I eventually finished reading the Hamzah Khan Serious Case
Review Overview Report (http://www.bradford-scb.org.uk/hamzah_khan_scr.htm). 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 (http://www.nursinginpractice.com/article/history-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 (http://www.bbc.co.uk/news/uk-england-24924117)
, 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.
