proportionate.

1. Declarations granted. It was lawful and in M’s best interests for the Trust to deprive him of his liberty during the proposed inpatient admission and to use physical or chemical restraint if necessary.
2. The proposed medical treatment and investigations were in M’s best interests. The urgent removal of the port-a-cath was required because it was no longer usable and presented an increasing infection risk, while regular treatment for granulomatosis polyangiitis was medically critical.
3. Given M’s previous conduct in hospital, including aggression, damage to hospital areas and refusal to comply with medical care, a detailed and tiered care plan was necessary. The plan was to use persuasion and less restrictive measures first, with chemical or physical restraint only at the last possible stage.
4. Any restraint had to be the least possible level required at the particular stage and proportionate to the situation. The same principles justified authorising potential physical restraint for the purpose of conveying M to and from hospital.
5. The court approved the amended care plan. M’s mother was to be fully involved, subject to the possibility that her involvement might sometimes increase M’s distress, and both parents were to remain fully informed. The declarations extended to the arrangements for M’s admission, treatment and discharge.

First instance decision. No prior appellate decision is stated in the judgment.