HARINGEY'S HEALTH AND SOCIAL SERVICES

In only two weeks inspectors have gleaned enough information on services in Haringey to know that something has gone very wrong. But most of the criticisms damn every agency – health as much as childrens’ services, and baby P will have died in vain if we leave it there.

There will be a huge temptation for the nation to sit back now, having watched an absolutely historic display of Haringey Council heads being fired, and sigh "so that’s alright then."

But things are not all right in Haringey and there are too many unanswered questions in the Ofsted report about the role of the Haringey health authorities in this sorry case.

Ten new health visitor posts have hastily been advertised. Residents in our part of Haringey will not be surprised. In the past two years Fortis Green clinic has been sold and Highgate clinic has been closed, with no services at Hornsey Central Hospital for nine years. A litany of budget cuts and reorganisations, privatisation plans and foundation status applications have been the dominant concern of our Haringey health bureaucrats. When they transferred administration of child health services at St. Ann’s Tottenham, several miles away to Great Ormond Street, signed off only this year, their only risk assessments were financial. Experience of community health, the need for health visitors and the medical training of practitioners in vulnerable children did not feature.

How many times the health visitor had seen baby P over seventeen months? The answer was five, with gaps and a change of health visitor towards the end of his life. Appointments had not been kept: "This is absolutely typical of the families seen" the health spokesman added. His response spoke volumes. How on earth did management think a vital trusting rapport between health visitor and mother could even begin when there was so little inadequate contact? The health authorities have a duty of care. Of course these families will be tricky. It comes with the territory. They wouldn’t be requiring close supervision otherwise. Regular missed appointments in these cases should ring alarm bells.

Baby P was a baby. He had no language. Social workers had to rely on medical assessments. But where were the meetings with health officials to discuss this? What really happened with Haringey's GPs, the Health Visitor and the Paediatrician. Is it true that it took months to obtain a medical assessment at St. Ann’s Hospital and that the paediatrician here was not properly informed that this was a child at risk?

The Ofsted report is littered with criticism of the health service management: Here are just some examples:

"Frequent unacceptable and extreme delays" in communications between health, childrens’ services and the police.

"Health service files are often poorly organised and the process and planning of individual cases is difficult to follow. (They) include hand-written notes which are sometimes illegible and do not identify the author. The standard of record-keeping in the health records of looked after children and young people is poor and some entries are inaccurate. There is insufficient evidence of managerial oversight and decision-making on case records."

"The quality of health assessments for cared for children is poor."

"There is insufficient guidance for and oversight of the work of general practitioners who undertake the majority of assessments."

Individual management reviews provided by the the North Middlesex University Hospital/Great Ormond Hospital NHS Trust, Haringey Teaching Primary Care Trust, were "inadequate. "
 
"The individual management reviews provided by social care services and the primary care trust lack rigour in their analysis and thus significantly undermine the integrity of the serious case review. The overview report does not look at the capacity of front line services to deliver what was required of them, or the quality of management oversight and support."
 
"Previous longstanding severe shortages of staff in community nursing services resulted in a reduction of preventative health care available to children and young people in the borough. ..Staff express concern that the level of staffing in child and adolescent mental health services is insufficient to meet the demand."
 
It is no wonder baby P was left to die.

Although heads have rolled in Childrens’ Services, the fact that so many of the criticisms are of all the agencies, and particularly health, means that we cannot leave things there. The residents of Haringey deserve a Public Inquiry. Haringey services need more than a fresh coat of paint. If our vulnerable people are to be protected in the future, all the wallpaper needs to come off this time, and that includes looking at what is underneath that thick layer of the health department, Haringey's Primary Care Trust.


Sue Hessel
Haringey Federation of Residents’ Associations (Vulnerable Groups Officer)
2.12.08