A social worker showed “alarming ineptitude” when handling a case where two children were unnecessarily medicated and kept in wheelchairs after their mother fabricated illnesses, a judge has found.
Her Honour Judge Mayer said Barnet council had “neglected” the case and missed opportunities to intervene after the social worker failed to act properly on concerns raised about the nine-year-old boy and his seven-year-old sister.
She made the criticisms in two rulings made public this week after the case had been heard in private.
The judge found the social worker was “inactive” despite medics and teachers all “clearly asking social services” to review concerns over the discrepancy between the mother’s description of her children and the experience of nursery and school staff.
Concerns about the mother’s fixation on the children’s health issues were first raised with the council in 2011, the judge said. When the children started in nursery in 2012, staff made “very early referrals” to the social worker. A year later a special educational needs officer made a referral to the Multi-Agency Safeguarding Hub, but this was not pursued.
The judge said the social worker “continued being inactive” and intended closing the case in February 2015. Two months later the boy made allegations against his mother that led to the case being reviewed and care proceedings being sought.
The judge said: “The local authority neglected this case and this family, and the social worker, who was allocated for six years, demonstrated alarming ineptitude in the face of clear and obvious concerns expressed by many over a long period.
“A number of opportunities to intervene and spare the children unnecessary medical intervention have been missed.”
The mother fabricated and exaggerated symptoms for the children throughout their lives, giving “untruthful information” to professionals, the judge said.
“Consequently, the children were subjected to a great number of unnecessary medical appointments, unnecessary attendances at A&E, unnecessary journeys in ambulances and, at times, to unnecessary admissions to hospital.
“Both children were unnecessarily medicated. They were both unnecessarily immobilised by spending time in wheelchairs.”
The judge said the mother had a history of complex, longstanding and entrenched issues. She said evidence from a psychiatrist suggested the mother met the criteria for somatic symptom disorder and factitious disorder.
The judge concluded that the children could no longer be cared for by the parents and should instead be placed in foster care.
She said there were “no safeguards that could be put in place” to keep the children at home, “certainly not before the mother has been assessed to have successfully completed her therapy and the father has done some additional safeguarding work.”
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This was an extremely troubled family with complex problems that continued over many years. The judge is right to say that the seriousness of the problems should have been recognised by children’s services much earlier. The poor quality of the initial social work assessment suggests that it was treated as a child in need assessment and not a child protection investigation. In hindsight it can be seen that the parents went to extraordinary lengths to cover up the truth. The initial concerns therefore required a much more probing style of working to uncover what was really going on in this family. A section 47 investigation should have been carried out then – to obtain a more comprehensive assessment of the family situation and a better understanding of the level of harm to the children. Although the social worker is criticised I would like to know what the organisational arrangements were for responding to child protection concerns. It is well known that the competence with which a child protection referral is handled will crucially influence the effectiveness of subsequent work.
There is also no reflection of the management oversight on such a case – surely the managers are also to blame for not adequately supervising the case if they allowed a SW to remain allocated for 6 years to a complex family when she was clearly not able to identify the harm to the children.
It can never be the fault of 1 SW though – the management and structure of the team in which the SW was based also needs to be questioned – if outside agencies were raising concerns and they weren’t being responded to then the agencies should have raised their concerns above the allocated SW to the DTM and TM and to the complaints officer if they were not being heard.
Yes indeed where was the management oversight?! One social worker is not responsible and furthermore if other professionals had concerns they were not being listened to there are appropriate ways to escalate higher. Scapegoating again.
Last guidance I read stated health are supposed to be the lead professionals in cases where factitious illness is suspected.
Love it when it’s the social worker asked to do a health chronology instead of erm, health? It took forever and the assistance of a kind school nurse who took pity and helped me by being able to read the case files with their abreviations.
I’m going to go out on a limb and state that managements view was to get it closed after 6 years.
Although the mother’s diagnosis is given as Factitious Disorder it is obvious she also suffered from Munchausen Syndrome by Proxy – which is a form of child abuse. So the local authority had a legal duty and lead responsibility to carry out a child protection investigation. Other agencies passed on their concerns to children’s services on a number of occasions but it repeatedly refused to recognise it as a ‘child protection’ case.
E.e.e.e.r.r.r.m….. Munchausen(‘s) Syndrome By Proxy has been a Factitious Illness for many years now so I don’t see the point you are making as it would require a health clinician to diagnose or give an opinion that the individual has this illness NOT a social worker – in that sense it is no different to a health professional giving an opinion on a cigarette burn/flea bite/skin blemish if we are talking about Child Protection.
By the way – how was it “. . . . obvious she also suffered from Munchausen Syndrome by Proxy”? Are you a mental health professional?
Child Protection is the responsibility of ALL of us
OK – I realise it is now called ‘Factitious Illness by Proxy’. However, the ‘by proxy’ part comes from seeing all the evidence from the two court Judgments. A large number of witnesses had given evidence indicating the seriousness of their concerns from 2011 onwards. Later on Dr Ward, Consultant Paediatrician, who made a report for the court, said the mother fabricated and exaggerated the children’s symptoms over the years and presented a high risk of harm to them. I note that the children had real medical issues but the court found that the mother escalated their symptoms without medical evidence.
The inaction of children’s services remains unexplained. A referral to MASH was made on 7 July 2014 and 2 months later (!) there was a meeting which decided a section 47 strategy meeting should take place. This did not happen. All of this suggests that no-one recognised that a threshold had been crossed and the children were at possible risk of significant harm.
When you say that child protection is the responsibility of all of us you give the impression it’s no-one’s responsibility. However, social workers do have legal powers and duties that other professionals don’t have. There seems to be a lot of uncertainty about the threshold for significant harm and I have written about this here: http://radical.org.uk/barefoot/drawingtheline.htm