Over the last few days the news has been dominated by the sad story of Mikaeel Kular. However, as the media focuses on the unfolding case in Edinburgh, CareKnowledge editor Jim Kennedy considers an important Serious Case Review which was published in England focussing on the death of another young boy:
Over the last few days the news has been dominated by the search for, and subsequent death of, Mikaeel Kular. Mikaeel’s case has prompted an unusual degree of public interest and his sad death has triggered an outpouring of community grief. We are reminded, once again, that young children are frail and vulnerable.
However, the unfolding events in Mikaeel’s case were reported over the same period during which an important Serious Case Review was published in England, focussing on the death of another young boy, Daniel, who died aged 23 months in 2012. The Review was published by Wolverhampton Safeguarding Children Board.
I wanted to write this blog because Daniel’s case illustrates some specific issues that can complicate and add to the vulnerabilities that young children face. Daniel died as result of heroin ingestion. Both of his parents were heroin addicts. Toxicology evidence showed that Daniel had been exposed to a number of other illicit drugs during his short life. Both parents are serving prison sentences for offences connected to his death.
Daniel’s mother was partially disabled and said to be in severe, continuing, pain as a result of injuries sustained in an earlier serious car accident. She had received substantial compensation for her injuries but was in on-going treatment for them throughout Daniel’s life.
As a result of the complex situation, the Review focuses on a much wider range of agencies than is sometimes the case, including local addiction and physical health services. The GP’s role in relation to the parents was also much more complicated as a result of their own combined health problems, and specialist hospital staff had had involvement at the time of Daniel’s birth. There were elven multi-agency Child in Need meetings, convened by children’s social services, during Daniel’s life.
Overall, the Review found that Daniel’s death was not predictable, but might have been avoided if different approaches to his care had been taken. Reading the Review report brings home the complex web of agencies and individuals involved when families have such multiple problems. It also reminds us that each has its own objectives and family/patient outcomes in mind, and that meeting one individual’s needs may prejudice the chances of meeting the needs of the others involved.
Even if the conflict in objectives isn’t as extreme as that, the complexity of managing and delivering an individual’s support needs when numerous agencies are involved makes for a demanding professional task. In some ways, the lessons learned in Daniel’s case echo the findings of other reviews, including the need for a clear focus on the child, the need to take proper account of incidents of domestic abuse, the need to have clear assessments of parenting capacity that go beyond parental interests and possible avoidance tactics, and the need for better, more reflective supervision.
But the Review raises particular issues, especially around the difficulties in assessing – and acting on – the impact of parental drug misuse on child care, and on the crucial need for addictions and social care services to overcome problems caused by their complex and somewhat different responsibilities. However, the Review also claims that if different health services are not working effectively with each other, it is unlikely that partnership working with social care will have a positive impact.
In this case, for example, the Review report notes that the mother was being prescribed medication for pain by the GP, but says that there was no collaborative working between the GP practice and the addictions service. This gap is seen as important since the mother claimed that pain was the reason she took heroin in addition to her prescribed methadone.
The report argues that better pain management might have reduced the mother’s need for illicit drugs. Leaving aside that argument, and stepping outside of the child protection concerns highlighted by Daniel’s case, I found it hard to imagine that addictions services and GP practices could ever work without effective collaboration. This goes to show that effective integration is as important inside individual agencies and service sectors, as it is across them.