1.5.4 Death or Serious Injury of a Child

SCOPE OF THIS CHAPTER

This chapter outlines the steps to be taken in the event of the unexplained 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 requirements of the London Child Protection Procedures. Please see Section 12, Unexpected Death of a Child of the London Child Protection Procedures and for procedures relating to Serious Case Reviews, see Section 19, Serious Case Reviews.

AMENDMENTS

This chapter was amended in October 2009 to include the above reference to the London Child Protection Procedures. In addition, revised addresses for notifications to the Department for Education and OFSTED are contained in the National Contact details.

Death of/Serious Injury to a Child in the Community
Death of/Serious Injury to a Looked After Child
Needs of Social Worker/Team/Manager/Carer

1. Death of/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: Immediately inform his or her line manager 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: Immediately inform the service manager and the Designated Manager (Death of a Looked After Child) by telephone and provide follow up information in writing as soon as possible afterwards.
1.3	The Designated Manager (Death of a Looked After Child) will: Inform the Director of Education, Children’s Services and Leisure and the Assistant Director, Children’s Services. Ascertain as full details as possible from the Police and any other source Request his or her administrative staff to check the electronic recording system for any information on the child and family and print out any information held Collect any files held on the child and family and secure them at his or her office 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 Arrange, in consultation with the Assistant Director, Children’s Services, an emergency Local Safeguarding Children Board meeting to consider the circumstances of the death/serious injury and the commissioning of a Serious Case Review Inform the Department for Education and the Regulatory Authority (see paragraph 1.4)
1.4	The report to the Department for Education and the Regulatory Authority will include the following information and must be approved by the Director of Education, Children’s Services and Leisure 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 the child was the subject of a Child Protection Plan 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 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 the London Child Protection Procedures - Section 19, serious Case Reviews. The agenda for the meeting will cover: Security of files and electronic records Sharing of knowledge about the situation so far; reports from individual agencies Discussion regarding the need for a Serious Case Review If a Serious Case Review is required, the commissioning of the Review and the setting of dates Arrangements for press/media liaison and ratification of a press statement if necessary Consideration of staff/public counselling needs and commissioning of the same from the Local Safeguarding Children Board Consideration of need for follow-up meetings and if so, the setting of dates.
1.6	The relevant service manager, together with the Designated Manager (Death of a Looked After Child), will determine the most appropriate person to carry out the internal management review of the case within Children’s Services. 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 Local Safeguarding Children Board, the author should consult with the Director of Education, Children’s Services and Leisure, and the Assistant Director, Children’s Services. The review should be completed within 10 working days of the child’s death or such other timescale as has been agreed.
1.7	The recommendations of the internal review report should be reported to the Management Group of Children’s Services, 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 of a Looked After Child) or his/her nominee.
1.8	If a decision is made not to hold a Serious Case Review, this must be ratified by the Director of Education, Children’s Services and Leisure and notified to the Department for Education. However, the Designated Manager, in consultation with the Director, may still decide that there are issues arising from the case which justify an internal management review described in Paragraph 1.6 and Paragraph 1.7.

2. Death of/Serious Injury to 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: Immediately inform his or her line manager Notify the parent(s) immediately and in person, if possible; 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); In the event of a serious injury to the child, arrange with the parent(s) to visit the child in hospital; Obtain as much information as possible on the circumstances surrounding the cause of death/serious injury and pass this to their line manager; and 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: Immediately inform the service manager and the Designated Manager (Death of a Looked After Child) by telephone and provide follow up information in writing as soon as possible afterwards; Advise Legal Services initially by telephone, then confirm details in writing; and Contact the Insurance Section of the Finance Department, initially by telephone and then in writing.
2.3	The Designated Manager (Death of a Looked After Child) will: Inform the Director of Education, Children’s Services and Leisure Consult the Director about the need for an internal management review of the case and if so, the appropriate person to conduct the review Where a review is to be conducted, collect any files held on the child and family and secure them at his or her office. Where the records are held electronically, contact the systems administrator at ECSL Resources and IT to restrict access to designated individuals only 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 Where appropriate, arrange, in consultation with the Assistant Director, Children & Families, an emergency Local Safeguarding Children Board meeting to consider the circumstances of the death/serious injury and the commissioning of a Serious Case Review Inform the Department for Education and the Regulatory Authority
2.4	The report to the Department for Education and the Regulatory Authority 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 the child was the subject of a Child Protection Plan 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, Death of/Serious Injury to a Child in the Community 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 of a Looked After 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.