Judges should explain their decisions to serious case review panels, according to an inquiry into the death of a baby at the hands of her violent father in Kent.
The serious case review into the case of “Brooke”, who died less than a month old, has found two court judgements in the case were “unhelpful”. One in a criminal court and the other in a family court “contributed to an erroneous belief that this was a ‘neglect case'”, the executive summary of the SCR states.
The SCR has made a national recommendation that the government should consider “how to involve the judiciary, when appropriate, in serious case reviews”.
The review found the baby’s death was preventable, given that her father’s two other children had been taken into care because of physical abuse and the mother had been in care herself as a child after concerns about incest and neglect,
A social worker was criticised for failing to act on concerns made to her by the paternal grandparents, that their son was expecting a child to another young woman.
A health visitor also tried to contact children’s social services. After leaving messages asking for a call back no action was taken.
“The identification of Mr S as the father and the extent of Ms B’s childhood problems would certainly have led to a multi-agency pre-birth assessment and, in all probability, care proceedings and action to protect Brooke as soon as she was born,” the SCR states. Several opportunities to make the connections between the pasts of Brooke’s parents were missed in children’s social services and health agencies, it claims.
The panel made recommendations for the training of social workers on the vulnerability of infants to serious and fatal abuse and the importance of listening to non-professionals who raise concerns.
Social workers should also be aware that children are not inherently safe because they are subject to care proceedings – this is in relation to the case of Brooke’s half-sister, “Susan”, who suffered facial bruising while waiting for a care order to be granted.