The deaths of three children who were smothered by their mother could not have been predicted or prevented, despite their cases meeting the threshold for child protection procedures twice before they died, a serious case review has found.
The three children had Spinal Muscular Atrophy Type 2, a complex, life-shortening physical condition, and as a result nine different health and social care agencies, as well as three different local authorities, Kingston, Wandsworth and Merton, were involved in their lives.
Children’s social services were concerned over potential medical neglect by the parents because the high-demand conditions put strain on the family, and the parents did not want medical intervention to address their children’s conditions. In particular, the mother was reported to “never have a full night’s sleep and often presented to professionals as tired and tearful”.
The review said the case met the child protection threshold in 2011, three years before the children’s deaths, and again in 2013, just one year before the children died in April 2014. In November last year the mother, identified as Tania Clarence, was given a hospital order after admitting manslaughter by diminished responsibility.
Fault for not initiating child protection procedures was shared, the review found, as agencies thought discussing the concerns meant they had been addressed.
“Whilst many discussions were held between health practitioners and social workers about concerns and consideration of whether or not the child protection threshold had been met, the communications were seen as having dealt with the matter. It was left as a social work decision on whether or not this constituted child protection,” the review found.
However, the report complimented professionals who “went out of their way to provide services for the family and the family were provided with every available resource”.
Various agencies had concerns with the family’s management of their children’s conditions. The parents did not want medical intervention because this would cause pain to their children, for whom they wanted a good quality life. But the children’s specialist and expert doctors thought that intervention was needed for the eldest child with the condition, and possibly the others, to reduce their discomfort and maximise the child’s potential.
‘Middle class status’
The report noted that there were cultural barriers between the authorities and the parents, who were South African, and also challenges due to the couple’s “affluent, middle class status”.
“Together with their assertiveness this posed challenge to professionals, some of whom would not be used to this level of questioning,” the review found.
It added: “What made this family extremely unusual and challenging for professionals to work with was the difficulty some professionals experienced in delivering the advice and support that was considered necessary for the children’s health and development. The reason for this was the lack of parental co-operation, and in particular the difficulties in developing a good working relationship with the mother. Her distress and perceived resentment towards some professional advice provided an obstacle which practitioners struggled to break through sufficiently.”
The report recommended that Wandsworth and Kingston local safeguarding children boards (LSCBs) should establish “if professionals are able to make specific child protection referrals when they have child protection concerns on open cases, so their view does not get lost as part of the usual information sharing process”.
However, it noted, how “had best practice been followed, it is not known how the mother would have reacted to the open expression of child protection concerns at an earlier stage”.
Lack of sensitivity
A change in approach by the disabled children’s team to focus more on safeguarding meant the family’s social worker was changed just weeks before the deaths. This was criticised for a “lack of sensitivity”.
“As a consequence the family were not given the chance to say goodbye to a social worker with whom they had developed a reasonable working relationship and were wary of what this change meant for the family,” it said.
Councils involved in the case should consider improving assessment practice so practitioners routinely explore parents’ individual cultural backgrounds and attitudes to services, the review recommended. Wandsworth and Kingston LSCBs, two areas where the family lived throughout the period under review, should agree a “consistent process” for identifying the lead professional among member agencies, and who has the responsibility for lead professional functions.
Deborah Lightfoot, chair of Kingston LSCB, which commissioned the report, said: “We accept the report findings that the parents’ laudable aim for their children was a good quality life which was as pain free as possible. Despite misunderstandings by the parents, this was the goal and view of the professionals too.”
However, the children’s father, Gary Clarence, has criticised social workers’ practice, according to The Guardian.
“Tania’s depression was certainly not helped by the constant pressure placed on the family by some aspects of the medical profession and social services who could not agree with our stance of prioritising quality of life for our children over medical operations and interventions that we felt were not always appropriate in the circumstances, or in our children’s best interests,” he said.