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1.5.2 Death of or Serious Injury to a Child

SCOPE OF THIS CHAPTER

This chapter outlines the steps to be taken in the event of the suspicious death of/serious injury to a child living in the community or the death of/serious injury to any Looked After child.  These steps are in addition to the carrying out of child protection procedures, as appropriate, in relation to any surviving children.


Contents

  1. Death or Serious Injury to a Child in the Community
  2. Death of a Looked After Child
  3. Needs of Social Worker/Team/Manager/Carer


1. Death or Serious Injury to a Child in the Community

Where information comes to notice of the suspicious death or serious injury to a child living in the community, the following tasks are required.

1.1

The child’s social worker or, if unallocated, the duty worker receiving the information will:

  1. Immediately inform his or her line manager
  2. Obtain as much information as possible on the circumstances surrounding the cause of death/serious injury and pass this to the line manager
1.2

The social worker’s line manager will:

  1. Immediately inform the service manager and the Designated Manager (Death/Serious Injury to a Child) by telephone and provide follow up information in writing as soon as possible afterwards.
1.3

The Designated Manager (Death/Serious Injury to a Child) will:

  1. Inform the Head of Service
  2. Ascertain as full details as possible from the Police and any other source
  3. Request his or her administrative staff to check the Framework-I records on the child and family and print out any information held
  4. Collect any files held on the child and family and secure them at his or her office
  5. Arrange through his or her administrative staff to inform the other relevant agencies about the death/serious injury and remind them to secure their files
  6. Arrange, in consultation with the Head of Service, an emergency meeting of the Safeguarding Children Board to consider the circumstances of the death/serious injury and the commissioning of a Serious Case Review
  7. Inform the Department for Education and OFSTED- refer to list below in 1.4. (See Department for Education and OFSTED)
1.4

The report to the Department for Education and OFSTED (using CP18 Form 1) will include the following information and must be approved by the Head of Service before it is sent:

  • Local Authority
  • Child’s Name
  • Parents’ names
  • Date of Birth
  • Date of Death/Serious Injury
  • Child’s Legal Status
  • Child’s ethnicity, religion, language, disability
  • Cause of Death as on Death Certificate
  • Dates if any when child was subject to a Child Protection Plan or on the Child Protection Register
  • The date and findings of the Post Mortem, Inquest and any criminal proceedings initiated. It may be necessary to notify these details at a later date
  • Brief details of the case
  • Local authority duties in respect of the child
  • Intention of the local authority to hold an independent review or inquiry
  • Policy and practice issues raised and intended local authority action (to follow later if necessary).
1.5

The emergency Local Safeguarding Children Board (LSCB) meeting must be held within 72 hours of notification of the death/serious injury of the child and should decide whether a Serious Case Review is appropriate under Oxfordshire’s Safeguarding Procedures.  The agenda for the meeting will cover:

  1. Security of files
  2. Sharing of knowledge about the situation so far; reports from individual agencies
  3. Discussion regarding need for Serious Case Review
  4. If a Serious Case Review is required, the commissioning of the Review through the Monitoring and Review Sub-Committee and the setting of dates
  5. Arrangements for press/media liaison and ratification of joint LSCB press statement if necessary
  6. Consideration of staff/public counselling needs and commissioning of the same from the LSCB’s Treatment Sub-Committee
  7. Consideration of need for follow-up meetings and if so, the setting of dates.
1.6 When a Serious Case Review is required, it will be commissioned through the Monitoring and Review Sub-Committee of the LSCB.  Each agency should commission an internal review report by a named independent individual.  A date should be set within 15 working days from the date of the child’s death/serious injury, for the Monitoring and Review Sub-Committee to meet and consider the individual agency reports on the case. The Sub-Committee will look at each agency’s report and consider inter agency working in the case, drawing conclusions and making recommendations for future action concerning procedures, training and management at an inter agency level.  The Chair of the Sub-Committee will then write an overview report, consult with the Chair of the LSCB and Head of Service about its contents, and present the report to a further Sub-Committee meeting within 8 working days of the first meeting.  A summary of the report will then be prepared and submitted to the Department for Education within 28 working days of the child’s death.
1.7 Where the case is complex and the above timescales are unrealistic, the Chair of the Sub-Committee will consult with the Chair of the LSCB and the Head of Service and agree a revised timescale, which must be endorsed by the Sub-Committee.  A letter will be sent to the Department for Education explaining the reasons for the delay and providing an anticipated completion date.
1.8 The relevant service manager, together with the Designated Manager (Death/Serious Injury to a Child), will determine the most appropriate person to carry out the internal management review of the case within Children, Young People and Families. The person undertaking the review will make a detailed chronology of what is contained in the records, conduct interviews with members of staff where necessary and critically analyse the social work practice. The objective is to establish whether the correct procedures were followed, whether professional judgments were sound and whether there are any training or management implications arising. The reviewer should draw conclusions and make recommendations for future action as a result of any lessons learned. The reviewer may also identify any issues arising for other agencies. Prior to presenting the review report to the LSCB, the author should consult with the Head of Service. The review should be completed within 10 working days of the child’s death or such other timescale as has been agreed under paragraph 1.7.
1.9 The recommendations of the internal review report should also be reported to the Senior Management Team of Children, Young People and Families and to the next LSCB meeting, together with a report of any follow-up action.  The recommendations should also be fed back to all relevant staff by the Designated Manager (Death/Serious Injury to a Child) or his/her nominee.
1.10 The Monitoring and Review Sub-Committee will also appoint a press liaison officer on behalf of the LSCB, who will liaise closely with the police press office to ensure consistency in messages given to the media about the case. 
1.11 If a decision is made not to hold a Serious Case Review, this must be ratified by the Head of Service and notified to the Department for Education (see list in pro-forma set out in paragraph 1.4.)  However, the Designated Manager, in consultation with the Head of Service, may still decide that there are issues arising from the case which justify an internal management review as described in paragraph 1.8 and paragraph 1.9.


2. Death of a Looked After Child

Where information comes to notice of the death of a Looked After Child, the following tasks are required.

2.1

The child’s social worker will:

  1. Immediately inform his or her line manager
  2. Notify the parent(s) immediately and in person, if possible;
  3. In the event of a child’s death, discuss with the parent(s) and reach agreement regarding the arrangements for the funeral (in the event of sudden, unexplained deaths arrangements for the funeral may need to be delayed);
  4. In the event of a serious injury to the child, arrange with the parent(s) to visit the child in hospital;
  5. Obtain as much information as possible on the circumstances surrounding the cause of death/serious injury and pass this to their line manager; and
  6. Discuss with the manager any necessary expenditure including reasonable travel expenses to assist the family in attending the funeral or visiting the child in hospital where it appears there is financial hardship.
2.2

The social worker’s line manager will:

  1. Immediately inform the service manager and the Designated Manager (Death/Serious Injury to a Child) by telephone and provide follow up information in writing as soon as possible afterwards;
  2. Advise Legal Services initially by telephone, then confirm details in writing; and
  3. Contact the Insurance Section of the Finance Department, initially by telephone and then in writing.
2.3

The Designated Manager (Death/Serious Injury to a Child) will:

  1. Inform the Head of Service
  2. Consult the Head of Service about the need for an internal management review of the case and if so, the appropriate person to conduct the review
  3. Where a review is to be conducted, collect any files held on the child and family and secure them at his or her office
  4. Arrange through his or her administrative staff to inform other relevant agencies about the death/serious injury and remind them to secure their files where a review is likely to be required
  5. Where appropriate, arrange, in consultation with the Head of Service, an emergency meeting of the Safeguarding Children Board to consider the circumstances of the death/serious injury and the commissioning of a Serious Case Review
  6. Inform the Department for Education and OFSTED (see paragraph 1.4.)
2.4

The report to the Department for Education and OFSTED (using CP18 Form 1) will include the following information in the order shown:

  • Local Authority
  • Child’s Name
  • Parents’ names
  • Date of Birth
  • Date of Death/Serious Injury
  • Child’s Legal Status
  • Child’s ethnicity, religion, language, disability
  • Cause of Death as on Death Certificate
  • Dates if any when child was subject to a Child Protection Plan or on the Child Protection Register
  • The date and findings of the Post Mortem, Inquest and any criminal proceedings initiated. It may be necessary to notify these details at a later date
  • Brief details of the case.
  • Local authority duties in respect of the child
  • Intention of the local authority to hold an independent review or inquiry
  • Policy and practice issues raised and intended local authority action (to follow later if necessary).

In the event of a Serious Case Review and/or internal management review being required, the steps outlined in section 1 above should be followed.


3. Needs of Social Worker/Team/Manager/Carer

During the implementation of this procedure consideration must be given to the needs of those staff involved in the case

The impact of a child death on social worker/team/manager/carer needs to be addressed in terms of:

  • The need for counselling for those involved
  • The manner in which such support is offered
  • The provision of access to legal and professional advice about the ongoing conduct of the case
  • The provision of a clear explanation of the process of a Serious Case Review
  • Support for staff in the event of police investigation/interviews
  • The need to inform and keep informed any relevant Trades Unions
  • The need for team de-briefings whilst observing confidentiality.  This must be discussed with the Designated Manager (Death/Serious Injury to a Child)
  • The need to acknowledge that a child death can impact on the productivity of any team and its ability to function; and the need to agree strategies to manage workloads.

End