The Chair of the North Wales Safeguarding Children’s Board commissioned a Concise Child Practice Review in October 2014 following the death of an 8-week old baby in Flintshire who was neither on the child protection register or a looked after child. The cause of the child’s death was as an episode of trauma to the head.
During the course of this review, a criminal investigation took place and the child’s father was charged with murder. The trial did not take place until after the conclusion of the review process and during the criminal trial the father pleaded guilty to manslaughter. He is now imprisoned.
The final Concise Child Practice Review Report was sent to Welsh Government in March 2016 and, under the regulations, if any further action is needed the Welsh Government Safeguarding Team can draw in other parts of the Welsh Government and the Inspectorates Group as appropriate. In this case no further action was needed.
This case highlights the importance and the necessity of undertaking a multi-agency pre-birth assessment. In this case, it is likely that if a multi-agency pre-birth assessment had been undertaken there would have been a different conclusion to the assessment of the parental capacity and likely that the case would have led to a Child Protection Case Conference. However the independent reviewers clearly state that even if this had occurred there is no evidence to suggest that the death could have been predicted or prevented.
There were also key learning points relating to the sharing of information between two neighbouring NHS areas.
Learning for all agencies has emerged from the review process, in particular in relation to information sharing between and within agencies. This is reflected within the action plan.
The action plan has been formulated and is being monitored by the North Wales Safeguarding Children’s Board to ensure that reflection and learning has taken place across all the agencies that worked with the family.
You will find the report in the CPR section of the website.
