Kaylea Titford had no care plan in place when she died, review finds

A 16-year-old girl with “significant and chronic disabilities” who died in squalor at her family home in rural mid-Wales did not have a care plan in place, a child practice review into her death has found.

Kaylea Titford, who had spina bifida and used a wheelchair, was found in conditions described as “unfit for any animal” in Newport, Powys, leading to her parents being jailed for manslaughter by gross negligence.

The review said that though many professionals were involved in Kaylea’s life, her care was not coordinated by a single person or organisation.

It concluded: “Child A [Kaylea] was not subject to a care and support plan at the time of her death. Although multiple health professionals participated in the delivery of her complex health care, this was not coordinated by a single agency or practitioner who had a holistic understanding of her complex health and care needs.”

The report said the teenager, who died in October 2020, had been isolated by the Covid pandemic because she had to shield for six months, and living on a hill in one of Powys’s poorest areas made it more difficult for her to get access to care.

It highlighted “challenges” in communication between health services in England, where she went for some treatment, and professionals in Wales, and it raised concerns that her weight was not monitored, though she was morbidly obese at the time of her death, weighing 146kg (22st 13lb).

The report said: “The local authority should have a system that identifies the children with disabilities in their region who are likely to need care and support. This information should be used to shape allocated resources and the services available to children in Powys.

“There is a void in current provision for children … with identified chronic disabilities who are not subject to a formal care and support plan to ensure periodic reassessment of changing needs.”

Paramedics were called to the family home in October 2020. The report said the condition of the teenager’s body “was a source of anguish and indicative of chronic neglect” and there were “significant concerns about the unhygienic and unkempt condition” of her home.

The report continued: “There was a sense of shock, distress and anger regarding what Child A [Kaylea] had experienced.”

A postmortem found Kaylea to be grossly obese and immobile, which meant she had extensive inflammation and infection leading to her death.

The report, commissioned by the Mid and West Wales Regional Safeguarding Board, said: “The absence of parental intervention to seek medical assistance for Child A lacked explanation and hindered immediate comprehension.”

Kaylea was described in the report as a tenacious and vibrant child determined to live a normal life. It said: “Child A was a wonderful, determined, fun, and headstrong girl who, despite her significant congenital disabilities, wanted to be treated as ‘normal’.”

It said she was discharged from Powys council’s integrated disability service in 2017 and added: “A child with significant and chronic disabilities such as spina bifida should not be discharged from services if that limits the support they receive.”

It said that at the beginning of 2019, Kaylea had 98% school attendance, but during that year her health problems escalated and attendance dropped to 70%. At the start of the pandemic in March 2020, Kaylea had to shield and was isolated for six months.

The report said there was no assessment of the likelihood that she could suffer significant harm during Covid. Her school did continue to speak to Kaylea’s family but the review team found only two recordings where it was explicit that the teenager was spoken to directly.

Her parents, Alun Titford and Sarah Lloyd-Jones, are serving 10 years and eight years respectively for manslaughter by gross negligence.

Powys county council, Powys Teaching Health Board and Dyfed-Powys police expressed their condolences to everyone affected by the teenager’s death.

In a joint statement, they said: “The review has been an opportunity to reflect and share learning amongst all partner organisations and practitioners.”