By Vicky Farrell, 22nd June 2026
As an experienced clinical lead within NHS community services for older adults, I recently attended a virtual hearing with the aim of gaining insight into how the Court of Protection facilitates complex decision-making outcomes. The case I observed was COP 20019749 before Mrs Justice Theis sitting at the Royal Courts of Justice on 20th May 2026 (via MS Teams).
There are times in my clinical practice where case management for complex individuals reaches a decision deadlock. Within frailty care, decision stagnation often appears to arise from either structural constraints (organisational boundaries, ability to allocate resource, insurances, GDPR, operational capacity and demand) or differing judgements about acceptable levels of risk and responsibility (what is considered ‘safe enough’ at home).
As a first time observer, I am grateful to another observer who watched the same hearing for provide a summary of the circumstances of this case which are as follows:
“The Capacity Assessment undertaken by the independent expert concluded that P lacks capacity. However, the parties subsequently drew up an agreed list of questions that has been put to her, and a response is required within four weeks. The applicant LA (Kent County Council) was seeking a direction for a timetable to be worked out for the outstanding issues to be resolved. P will reach 18 in two months’ time and faces an uncertain future as an adult with several different agencies involved or disputing their involvement. Specifically, the referrals for P to have an OT assessment and a Speech & Language assessment, and the fulfilment in her EHCP that she should have education provided for her, are all seemingly stuck at the moment because of this dispute.”
The similarities – What took me by surprise was how similar the conversations in court felt to discussions in my own clinical practice: such as who are the appropriate representatives at this discussion, who is responsible for assessing care and support needs, who is responsible for funding such care, services, continuation of care across geographical boundaries, and what happens when stakeholder opinions do not align. The hearing was also affected by the same constraints and contexts that shape frontline decision-making. One example was that a professional had not responded to requests for information and P was on waiting lists for statutory services whose assessments may support and inform court processes and outcomes. The most interesting part for me was the request from the barrister representing P, who asked for a framework setting out how organisations are going to work together to provide integrated and coherent care. In other words, how are multiple organisations going to share and hold risk, information, and responsibility and how will this look in practice.
The differences were significant – Decision-making within complex at-home clinical care utilises pattern recognition, ‘rule of thumb’, experience, and the need to assess and implement care plans rapidly. Today, the judge had access to all submitted documentary evidence in order to make informed decisions and this clarity in ownership of information provided a clear trail of accountability. This was highlighted when the judge referred to written records to confirm how long P had been on a particular waiting list. In day-to-day clinical practice, fragmentation of information across systems and organisations perhaps creates greater levels of uncertainty in what can be known. While the outcome of a hearing is subject to appeal, a judge holds authority to compel action from others and if required, can make a final decision. The designated ‘decision-maker’ is more challenging to identify in frontline clinical practice, regardless of whether the decision is being made using the best interests process. This is because no stakeholder can compel another person from another organisation to act. So if an adult holds full capacity to decide on how their safety can be supported at home, their proposed care plan still requires alignment and agreement across the family members and organisations who provide the resources necessary to enable the care plan to work. Within my day-to-day world, there is no operational framework that allows one of these individuals to exercise authority over another, in order to make a final decision.
In summary – What surprised me most was not how different the Court of Protection was from frontline practice, but how similar many of the underlying challenges appeared to be. Questions about responsibility, risk, information sharing and cross-organisational working remained central. The key difference was that the court provided a clearly defined decision-maker with authority to direct action when agreement could not otherwise be reached.
Vicky Farrell is an Advanced Practice Physiotherapist and Predoctoral Clinical Academic Fellow at University of Exeter. She is planning to carry out doctoral research on how complex care decisions are made when supporting older adults living with frailty to remain at home.
Note: From the other observer’s feedback form: The judge set timescales for various evidence documents to be submitted, and set the next Case Management Hearing for either 23.06.26 or 24.06.26 (remotely), and the further full day’s hearing (with evidence from both a doctor and a social worker) on 08.07.26 (hybrid).
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