Editor’s blog Tuesday 27 July 2010: Notes from the Khyra Ishaq Serious Case Review

I'm not going to say much about the following series of quotes from the Khyra Ishaq Serious Case Review.

I am sure that I cannot understand how difficult it must be to deal with people being deliberately obstructive about access to ensure their children's health.

I think that I will just say that I'm writing this with a full stomach, and I hope you are reading it with the same. Khyra Ishaq starved to death in the sixth largest economy in the world.

Difficult as it is, there are lessons here to reduce the chances of a similar event.

The quote start here:

"At the time of death the child weighed 16.7 kilograms with a height of 125 centimetres; this gave a body mass index of 10.7 kg/m2 (the normal range being 18 - 24 kg/m2). The child was described as extremely malnourished with severe wasting, weight for height being less than 70%".

Recommendation 2
South Birmingham NHS Primary Care Trust should evidence through audit processes that children who are subject to weight and height checks as part of school medicals, have their data fully recorded and plotted on a growth chart in their notes, to provide a complete and readily accessible picture of the child’s development.

Recommendation 3
NHS Primary Care Trust’s should review processes for obtaining parental consent for child access to the school health service and implement, including a process of follow up action for parental refusal or withdrawal of consent.

Recommendation 15
Heart of Birmingham Teaching NHS Primary Care Trust should review and satisfy themselves that all GP’s are aware of their professional responsibilities to communicate safeguarding concerns that arise as part of their interaction with children and families, in line with existing safeguarding procedures.

Recommendation 17
Heart of Birmingham Teaching NHS Primary Care Trust and South Birmingham NHS Primary Care Trust, Birmingham Children’s Social Care and Education Otherwise agencies should provide evidence to demonstrate an effective response to missed or failed appointments.

23rd March 2007 - Teaching Assistant school 1 recorded a session with the child. They discussed taking food from other pupils. The child showed new shoes and said mother bought them for a birthday because the child had been good. The child stated that “I am good now and I do not steal anymore”. The child talked about tasting crisps, finding chocolate in the hall and eating someone else’s dinner because the child wanted to taste it. But kept stressing that “I was good now”.
The child talked about home cooking and for breakfast having porridge with chocolates and nuts because mum said that the child was good now. “When not good would get horrible porridge”. The child went on further to say that mother says “I can stop eating dinner when I am full. It’s rude not to eat it all but I can stop when I am full. The Teaching Assistant asked the child how old they were. The child responded “I am good, I am 100 years old”.

19th December 2007 - Staff returned to school but did not feel reassured and continued to fax their referral to Children’s Social Care, needs were identified as emotional and behavioural development, health and basic care. The referral included information that the class teachers for both the child and a sibling had seen them trying to take food from other children’s bags, cramming fruit into their pockets and that both children are very slender. The sibling had been feeling cold; that a teacher had met with mother about food being taken and that the child had not been into school since this point

8th January 2008 - School Nurse from South Birmingham NHS Primary Care Trust was asked to see a sibling by class staff who were concerned with the child’s weight. During this weigh-in, the weight was between the 25th and the 50th centile (previously the child had been on the 75th centile). Staff reported that mother was restricting the diet in school and was not allowing snacks like the child’s peers. School staff were unaware of the reasoning behind this behaviour and reported that the sibling was asking for food saying it was hungry. There was a record to note they will ask mother to see the school doctor on 16th January in school at 2pm.

Between 1998 and 2008 the children missed a minimum of 129 appointments, 43 (33%) of those relate directly to appointments for the child. A large proportion of these appointments were for health related activities. It must be recognised that in a family of six children, several of whom with statements of special educational need, creates particular pressures and stresses for parents and a degree of failed appointments would be expected. However, the pattern of failed appointments escalated dramatically during 2007, 26 (20%) ppointments were missed, as relationships with professionals deteriorated. Between January and May 2008 a further 7 were defaulted. … It is from October 2007, with failures to attend hospital appointments and school medicals, that the greatest increase is seen