SECRET CONCERN FOR 4000 LOTHIAN CHILDREN

HEALTH workers have failed to report concerns about the welfare of
4000 children in the Lothians.

The shocking statistic has emerged from an NHS inquiry into the case
of toddler Michael McGarrity, who was left to survive for six weeks
alone in a flat with the body of his drug-addicted mother. The probe
found that health workers failed to raise the alarm about the Leith
youngster despite being concerned about his wellbeing.

And it uncovered 4000 other cases where health workers have raised
concerns - often because of their parents' drug abuse or drinking -
but failed to alert social workers.

The findings today sparked demands for an independent inquiry.

The failings have been uncovered two years after the O'Brien Report
into the death of baby Caleb Ness in Edinburgh. It warned then that
the NHS needed to react better to the concerns of health visitors
about children who may be at risk and said it needed to communicate
better with social services.

The internal health service investigation was launched after
three-year-old Michael was discovered close to death after surviving
for six weeks alone in a flat with the body of his drug-

addicted mother. Police officers finally broke into the Leith flat
where they were living after staff at Michael's nursery school
finally raised the alarm.

Two health visitors were suspended by NHS Lothian as it investigated
whether Michael's ordeal could have been avoided.

The Evening News understands the investigation has discovered that
the health visitors who had contact with Michael and his mother
recorded concerns about his wellbeing.

Michael's mother, Anne-Marie, was a recovering heroin addict, who was
taking a methadone prescription.

The results of toxicology tests on the 33-year-old's body are awaited
by police, who have not ruled out a drug overdose as the cause of death.

Senior sources said chief executive Professor James Barbour held a
furious meeting with care managers after learning of the results of
the investigation.

The report, which is due to be published in the coming days, is
understood to warn that Michael's case is not an isolated one.

Health visitors have identified the home circumstances of other
children as "cause for concern", but failed to alert social workers
about their fears.

However, health chiefs are understood to have left the 4000 figure
out of a final draft of the report for fear of the concern it would raise.

Both the O'Brien report and the latest guidelines on child protection
make it clear that health workers should report any concerns at all,
even if they do not feel action must be taken, to the council's
social work department.

But a spokeswoman for NHS Lothian insisted that although health
professionals had raised concerns about 4000 children, their cases
were not felt to be serious enough to be reported to the council.

Director of Public Health, Alison McCallum, who is chairing the NHS
Lothian critical incident team investigating the McGarrity case,
said: "The NHS has been working very closely with the City of
Edinburgh Council through our investigations into the circumstances
of the Michael McGarrity family case.

"The full findings of the critical incident team are not as yet
available. Until the team has concluded its investigations and has
completed a report on its findings it will be inappropriate to
comment any further."

BUT councillor Tom Ponton, convener of Edinburgh City Council's
influential social work scrutiny panel, called for an independent
inquiry into the way NHS Lothian deals with child protection cases.

He said: "If the health board are withholding information, we are in
a very serious situation. I am very worried about these children.

"The less we know about their history and the way they are living,
the harder it is to protect them.

"There could be hundreds of children in a similar situation to
Michael McGarrity or Caleb Ness.

"We have the networks to deal with situations like this, but if
[health workers] are not giving us the names of the children who may
be at risk in the first place, we cannot do our job."

Caleb Ness died in 2002 when he was 11 weeks old after being released
into the care of his drug-addict mother and brain-damaged father, who
shook him to death.

As a result of the O'Brien Report into the tragedy - which found
"failures at every level" of the city's child care system - new child
protection rules were unveiled last week.

The rules, drawn up by police, social work and health chiefs,
outlined the need for better communication between NHS workers and
the city council's social work department.

SNP health spokeswoman Shona Robison said she was disturbed by
another failure to pick up on warning signs that a child may be in danger.

She said: "Precautionary action is obviously a clear recommendation
from both the O'Brien Report and the latest guidelines that should
have been followed. It is disturbing that once again, there has been
a failure to observe them.

"Although not all of those 4000 cases that have been highlighted are
of immediate concern, there will be some there that are as urgent as
Caleb Ness or Michael McGarrity.

"Poor communication always increases the risk of there being more
cases like these.

"If vital information hasn't been passed on from health workers to
the social work department, the chance of something happening is
greatly increased." Health visitors are required to keep a record of
any families - such as Michael McGarrity and his mother - that they
believe give "cause for concern". Visits to these children should
occur on a more regular basis.

There are a wide variety of factors which could lead to health
visitors deciding to record a "cause for concern", including parents'
drug and alcohol habits. However, many will be as a result of less
serious circumstances, such as, perhaps, a particularly dirty house,
which could put the child's health at risk.

One health service source said normal practice among health visitors
was to notify social workers only of the most serious of cases marked
"cause for concern". That would normally be just cases where parents
were active users of hard drugs or had serious alcohol problems, the
source said.

"I don't think [social work referral] is happening in all cases
[where parents are using hard drugs]. I think if the people of
Edinburgh found out how many pregnant women are on drug prescriptions
or are regular users of heroin, they would be horrified. There are a
very large number of women in that situation."

Union leaders defended the work being done by health visitors in
Edinburgh, but said they often had to struggle under a heavy workload.

A spokesman for public sector union Unison said: "Health visitors and
social workers tend to communicate very well in Edinburgh, and much
better than those in general practice, for example.

"We are also aware that social workers and health visitors have very
heavy workloads."

Ms McCallum added: "Even in cases where social services were not
involved with children in a statutory sense, they would provide
advice, support, and signposting to help children and families access
appropriate services from other statutory or voluntary agencies.

"This is not contrary to any of the guidelines developed following
the tragic death of Caleb Ness or the recent ELBEG guidelines"

Warnings That Should Have Been Heeded In Wake Of Caleb's Death

THE O'Brien Report into the death of baby Caleb Ness was issued on
October 9 2003. Its 35 recommendations included:

That the best means of triggering early reviews or immediate action
in response to health visitors' concerns be investigated, and
improved upon, as a matter of urgency

That serious dialogue is undertaken to clarify the role of the
trusts' child protection services within an interagency context

That all agencies make it a priority to collaborate and put in place
effective risk assessment processes to underpin decision-making

That the Lothian University Hospitals Trust reviews the accuracy of
its record keeping for at-risk children

That Lothian Health ensures that its various Trusts fund the training
requirements identified by their own senior staff with management
responsibility for child protection

That senior managers with responsibility for child protection
practice have appropriate training to discharge that responsibility,
in every agency

That the chief executives and medical directors give urgent
consideration to lines of accountability

The report also noted: "We do consider that it is imperative that the
social workers actually providing a system of child protection should
know precisely what they can expect from their medical colleagues.
Social workers and health workers have to be aware of the need to
open up a channel of communication in every case."

New child protection guidelines were issued last Friday by Edinburgh
Lothian Borders Executive Group (Elbeg), a body formed following the
O'Brien inquiry to oversee child protection in the region, including
senior representatives of the four Lothian councils, NHS Lothian and
Lothian and Borders Police. These noted: "An inter-agency assessment
should be undertaken on all parents and expectant parents with
problem substance use where there is a level of concern about the
welfare and safety of the child.

"A 'lead professional' should be identified to manage this assessment
process, request and collate the information on significant risk
factors that are likely to affect parenting capacity.

"The assessment should be completed within four to six weeks of
referral and with pregnant women, by no later than 28 weeks gestation.

"The assessment should include at least one home visit, should be
recorded and retained in the client's case file. Copies of the
assessment and its outcome should be sent to all practitioners
involved with the family."