Wednesday, 20 November 2013

Hamzah Khan – four types of failing

I eventually finished reading the Hamzah Khan Serious Case Review Overview Report ( I ploughed on to the bitter end…. 

The report is not easy to read. It is long and quite confusing. Fact, deductions from fact and opinions are often mixed together in a way that I found hard to digest. In some places there is too much detail, but in other crucial areas there is too little. I can now understand why ministers and civil servants may have become impatient with it.

Although the report does not, in my view, satisfactorily address why questions, it does identify what seem to be four areas of service failure.

Firstly there was a failure of health surveillance. The ideal is that most families with small children should receive some regular input from their GP and Health Visitor during the early years. Hamzah’s mother did not co-operate with health professionals and it seems to have taken far too long for any action to occur to try to overcome her resistance. The GP appears simply to have thrown in the towel and removed the name of the child from the practice list.

This is the issue in the case that concerns me most. For reasons that have never been clear to me, the number of Health Visitors was allowed to fall under the last Government resulting, by 2010, in very high caseloads and overworked practitioners. Although the present Government has an ambitious target for reversing this decline, it is not clear whether this can be met and progress to date has been modest.

Dating back more than 150 years, the UK tradition of Health Visiting ( is one that has been widely admired and copied in other countries. Most families with very young children welcome the help and support of a Health Visitor in providing advice and guidance about their child’s health. Sadly, in recent years, because of high caseloads, services have become increasingly focused on families who have already been identified as being high-need.

I believe all children have a right to health care and to have appropriate access to health care professionals. In most cases parents facilitate this right, but in rare instances they frustrate it. The NSPCC is certainly right to suggest that a ‘red flag’ should be raised by health professionals if a child slips off the health surveillance radar ( , but I wonder whether we need something more.

Although I have never been a fan of more legislation, I do wonder whether or not we should consider some way of overcoming a parent’s unwillingness to having their child medically monitored during the early years. Perhaps some sort of court order, possibly like a Child Assessment Order, could be introduced to allow health professionals to conduct a non-invasive medical examination where there was a proven refusal by a parent to have their child checked for milestones. In most cases parents would probably consent to an examination of their child once they were informed that otherwise an order would be applied for. This idea might sound heavy handed but, without something like this, I do not see how we guarantee a child’s right to health care when a parent wilfully denies the child access to health professionals.

Another theme from the Review is professionals’ failure to consider the impact of domestic violence on the children. In this case the father, who was seen as the perpetrator, had been removed from the home and mother was conceived of as the victim. The focus of help appears to have been on protecting her from him. As so often in child protection we see confirmation bias and fixation error resulting in professionals focusing on one aspect of the case and simply not being able to see other aspects. The children's needs were largely invisible. Training professionals to spot when loss of situation awareness is  happening is something that should be much more common. Building simple mechanisms to review and challenge received-opinions about a case should be an important focus of management. Had one group or another de-briefed properly following contact with this family, somebody might have asked the key question – does mother pose any sort of danger to her children?

That brings us to failures to listen to children and young people. A cry for help from one of Hamzah’s older siblings went unheard, wrongly interpreted as teenage angst.

It is easy to say that we must listen to children more, but adults need to be educated and trained to listen to children better and they need to be supported in articulating a child’s voice within organisations in which adult values and approaches dominate decision-making. Most children’s services remain strongly maternalistic/paternalistic. We need to think of ways in which they can become less so.

Some adults are naturally very able at talking to and listening to children, but most, who aren’t, need to be helped to become better. That is quite a tall order but it does seem to me to be a clear priority for training and staff development across all professional groups who work with children and young people. Talking to and listening to children should be a key part of any qualifying training across a range of professions delivering children’s services and there should be regular top-up training, in my view at least annually. And we should assess children’s services professionals according to how well they are able to communicate with children.

The final area concerns failures to respond to child protection referrals appropriately. This is the area that the minister feels is not addressed clearly in the report and I think most people would agree with him that the report does not provide a clear picture of why referrals were not followed up. Hopefully the report’s authors will be able to assist in answering the minister’s questions. I will return to this area in a new post, when the additional information becomes available.