Application by the Trust for permission to amputate the P's leg was granted.

The court had to decide whether the assessment of capacity to make decisions about diabetic management is one macro-decision which encompasses all of the many micro-decisions that the P is required to make when managing her diabetes, or, whether the P's capacity should be assessed in respect of each micro-decision or group of micro-decisions.

The P is a 64-year-old woman with a personality disorder with components of different types and has an emotionally unstable paranoid histrionic and dependant personality disorder. She also suffers from a number of physical health conditions, including hypertension, chronic obstructive pulmonary disease and unstable diabetes, which has led for instance to her having a below-the-knee amputation. Generally, she is compliant in the administration of the insulin, but not compliant in relation to other forms of medication. The management of her healthcare has been increasingly very difficult. Over four days in June 2018, Cohen J heard several applications concerning the P, concerning her capacity to make decisions about her residence and care. There are occasions when the P has the capacity to make micro-decisions in respect of her diabetes and occasions when she does not, i.e. that her capacity fluctuates. This hearing was to determine whether, when deciding if the P has the capacity to manage her diabetes, this is to be considered as one macro-decision, a series of micro-decisions which need to be made on a regular ongoing basis, or as a group of decisions.

The court approached the matter on the basis of the experts' conclusions, logically, legally and practically, and concluded that it was a macro-decision, and the P lacked capacity to take the macro-decision. The issue of fluctuating capacity, therefore, simply did not arise.

Read the full text of the judgment on Bailii

The P was found to have capacity to consent to sexual relations.

​Application by NHS Trust for the court to make an anticipatory and contingent declaration in the event that the pregnant P became incapacitated. The application was granted.

Application in respect of costs within proceedings brought under Section 21A of the Mental Capacity Act 2005 was dismissed.

The court ruled that the P's LPAs were invalid as one of the attorneys had witnessed the donor's signature. The registration was cancelled.

Guidance has been given on the taking of samples from a person who does not have the capacity to consent.

Can, or should, the court appoint as deputy the holder of a specified office or position (as distinct from a named individual holding such office at the time of the appointment)? Yes, as long as certain conditions are met.

An application was made by the current holder of the post for the appointment of “The Head of Business Development & Client Finance” of Focus Independent Adult Social Work C.I.C. as property and affairs deputy for the P. The court had to decide whether the current holder of such a post, as opposed to a named individual, could be appointed as deputy, and, if they could, whether there should be any specific requirements in the order of appointment in respect of notification to the court and/or the OPG of any change to the holder of the office of Head of Business Development and Client Finance at the Applicant company.

The court held that such an appointment could be made on condition that the deputyship order shall specifically include requirements that the holder of the post of Head of Business Development & Client Finance at the date of the appointment notifies the Public Guardian forthwith if:

• she ceases to hold that post; and/or
• there is any change to the competence of Focus Independent Adult Social Work C.I.C. to carry out the functions of deputyship, by variation of its Articles of Association or otherwise. 

Read the full text of the judgment on Bailii

A scathing judgment where the Judge made critical findings against the London Borough of Lambeth and Lambeth CCG for their handling of the repatriation of the P to Colombia.

​Appeal against an order made in COP proceedings where the judge who made the order had also been the judge in related family proceedings. Appeal allowed and the order was set aside.