Pubdate: Sat, 12 Nov 2005
Source: Scotsman (UK)
Copyright: The Scotsman Publications Ltd 2005
Contact:  http://www.scotsman.com/
Details: http://www.mapinc.org/media/406
Author: Jane Bradley

SECRET CONCERN FOR 4000 LOTHIAN CHILDREN

HEALTH workers have failed to report concerns about the welfare of 
4000 children in the Lothians.

The shocking statistic has emerged from an NHS inquiry into the case 
of toddler Michael McGarrity, who was left to survive for six weeks 
alone in a flat with the body of his drug-addicted mother. The probe 
found that health workers failed to raise the alarm about the Leith 
youngster despite being concerned about his wellbeing.

And it uncovered 4000 other cases where health workers have raised 
concerns - often because of their parents' drug abuse or drinking - 
but failed to alert social workers.

The findings today sparked demands for an independent inquiry.

The failings have been uncovered two years after the O'Brien Report 
into the death of baby Caleb Ness in Edinburgh. It warned then that 
the NHS needed to react better to the concerns of health visitors 
about children who may be at risk and said it needed to communicate 
better with social services.

The internal health service investigation was launched after 
three-year-old Michael was discovered close to death after surviving 
for six weeks alone in a flat with the body of his drug-

addicted mother. Police officers finally broke into the Leith flat 
where they were living after staff at Michael's nursery school 
finally raised the alarm.

Two health visitors were suspended by NHS Lothian as it investigated 
whether Michael's ordeal could have been avoided.

The Evening News understands the investigation has discovered that 
the health visitors who had contact with Michael and his mother 
recorded concerns about his wellbeing.

Michael's mother, Anne-Marie, was a recovering heroin addict, who was 
taking a methadone prescription.

The results of toxicology tests on the 33-year-old's body are awaited 
by police, who have not ruled out a drug overdose as the cause of death.

Senior sources said chief executive Professor James Barbour held a 
furious meeting with care managers after learning of the results of 
the investigation.

The report, which is due to be published in the coming days, is 
understood to warn that Michael's case is not an isolated one.

Health visitors have identified the home circumstances of other 
children as "cause for concern", but failed to alert social workers 
about their fears.

However, health chiefs are understood to have left the 4000 figure 
out of a final draft of the report for fear of the concern it would raise.

Both the O'Brien report and the latest guidelines on child protection 
make it clear that health workers should report any concerns at all, 
even if they do not feel action must be taken, to the council's 
social work department.

But a spokeswoman for NHS Lothian insisted that although health 
professionals had raised concerns about 4000 children, their cases 
were not felt to be serious enough to be reported to the council.

Director of Public Health, Alison McCallum, who is chairing the NHS 
Lothian critical incident team investigating the McGarrity case, 
said: "The NHS has been working very closely with the City of 
Edinburgh Council through our investigations into the circumstances 
of the Michael McGarrity family case.

"The full findings of the critical incident team are not as yet 
available. Until the team has concluded its investigations and has 
completed a report on its findings it will be inappropriate to 
comment any further."

BUT councillor Tom Ponton, convener of Edinburgh City Council's 
influential social work scrutiny panel, called for an independent 
inquiry into the way NHS Lothian deals with child protection cases.

He said: "If the health board are withholding information, we are in 
a very serious situation. I am very worried about these children.

"The less we know about their history and the way they are living, 
the harder it is to protect them.

"There could be hundreds of children in a similar situation to 
Michael McGarrity or Caleb Ness.

"We have the networks to deal with situations like this, but if 
[health workers] are not giving us the names of the children who may 
be at risk in the first place, we cannot do our job."

Caleb Ness died in 2002 when he was 11 weeks old after being released 
into the care of his drug-addict mother and brain-damaged father, who 
shook him to death.

As a result of the O'Brien Report into the tragedy - which found 
"failures at every level" of the city's child care system - new child 
protection rules were unveiled last week.

The rules, drawn up by police, social work and health chiefs, 
outlined the need for better communication between NHS workers and 
the city council's social work department.

SNP health spokeswoman Shona Robison said she was disturbed by 
another failure to pick up on warning signs that a child may be in danger.

She said: "Precautionary action is obviously a clear recommendation 
from both the O'Brien Report and the latest guidelines that should 
have been followed. It is disturbing that once again, there has been 
a failure to observe them.

"Although not all of those 4000 cases that have been highlighted are 
of immediate concern, there will be some there that are as urgent as 
Caleb Ness or Michael McGarrity.

"Poor communication always increases the risk of there being more 
cases like these.

"If vital information hasn't been passed on from health workers to 
the social work department, the chance of something happening is 
greatly increased." Health visitors are required to keep a record of 
any families - such as Michael McGarrity and his mother - that they 
believe give "cause for concern". Visits to these children should 
occur on a more regular basis.

There are a wide variety of factors which could lead to health 
visitors deciding to record a "cause for concern", including parents' 
drug and alcohol habits. However, many will be as a result of less 
serious circumstances, such as, perhaps, a particularly dirty house, 
which could put the child's health at risk.

One health service source said normal practice among health visitors 
was to notify social workers only of the most serious of cases marked 
"cause for concern". That would normally be just cases where parents 
were active users of hard drugs or had serious alcohol problems, the 
source said.

"I don't think [social work referral] is happening in all cases 
[where parents are using hard drugs]. I think if the people of 
Edinburgh found out how many pregnant women are on drug prescriptions 
or are regular users of heroin, they would be horrified. There are a 
very large number of women in that situation."

Union leaders defended the work being done by health visitors in 
Edinburgh, but said they often had to struggle under a heavy workload.

A spokesman for public sector union Unison said: "Health visitors and 
social workers tend to communicate very well in Edinburgh, and much 
better than those in general practice, for example.

"We are also aware that social workers and health visitors have very 
heavy workloads."

Ms McCallum added: "Even in cases where social services were not 
involved with children in a statutory sense, they would provide 
advice, support, and signposting to help children and families access 
appropriate services from other statutory or voluntary agencies.

"This is not contrary to any of the guidelines developed following 
the tragic death of Caleb Ness or the recent ELBEG guidelines"

Warnings That Should Have Been Heeded In Wake Of Caleb's Death

THE O'Brien Report into the death of baby Caleb Ness was issued on 
October 9 2003. Its 35 recommendations included:

That the best means of triggering early reviews or immediate action 
in response to health visitors' concerns be investigated, and 
improved upon, as a matter of urgency

That serious dialogue is undertaken to clarify the role of the 
trusts' child protection services within an interagency context

That all agencies make it a priority to collaborate and put in place 
effective risk assessment processes to underpin decision-making

That the Lothian University Hospitals Trust reviews the accuracy of 
its record keeping for at-risk children

That Lothian Health ensures that its various Trusts fund the training 
requirements identified by their own senior staff with management 
responsibility for child protection

That senior managers with responsibility for child protection 
practice have appropriate training to discharge that responsibility, 
in every agency

That the chief executives and medical directors give urgent 
consideration to lines of accountability

The report also noted: "We do consider that it is imperative that the 
social workers actually providing a system of child protection should 
know precisely what they can expect from their medical colleagues. 
Social workers and health workers have to be aware of the need to 
open up a channel of communication in every case."

New child protection guidelines were issued last Friday by Edinburgh 
Lothian Borders Executive Group (Elbeg), a body formed following the 
O'Brien inquiry to oversee child protection in the region, including 
senior representatives of the four Lothian councils, NHS Lothian and 
Lothian and Borders Police. These noted: "An inter-agency assessment 
should be undertaken on all parents and expectant parents with 
problem substance use where there is a level of concern about the 
welfare and safety of the child.

"A 'lead professional' should be identified to manage this assessment 
process, request and collate the information on significant risk 
factors that are likely to affect parenting capacity.

"The assessment should be completed within four to six weeks of 
referral and with pregnant women, by no later than 28 weeks gestation.

"The assessment should include at least one home visit, should be 
recorded and retained in the client's case file. Copies of the 
assessment and its outcome should be sent to all practitioners 
involved with the family."
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MAP posted-by: Beth Wehrman