There have been a number of high profile cases where parents have been wrongly accused of or made to feel responsible for the death of their child. So was that the “bad old days?” or have the many calls for professionals to “listen to the voices of parents” fallen on deaf ears? Next week, Dr Denise Turner, a trained social worker whose own son Joe died suddenly in 2005, presents new research at the ESRC Research Methods Festival in Oxford which investigates whether the authorities and society as a whole is still failing to balance suspicion and sensitivity.
The sudden, unexpected death of a child now occurs rarely in the U.K. Improvements to housing, sanitation and medicine, together with more rigorous safeguarding procedures, have all contributed to this gradual but dramatic decline. When such deaths do come to public attention, it is usually through media reports of wilful harm or neglect.
However, just over a decade ago in 2003, the high profile news stories of Angela Cannings, Sally Clark and Trupti Patel, filtered this media reporting and consequent public interest, through a different lens. The three women had all experienced the unexplained death of more than one child and, after periods of imprisonment, each had their conviction declared unsafe by the Court of Appeal.
Following their release, much of the original evidence in their trials was placed under heavy scrutiny. As part of this, The Royal College of Pathologists and the Royal College of Paediatricians and Child Health established a Working Party to investigate concerns about the role and evidence of expert witnesses in Court, together with a review of procedures for the investigation of sudden, unexpected child deaths.
The findings of this Working Party were published as the report ‘Sudden, Unexpected Death in Infancy’ which rapidly became known as the Kennedy Report, after its chair, Baroness Helen Kennedy.
The Kennedy Report made a number of recommendations, which in 2008 became part of a national protocol for investigating sudden, unexpected child deaths and which remain in place to date. Key amongst these was the formalisation of a professional Rapid Response to include immediate investigation and evidence gathering by the police. Subsequent to this immediate intervention, the new protocol also recommended a series of multi- professional meetings, usually culminating in a Case Review.
In addition to defining standards for investigation, the Kennedy Report argued for a compassionate approach to investigation, which could support parents in the first moments following the death. The police are required to treat all sudden, unexpected child deaths as potential crimes and although the Kennedy Report noted that very few of these deaths will be in any way suspicious, it stressed the need for careful investigation, balanced with sensitive support for the family. In order to help achieve these aims, the report identified a strong need for appropriate training which would help professionals become more sensitised to the possible range of emotions experienced by parents.
However, despite this stress on improving communication between professionals and parents, no parents actually participated directly in the Working Party for the Kennedy Report which was formed entirely from different stakeholding professionals. Similarly, despite the Kennedy Report’s emphasis on improving dialogue and understanding between professionals and parents, no opportunities are provided for parents to attend any of the meetings following their child’s death making it difficult to enhance understanding and thereby to reduce the risk of further cases like those of Sally Clark, Angela Cannings and Trupti Patel.
The Kennedy Report itself concedes this, stating that the nature and sensitivity of the subject has led to enduring contentious issues, on which it invites feedback from interested parties.
Telling the story
From 2007 to 2014, as part of a part time PhD in Social Work, I conducted a qualitative research study, based on the in-depth accounts of eight parents who had experienced professional intervention following sudden, unexpected child death. General findings from this show that many of the contentious issues referenced in the Kennedy Report are situated within a prevailing cultural avoidance of death.
Despite a growing debate around cancer and end of life care, the widespread emphasis on youth largely sequesters general discussion and education of death, which does not appear as a distinct area of study within UK social work programmes. Additionally, a prevailing culture of risk aversion and blame has created an environment of fear for professionals who are nevertheless required to show sensitivity towards parents whilst investigating them for a potential crime.
The death of Jayden Wray in 2009, demonstrates the potentially tragic consequences of this. Jayden was four months old when he died as a result of rickets, caused by a genetic condition passed within breast milk. His concerned parents had initially taken him to the GP who advised hospital examination. Following a series of errors by senior hospital staff, who ignored suggestions that Jayden may have rickets, his parents were arrested on suspicion of causing grievous bodily harm and never saw Jayden again.
When the couple’s daughter Jayda was born on 17 October 2010, no family members were allowed to attend, and the baby was removed at birth. The parents were eventually acquitted of murder by the Old Bailey in December 2011, two years after Jayden’s death, following post mortem evidence which clearly demonstrated Jayden’s rickets. The trial judge said in judgment that Jayden had received ‘suboptimal care’ from two hospitals and Jayden’s baby sister was finally returned to her parents by the Family Courts in April 2012.
This case and the missed opportunities, which led a non-emergency visit to the GP to terminate in death and prosecution, echoes the previous cases of Clark, Cannings and Patel and powerfully demonstrates how fear may cause professionals to mis-diagnose a health condition in favour of a less obvious conclusion of non-accidental injury. It demonstrates also that the balancing of suspicion with sensitivity so clearly recommended by the Kennedy report is still failing to be properly implemented.
Rapid response effects
Within the general culture of fear so vividly demonstrated by many of the professionals involved with Jayden Wray, my research found a number of specific issues which could easily be addressed in order to improve the experience of sudden, unexpected child death.
One of the most concerning of these is the effect of Rapid Response on any surviving siblings of the dead child. Rapid Response, as its name suggests, involves an immediate intervention by police and other professionals in which the child’s room and body are identified as crime scenes, parents are interviewed separately by police and the house is effectively cordoned off with restrictions as to leaving and entering.
The practical application of these restrictions led to situations, discussed in my research, where children were told they could not leave houses which had become crime scenes , whilst conversely parents returning from seeing their dead child in hospital, were prevented from re-entering their homes to be with a surviving child.
The Kennedy Report did not consider the potential effects of Rapid Response on surviving children and my research has highlighted that this risks causing as much harm as the investigation itself hopes to prevent.
Despite the emphasis on balancing suspicion with compassion, the police teams who arrive on the scene following a sudden, unexpected child death are commonly named Child Abuse Investigation Teams, causing many of the parents in my research to feel under suspicion for harming their child at such a deeply traumatic time. This is an unnecessary ordeal which could be alleviated by a simple commitment to changing to the terminology.
Similarly, when the Rapid Response is complete, if no charges are brought, parents do not hear again from the investigating professionals and there is no official closure, causing parents in my research to feel under suspicion often years after the death. Parents suggested that a letter could be sent which simply outlined that there would be no further action taken and no grounds for prosecution.
Listening to parents
My research also highlighted the lack of formal opportunities for parents to share their experiences of professional practice and the concomitant lack of learning. Parents in the study all expressed a wish to feed back into the processes which follow sudden, unexpected child death and this could form an effective part of the training identified by the Kennedy Report.
Finally, although child deaths are now rare, a fairly recent Dept of Health Report on Children and Young people’s Health Outcomes showed that they remain comparatively high, with more under 14 year-olds dying in England than in the rest of northern or western Europe. Some of these deaths may be subject to a Rapid Response, and thus the need to foster understanding and engage in debate about improving the experience remains vital.
By its very nature, sudden, unexpected child death is both sudden and unexpected and could therefore happen arbitrarily to any one of us. A decade after the exonerations of Angela Cannings, Sally Cark and Trupti Patel, the case of Jayden Wray, together with findings from my study demonstrate the need for further research and general death education, alongside a targeted policy of improving interventions and procedures in order to improve the experience for all those involved with sudden, unexpected child death.
Dr Denise Turner is a Lecturer in Social Work and Social Care (Social Work and Social Care) at the University of Sussex. Read more about her story in the Family Guardian.