The court heard oral evidence from Dr F, Ms C and the Children’s Guardian. 26. Dr F has been involved in his care since April 2022 and had most recently cared for Archie last weekend and earlier this week. She described what she regarded as the ‘not insignificant’ risks of moving Archie to a hospice as being first the physiological risks that are inherent with regard to Archie’s condition, such as the risk of a drop in blood MRS JUSTICE THEIS Barts Health NHS Trust v Dance and Battersbee Approved Judgment pressure when he is turned and moved. This is a particular risk in the moves from bed to trolley and movement in and out of the ambulance. Second, human or accidental error that may dislodge tubes with medication that is there to support him in the context of a small transport team that would not be familiar with his care. Third, higher risk of equipment failure (battery run) and inherent risks of being in an ambulance on the road. Fourthly, the logistical risks regarding transfer of someone in Archie’s condition, including delay and the need for the ambulance retrieval service to liaise with the palliative care team at X hospital, co-ordinate with the hospice as to bed availability, have conversation with the family to ensure understanding intensive care will not be continued and treatment would be withdrawn within a very short time after arrival, usually about an hour. There would also need to be an additional ambulance team involving specialist staff and an additional ambulance to be available. Only once that is in place would the hospital finally liaise with the hospice and confirm bed availability. Although accepting it was difficult to judge she was informed this is likely to take a minimum of 48 hours. This is subject to a number of variables such as availability of staff, ambulance, and other demands on the service. 27. It was accepted that Archie had been moved during his time in hospital, such as for scans, which had involved movement around the hospital and movement from his hospital bed. Dr F was clear that was different is a hospital setting with his treating team on hand to the proposed transfer by the ambulance retrieval service. 28. As regards the option of ‘blue lighting’ during any transfer Dr F said her understanding is in circumstances such as this that would not be an option if Archie deteriorated during the journey due to his clinical circumstances. There would also be clinical reasons not to do that due to the risks of making matters worse. 29. Dr F placed emphasis both in terms of assessing the risks of Archie moving and the benefits of remaining at the hospital. Archie has what she described as a bespoke care regime to meet his particular needs. Once he leaves the hospital Archie would be with people who would be unfamiliar with his particular care needs and would be caring for Archie in very different circumstances, in the confines of a vehicle and a reduced care team. 30. In her oral evidence she emphasised that in reaching their conclusion the treating team have to weigh in the balance the views of the family and their wishes in reaching a conclusion about what is in Archie’s best interests. They also have to consider the impact of delay in the context of the conclusions that have been reached about Archie’s condition. 31. Turning to the evidence of the mother about what she has observed as a possible change in Archie’s clinical condition Dr F’s evidence was clear that this was not related to Archie breathing, this had not been observed by any staff. Dr F described the sensitivity of the breathing equipment, how it responds to things like condensation or small movement, for example during physiotherapy movements that can result in a change of pressure onto abdomen or stomach that moves air into the chest. These incidents cause the ventilator to display this change, for example by a white line. She described the steps taken by the clinical team on 26 July 2022 having been told of the changes the mother reported, those actions did not support any evidence of independent breathing by Archie. The white lines alone do not represent Archie breathing, there is a need to look at the patient and see if there is any chest movement. That has not been observed MRS JUSTICE THEIS Barts Health NHS Trust v Dance and Battersbee Approved Judgment and when the steps are taken (such as to remove water condensation) the white line disappears. The PICU chart recordings have remained constant. When asked about the more recent changes noted by the mother Dr F was not aware of them or them having being brought to the attention of the treating team and considered they were more likely to have been caused by the factors she had outlined and the sensitivity of the machine. As regards the level of the alarm settings the mother refers to in her recent statement, Dr F said the important alarm setting is for apnoea in the context of the high level of