To think Health Visitor home visits should be compulsory by law? Distressing content.

[PeaceBeWithYou]

If you miss one, cancel one, are not in etc, another one should be scheduled within 3 month period and if it is again missed without adequate explanation, then police should be granted access with a HV to check on the children's welfare. Health and well being home visits should be scheduled up to the age of 10 perhaps?

Rather extreme but could this have prevented Hamzah Khan's terrible life and needless, horrifying death?

Agencies were involved with the mother but she was 'obstructive' apparently. That poor boy must have been starved from birth to be so stunted in his growth. No medical reasons have been given and also no medical professionals were aware of it so it seems. No mention that Hamzah was ever seen by a HV. The mother did not seek medical attention either .

Those other 5 DC in the house were also subjected to living in absolute filth and from some of the houses I've sen it is probably the tip of the iceberg.

We are too bloody worried about upsetting parents and not enough focus is on helpless DC IMO. The gloves should be off. If you have DC which are part of society, then society should take a firmer hand into ensuring their well being as it seems all too apparent that some parents can't be trusted.

One life saved or changed would be well worth it IMO.

[friday16]

We are talking about purely for health checks

What's the point? The children who die or are seriously harmed are being seen weekly, in many cases daily, by an army of health care professionals. The Khan case is a wild outlier, but even in his case he was seen as a subject of concern and was the subject of two case conferences. In the Connolly, Pelska, Ishak, Williams and Climbie cases, the mothers/carers were manipulative and convincing, and were able to persuade senior social workers, consultant paediatricians and the police of their bona fides. People who are able to deceive and/or intimidate senior professionals are not going to be "found out" by health care visitors. The problem is not making the initial assessment of being at risk, as that happens already; the problem is doing something about it.

In the Khan case, there is quite rightly outrage about the boy's body being left to mummify in situ. It's a symptom of the failure of the system that he was invisible alive and unnoticed and unmissed dead. But what is more frightening is that an obviously out of control alcoholic, the subject of multiple concerns about domestic violence and with a large number of children and no visible income, was the subject of multiple case conferences at which point it was decided to take no further action. The mantra of "good enough parenting" and "professional optimism" went too far. In the case of Connelly and Pelska, concerns about DV affecting the mother similarly overrode protection concerns for the child, and the child's place at the centre of child protection was lost.

If you want to protect children, it does not involve naive health visitors turning up on the doors of functioning families in order to make us all feel better about ourselves. It involves social services being willing to make tough decisions to remove children from women who are already themselves victims.

Khan, Connolly, Pelska, Ishak, Williams (Rebecca Shuttleworth), Climbie (Marie-Thérèse Kouao): take out the fact that they killed a child they were responsible for and they are sympathetic cases: raped as child, refugee, victims of DV, abused by schizophrenic husband, etc. They were hopelessly, pathetically inadequate parents, and with the possible exception of Kouao, they did not set out to kill a child. Social workers saw them as victims themselves, and attempted to make them better parents. The social workers didn't expect them to kill their children, because most pathetically inadequate parents don't. The question is: should we be leaving children to be raised by pathetically inadequate parents, even if with a lot of help they become slightly less inadequate? What life was Peter Connolly or Hamzah Khan destined for had they not died?

There isn't a queue, or even a vague huddle outside the door, of competent people wanting to adopt trouble toddlers. Children's homes have proved disastrous. There's a critical shortage of foster carers. What do we want to do about children being raised badly by inadequate parents? What's the point in identifying the tiny handful that slip through the system, when we're so bad at helping the vast majority that don't?

[filee777]

I read the Williams case review and it said they had signed his siblings off the child protection register.

That was a huge failing of social services make no mistake.

A child growing up in care is better than a dead child.

[friday16]

I read the Williams case review and it said they had signed his siblings off the child protection register.

Exactly. So what would visits from Health Visitors have achieved? Junior staff raised concerns. They gave those concerns to social services. Social services said it was OK. What do you want to happen next? Shuttleworth was herself subject to social services review as a care leaver. There was no shortage of oversight, it was just that they were concerned about care leaver Rebecca rather than her children. She didn't conceal her children from anyway: it's just that no-one gave a toss about them.

One of the most blame-shifting things in the Pelska SCR was the argument that social services having declined to take action about Daniel, the school should have escalated the concerns. That really is a dreadful argument: it's saying that social services are not responsible for reviewing their own judgements, and want to be able to cock things up secure in the knowledge that any failures are the responsibility of other, far less trained, staff failing to demand a reappraisal.

[filee777]

Williams was never on the register, his siblings were, a year case review in the home may well have saved his life.

[filee777]

I agree with you about social services though. Completely.

[Pagwatch]

I want to reply to you Ain't but tbh Friday said everything I wanted to.

It's just pointless to suggest that forcing me to produce my much loved and well cared for child for scrutiny once a year will do anything to help the vulnerable.
It's just a ridiculous suggestion.

[friday16]

A child growing up in care is better than a dead child.

Are a hundred children growing up in case better than a dead child? 99 children might not agree, and telling people that the destruction of their family is acceptable collateral damage in exchange for protecting other children is a pretty cynical argument.

Taking children into care has catastrophic consequences on their life chances. It's easy to look at the cases where children died and then point to the reasons they should have been in care, but hindsight is a wonderful thing. However, the consequences of a more gung-ho attitude toward taking children into care is that more will be taken into care who would not have been killed or seriously harmed in their parents' care. Given how bad the outcomes are for children in care, leaving them where they are would have been better.

How many children are we willing to see taken into care, which will potentially do them active harm, in order to prevent harm to one other child? Be careful how you answer: the "if only one life is saved" argument doesn't work well in this scenario.

[friday16]

It's just pointless to suggest that forcing me to produce my much loved and well cared for child for scrutiny once a year will do anything to help the vulnerable.

It's worse than pointless.

Social services would spend their time pursuing compliant middle class parents living in settled accommodation. They could then worry about whether mothers are breastfeeding too much or too little, making wild claims about the health implications of using the wrong sort of washing powder and checking that stair gates are properly fastened. They'd know where the mothers are, the houses would be reasonably clean, there wouldn't be any nasty dogs or piles of rubbish, and social workers would enjoy the power of dealing with women with a lot to lose who would be frightened of, and attentive to, the "orders" social workers could issue. They might even get a nice cup of tea.

Meanwhile, vulnerable parents without fixed addresses, whose children are genuinely at risk from chaotic lifestyles, who have had regular contact with social services already and therefore know how to manipulate the system, are not remotely intimidated and who are unlikely to be responsive to any sort of intervention, will be ignored even more than they already are.

Who would be helped by this?

[filee777]

Ummm... Who said anything about taking kids into care?

I said have the right to interview/examine them, not take them into care.

People just go totally over the top don't they!

[friday16]

I said have the right to interview/examine them, not take them into care.

How many children have been subject of SCRs in the past ten years who had not been involved with social services, including some sort of protection plan? What makes you think that health visitors would do a better job? What is the purpose of the interview? The children are already subject to protection plans anyway.

Children are not being abused in isolation from social services. Families are coming to social services' attention and social workers (trained social workers, a lot more trained in child protection than health visitors) have two choices: support the parents (usually the mother) or remove the child. Those are the options. They start off supporting the mother, and what's gone wrong is that having made the decision to try to make the mothers "good enough", they didn't realise that the moment had come to switch from support to protection and remove the child. A well-meaning amateur interviewing the child once a year would make no difference to that.

[filee777]

I think it would have made a difference to Williams and the two mummification cases!

Someone on a different thread mentioned that in France if worries were founded the school would allow a child to be examined there. What exactly is wrong with that?

Before school, it's clear that we need to give children more support and monitoring because they keep being murdered by their parents! It happens too much. One meeting a year in house is not ridiculous, it's sensible. Until school age when the schools should be conducting such assessments regularly and contacting relevant authorities.

[friday16]

I think it would have made a difference to Williams

How? He was seen at home, repeatedly (SCR p. 39). Those visits raised concerns. Within a few months, there had been a S.47 enquiry and a core assessment. (page 40).

Keanu Williams was killed in spite of an a S.47 enquiry, a core assessment and a recommendation tha an IPCC be convened? What do you think a health visitor could do better? The failures started once social services were considering protection measures, not in realising that protection was needed.

"...the focus of the meeting was not on the history of Rebecca Shuttleworth and Keanu but on the immediate concerns about Father 1‘s reported ‘threats. Rebecca Shuttleworth was seen by the professionals as plausible and as a ‘victim’ in relation to Father 1."

He didn't die because people didn't know he was at risk. He died because people didn't do anything about it.

[filee777]

Sorry I must have my case reviews crossed.

Definitely would have helped in the other two cases though.

I think there are two issues here, one with children disappearing and another with totally inadequate judgement calls being made by relevant authorities.

[friday16]

Definitely would have helped in the other two cases though.

How do you know that?

There hasn't been an SCR into the Khan case published.

The other example you quoted, the death of Declan Hainey, I simply can't see what point you're making.

The mother had been under constant supervision by social services, and had been subject to repeated case conferences. The child was seen at home (Significant Case Review, paragraph 24) and concerns were raised to a senior social worker, but nothing was done. Again I ask: why do you think the problem is people being detected as being at risk, rather than what is done? How in this case would someone else reporting concerns have helped?

After the child's death, by the way, it's a complete car crash of a judicial process.

The mother was prosecuted and convicted, but all the convictions have been overturned by an appeal court and the original trial was, we now know, a total shambles. There's no evidence that the child was mistreated, at least to the extent of serious harm, as the appeal court rejected all the evidence (given, we now know, by an "expert" who had no medical qualifications, and neglected to mention that the other witness who supported her was her PhD student).

At worst, you have a child who died of unexplained causes and whose death wasn't reported by a mother who was very vulnerable. So you think that a child who may not even have being abused could have been "saved" had there been more contact? On what possible evidence?

Read about the whole disaster here.

[filee777]

I don't think you can possibly say (regardless of the retrial) that it was not wholly unaccountable that the little
Boy was missing for so long and nobody noticed. That's the point I am trying to make, children should not just 'go missing' and I do believe that a lot more needs to be done to make social workers and other HCP's have more powers as they are the people who see it, not just hear about it from a script.

Thanks for the link I read it through and it's interesting to me that after hearing she was absolutely responsible for leaving that little boy to die, that it might not be the case. It shows up yet another flaw in our social system.

I have to sleep now, but I will think on it and come back. Thanks again.

[JakeBullet]

As an exHV I have to say that I don't think this would work....although I can utterly understand OP's thinking about it.

I have taken regular calls about children who have not been seen by anyone for long periods of time and in most cases there is good reason for this. Parents who go abroad regularly, those who shun nurseries etc and travellers etc.

Finding these children takes time ...on one occasion it took me nearly 18 months to track down a child who the nursery expressed concerns for as he had simply disappeared from their nursery and they had concerns about his development. It turned out that the parents had gone abroad for a year and returned to a completely different address over a year later.

I have also seen families who have good reason for requesting no further HV involvement. Those who have children with disabilities are often inundated with appointments and the last thing they need is to add a HV to that.

The key issue is that most children are seen regularly by SOMEONE ...usually that is in nursery etc and then later on school. It doesn't have to be a HV but perhaps there needs to be a system for flagging up those children not being seen by anybody.

In the case of AH, she would have had regular post natal visits from a midwife and a new birth visit from a HV. Evidently life was more normal then as none of these visits flagged up concerns. AH was an experienced mother and rightly left to make her own decisions regarding baby clinics etc. most women who have had a third, forth or fifth baby will not bother with baby clinic and in the absence of any safeguarding concerns there is no reason for interference.

I gather that systems for checking on children who have not been seen by anyone are being looked at in the light of this case. I doubt that it will result in enforced HV contact though.

[TidyDancer]

In the one case I personally know of that needs so,etching done about it, the HV has been fucking useless, but then so has every other agency/organisation. The two children in the family live in squalor (not quite as bad as the Hamzah case, but could easily get there) and they have been reported to SS multiple times. The HV comforts the mum every time this has happened, not offering any real support to improve things and the mum is now able to avoid seeing her in the home. SS have told the mum that because they have seen worse, no further action will be taken. Police were refused entry at the front door on one occasion and never pursued it.

The DCs are neglected and not abused in the family I refer to, but I have no faith in any agency if that situation can be allowed to continue. I fail to see how increased visits from an HV would help.

[TidyDancer]

so,etching should be 'something'

[friday16]

they have been reported to SS multiple times. The HV comforts the mum every time this has happened

The protection of Peter Connelly failed because the social worker assigned to the case, MW, saw her role as supporting Tracy Connelly. Each time there was a threatened escalation of protection, MW worked with Tracy Connelly - whom she saw, at that point, with some justification as a vulnerable victim - in order to stabilise the situation. In the case of Keanu Williams, the SCR explicitly points out that because of her extensive experience in the care system, Rebecca Shuttleworth was plausible and convincing as a victim and knew how to work the social workers to keep them onside. Having now (thanks filee) read the SCR into the death of Declan Hainey, at paragraph 18 it states "(mother) presented as an articulate and intelligent woman who was able regularly to provide very plausible reasons for failure to attend for planned appointments".

Health Visitors are not primarily intended to do child protection. Child protection requires what is referred to as "respectful disbelief" or "professional scepticism": there are already protection concerns, and the social worker should be starting from the position that if the child is being abused, then the carers are lying. It's the failure of that scepticism, when the social worker starts to believe the carer and see them as the victim, that is the heart of several recent failures of protection.

Should Heath Visitors arrive in houses and start from the position that if the child is in any way remarkable (underweight, overweight, marks, not sleeping, making poor eye contact, too noisy, not noisy enough) or the house is in any way remarkable (too tidy, too untidy, too warm, too cold) that the mother is lying and the child is at risk? If "yes", then what you've just done is destroyed the potential value of health visitors to the 99.9999% of parents who are not abusers. If "no", then your desire to have them as frontline investigators of potential abuse just failed.

[filee777]

Interesting Friday.

You don't think there is room for both?

Although, of the three hv's, one has been completely useless.

Well has anyone got any thoughts on what should change? Because surely something must.

[ender]

Ninjanurse - you said you're a staff nurse working with a health visiting team. You mentioned that you do new birth visits.
Am surprised at this, I thought the first visit was done by a HV who made an assessment then delegated to skill mix team if appropriate.
Is this happening because the PCT can't recruit qualified health visitors? Or perhaps it's to cut costs, HVs earn more than staff nurses.

[friday16]

You don't think there is room for both?

No. Specialist, trained social workers have routinely failed when trying to balance supporting the mother with protecting the child, and they are only involved when there are already concerns. It would be impossible to be appropriately sceptical when there are no prior concerns (ie, when the chance that abuse is happening is perhaps a hundred times smaller) and 99 times out of 100 they would be right to support the mother rather than regard it as abuse. And, as JakeBullet points out, even if they did start reporting suspicions, the amount of extra work created would detract from real protection work.

[filee777]

Then what, in your opinion, needs to change Friday.

[friday16]

When reports are made, and case conferences convened, social workers with protection in mind need to take and follow through sceptical, focussed action. Social workers must not accept conditions (filth, squalor, drug and alcohol use) that they would not tolerate for their own children. Children should be listened to, and should be at the focus of child protection. If a child being removed to a place of safety will cause harm and upset to alcoholics and drug users, that tough shit: it is not the role of small children to act as animated teddy bears for the comfort of inadequate parents. "Cultural sensitivity" (Climbie, Ishak, Pelska, probably Khan) must not trump child protection. Drug users and alcoholics are not fit parents, and should not be treated as such. When a child is being abused, they are the victim, not the abuser, no matter how touching their backstory.

Social work has been contaminated by the idea that they should not be judgemental of "other" lifestyles. That has to change.

[filee777]

I agree with the lack of judgment thing but I disagree with the 'alcoholics and druggies' thing, I know plenty of pot-heads who are great parents, or folk who can't get through an evening without a drink but always put their kids first.