A serious case review into the death of 4 year old Daniel Pelka has found that whilst none of the agencies involved could have predicted Daniel’s death, opportunities were missed to help the schoolboy who was murdered by his mother and her partner in Coventry. It highlighted a lack of information sharing and a failure to work in a `joined up’ way contributed to obstructing professionals from seeing the bigger picture.
The problem that is raised in almost every single serious case review is a lack of information sharing. And certainly many of the failings identified in serious case reviews could have been addressed through improved communication between agencies. A lack of information sharing, professionals who are not informing each other of their little piece of the jigsaw – these are key to helping agencies see the bigger picture that would enable them to put interventions in place.
Gary Pettengell, Chief Executive, ECINS
For multi-agency partnerships to be fully effective, information must be shared securely, in real time, between partners. We are proud to have created an environment where everyone knows what everyone else is doing whilst at the same time complying with the Data Protection Act.
We are now talking to counties that are looking to sign up all their schools to ECINS. Another county is already running a restorative justice programme in their schools with all cases being uploaded to ECINS.”
The report raised some of the issues professionals faced when dealing with the family, “Some of the problems, such as the changes of addresses by the family, including moving out of Coventry for a period of time, made professional communication a more challenging process but it is fully possible now, through the use of a cross-border multi-agency system to keep external agencies, even those in different counties fully abreast of information relating to a particular case.” said Gary. “Professionals who are in a position to make a decision about their own interventions can now easily access views and opinions from other professionals to build up a more accurate picture of the type of interventions required.”
Martin Reeves, chief executive of Coventry City Council said “The report makes clear that the sharing of information and communications between all agencies was not robust enough and no-one fitted together the jigsaw of what was really happening to Daniel… every agency in Coventry needs to stand up and take responsibility individually and collectively for missed opportunities to have protected Daniel better. We must have a situation whereby people will be able to stand back… join the dots up and make that decisive judgment call. Judgements which are really difficult, arguably impossible sometimes, about the right thing to do regarding a child and their family.”
A spokesperson for Coventry City Council – Children, Learning and Young People Directorate said “In Coventry a system had been set up to jointly screen domestic abuse referrals on a multi-agency basis and ten such meetings were held during the domestic abuse history of this family… “at some meetings, domestic abuse incidents were being discussed up to three months after they had occurred and decisions made were not recorded in order to review actions….also the information about incidents of concern was not always readily accessible.”
Gill Mulhall, Daniel’s head teacher at Little Heath Primary in Coventry, said: “His mother was a convincing manipulator. If we were aware of the bigger picture of his life or had doubts about her, we would of course have acted differently. We want to see changes where schools are aware of concerns from other agencies which affect our pupils.”