Vulnerable child care
32 items
2 sources
Lack of consistent prescribed care for highly vulnerable children due to insufficient care package reviews and staff training.
Cross-Source Insight
Vulnerable child care has been flagged across 2 independent accountability sources:
7 inquiry recs
25 PFD reports
This issue has been identified by multiple independent accountability bodies, suggesting it is a recurring systemic concern.
Inquiry Recommendations (7)
11 — Review E Wing suitability for vulnerable detainees
Recommendation: The Home Office and the current operator of Brook House must keep under review the appropriateness of the multi-purpose use of E Wing, particularly in relation to its suitability as a location to detain vulnerable people.
Gov response: The government stated the multi-purpose use of Eden Wing at Brook House is under consideration, and learning would be applied across the estate.
Accepted in Part
Delivered
11 — Ban CSE-risk children from semi-independent placements
Recommendation: The Department for Education should ban the placement in semi-independent and independent settings of children aged 16 and 17 who have experienced, or are at heightened risk of experiencing, sexual exploitation. This should be implemented without delay.
Gov response: On 30 June 2022, the UK government provided the Inquiry with its provisional response to this recommendation. The UK government stated its final response to this recommendation would be provided within six months of the …
Accepted in Part
In progress
WATE-(10) — Assign field social worker to every looked after child in and after care
Recommendation: An appropriate915 field social worker should be assigned to every looked after child throughout the period that the child remains in care and for an appropriate period following the child's discharge from care.
Unknown
WATE-(11) — Require field social workers to visit looked after children every eight weeks
Recommendation: Field social workers should be required by regulation to visit any looked after child for whom they are responsible not less than once every eight weeks916. In the case of older children, they should be required also to see the …
Unknown
WATE-(12) — Safeguard field social worker's responsibilities for placement supervision and care planning
Recommendation: Any arrangements made for the provision of residential care or fostering services should expressly safeguard the field social worker's continuing responsibilities for supervision of the placement and care planning.
Unknown
WATE-(16) — Advise police on absconders from care homes and social worker consultation
Recommendation: Police officers should be reminded periodically that an absconder from a residential care or foster home may have been motivated to abscond by abuse in the home. They should be advised that, when apprehended, an absconder should be encouraged to …
Unknown
WATE-(17) — Require reporting of absconsions to social worker and independent follow-up
Recommendation: It should be a rule of practice that any absconsion should be reported as soon as possible to the absconder's field social worker and that the absconder should be seen on his return by that social worker or by another …
Unknown
PFD Reports (25)
Marcia Grant
Concerns: A shortage of foster placements, combined with inadequate documentation, poor communication of risks, and a failure to assess risks to carers, led to an unsuitable child placement.
Overdue
Callum Hargreaves
Concerns: A prolonged dispute between a social housing provider and the Council over rehousing a cuckooed tenant remained unresolved, highlighting a failure to support vulnerable individuals and inconsistent council policies on homelessness applications.
Responded
Callum Hargreaves
Concerns: Sanctuary Housing failed to properly investigate cuckooing and property damage for a vulnerable tenant, leading to an eviction notice instead of support, and lacked a clear policy for such situations.
Responded
Sebastian ‘Benji’ Oliver
Concerns: Police inappropriately closed a "safe and well" check based on an outdated capacity assessment, demonstrating shortcomings in training and communication with paramedics regarding patients with fluctuating capacity who abscond from treatment.
Responded
Locket Williams
Concerns: Insufficient in-county psychiatric inpatient beds for children persist, with new units inadequate for demand or specific needs. A new suicide risk assessment system lacks clear alerts on medical records, risking clinicians missing vital information.
Responded
Christopher Vickers
Concerns: There were multiple missed opportunities to coordinate care through multi-disciplinary meetings and to make safeguarding referrals despite the deceased's known escalating risks.
Responded
Terence Davenport
Concerns: A patient remained in an unsuitable acute hospital due to a lack of care beds. Poor information sharing between authorities also failed to recognize a safeguarding risk, endangering residents and staff.
Responded
Stefan Kluibenschadl
Concerns: A critical failure to provide a case manager or key worker for autistic young people, as per NICE guidance, limits access to support services and prevents navigation of care pathways.
Overdue
Melsadie Parris
Concerns: Social work failed to conduct renewed home visits or liaise with mental health teams regarding a carer's admitted psychosis, relying on old assessments and missing critical information about the carer's deteriorating mental state.
Responded
Rebecca Hayward
Concerns: Inexperienced staff conducting assessments for vulnerable individuals with homelessness and substance misuse issues lead to inaccurate plans, and Care Act re-referrals for changing accommodation are resisted.
Responded
Asher Sinclair
Concerns: A highly vulnerable child was not provided prescribed 2:1 care, their complex package lacked proper review or quality checks, and critical parental concerns were ignored, compounded by inadequate staff training.
Responded
Samuel Alban-Stanley
Concerns: Inadequate support and psychosocial interventions were provided for a child with Prader Willi syndrome and high-risk behaviours. Poor communication between agencies also prevented coordinated care.
Responded
Xuanze Piao
Concerns: The university failed to hold a face-to-face meeting or contact the guardian/parents of an under-18 overseas student before sending a critical email indicating course removal risk, revealing a lack of clear communication policy.
Responded
Ewan Brown
Concerns: A lack of joint police-health policies for vulnerable missing persons, absence of multi-agency meetings, inadequate police mental health training, and poor information sharing protocols hindered effective risk assessment and search efforts.
Overdue
Shannon Quinn
Concerns: Multiple failures in multi-agency communication, inadequate staff training, and poor risk management regarding ligature use, patient observations, and resuscitation significantly compromised care for a patient with complex mental health needs.
Overdue
Ezra Boulton
Concerns: Critical issues include a lack of continuity in antenatal care, insufficient safe-sleeping advice provided post-natally, and midwives' unawareness of criminal implications of infant overlay with alcohol/drugs.
Overdue
Joseph Grantham
Concerns: Key concerns include significant delays in discharge paperwork and specialist letters, unclear care responsibility, missing patient notes, inadequate instructions for community monitoring, and a lack of protocols for inter-hospital care transfers.
Overdue
Enric Elliott
Concerns: Vulnerable young mothers who book late for maternity care are often excluded from the Family Nurse Partnership due to rigid gestation limits, despite late booking indicating increased risk.
Responded
Jeremiah Obaka
Concerns: Lack of a consistent, agreed policy between the local authority and care agency regarding actions when service users do not respond or cannot be found.
Overdue
Steffan Bonnot
Concerns: Inadequate and undocumented disclosure of a child's background information to prospective foster carers caused anxiety and posed a risk to informed placement decisions.
Overdue
Natalie Gray
Concerns: Concerns included an unfinalized discharge pathway for personality disorder patients, inadequate risk assessment forms and subjective terminology leading to inaccurate assessments. Crucially, significant third-party information was not consistently recorded.
Responded
Amy El-Keria
Concerns: Hounslow Social Services misunderstood their ongoing welfare role for a child placed far from home and failed to assess for support, neglecting family contact issues.
Responded
Finnulla Martin
Concerns: Multiple agencies demonstrated critical failures: unclear protocols for voluntary mental health patients with police, inadequate patient assessment (missing suicide inquiries, collateral history), poor inter-agency communication, and failure to record vital suicidal declarations.
Overdue
Mary Stroman
Concerns: A child's recommended long-term therapeutic placement was delayed and ultimately overturned by Children's Services, despite multi-agency support, due to a perceived failure to meet statutory accommodation thresholds.
Responded
Timothy Cowen
Concerns: New training on procedures is not mandatory for all staff, and the Acute Liaison Nurse role, crucial for patient support, lacks adequate cover during absences.
Overdue