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In January 2003 Lord Laming reported a widespread organisational malaise and lack of good practice within the police and social and health services that had resulted in “a lamentable failure” to protect Victoria Climbié.1
“The investigation and management of a case of possible deliberate harm must be approached in the same systematic and rigorous manner as would be appropriate to the investigation and management of any other potentially fatal disease”.1
Twenty seven of his 108 recommendations related to health services, with a 2-year timescale for implementation. This study examines the extent of the implementation of these recommendations. We are not aware of any other study in this area since the publication of the report.
A questionnaire designed to ascertain the extent of implementation of the healthcare recommendations was sent to the named doctor for child protection in 165 NHS trusts in England and Wales in April 2005, and was re-sent to non-respondents in June 2005. The names were obtained through direct telephone enquiries and in conjunction with the Child Protection Committee of the Royal College of Paediatrics and Child Health (RCPCH).
We received 122 replies (74%). We set 70% (86 of 122) as the number of affirmative responses required for each recommendation to indicate successful national implementation.
Communication and documentation
Successfully implemented: (percentage replying “yes” noted in brackets)
Appropriate translator services must be available (75%).
Full discussions must be held and recorded for all child protection cases where medical opinions conflict (87%).
All discussions (including telephone ones) regarding child protection issues must be documented for each patient (85%).
Clinicians should make their own comprehensive and contemporaneous notes (94%). …
Competing interests: None.
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