Enhanced health visiting service could help identify children at risk of abuse

Des Mannion
Tuesday, July 19, 2016

The murder of a 17-month-old boy has rightly put a renewed spotlight on how we can better protect children. Finley Thomas was beaten to death by his mother's partner. He suffered head injuries and medical examinations of his body also found previous bleeds and injuries to his head and spine. In June, Sean Buckley from Tonypandy in the Rhondda Valley was found guilty of murder and received a life sentence. Finley's mother, Chloe Thomas, had earlier pleaded guilty to cruelty and has now been sentenced to 20 months. It's absolutely crucial that we learn lessons from this case, and a multi-agency child practice review will help us do that. But until its publication, we can only wonder about Finley's final months and what could have been done differently to protect him.

There are a number of options that can be considered to improve our early response to abuse and neglect. Babies need to be nurtured and their needs must be met to enable them to thrive. There is a wealth of evidence that the first thousand days, from pregnancy through to a child's second birthday, is the most significant in a child's development. It shapes everything - their future health and wellbeing, academic attainment and quality of life. A baby's brain grows from 25 per cent of its adult size at birth to about 75 per cent by the end of the second year. It's a time of enormous vulnerability but also of enormous potential. If a parent is not providing the love and care a baby needs, this is the window of opportunity to intervene.   

While most parents do provide babies with the love and care they require, we know that under ones are disproportionately vulnerable to abuse and neglect. This is reflected on the Child Protection Register, where they're the biggest group, making up 10 per cent of the 3,000 under-18s registered in Wales. Each of those babies is at risk of neglect or physical, emotional or sexual abuse. We also know that in England and Wales, babies are eight times more likely to be killed than older children.
Early adverse childhood experiences cast a long shadow and children who suffer them are far more likely to develop health-harming behaviours and anti-social behaviour in later life. Child maltreatment (verbal, physical or sexual abuse, and neglect) domestic abuse, mental illness or substance misuse are all known risk factors and the more that are present, the greater the danger and the more important it is to intervene early.

But how can we prevent babies being abused and neglected? Health practitioners such as GPs, midwives and health visitors are crucial as they see babies routinely. They need to be equipped to spot the signs of abuse and neglect. We are very supportive of the Flying Start programme currently running in the areas of greatest deprivation in Wales which provides children and parents of under-4s with intensive health visiting and other support services. But parents outside Flying Start areas may have a health visitor with a case load of 400 families and I fail to see how babies can be effectively monitored and protected in those circumstances.

This is why we believe that Wales needs an enhanced health visiting service outside Flying Start areas to ensure our babies are protected from harm and ensure they have the best possible start in life. We would like to see more health visitors and support staff to assist them in their role together with evidence-based family support programmes to properly support parents so that problems can be addressed early.
There's also a key role to play for the public. People who have concerns about babies and children should be encouraged to speak out about their concerns without delay.
Learning and improving when things go wrong is hugely important and the child practice reviews in Wales are key to preventing similar events happening again. We're urging the Welsh government to analyse child practice reviews and share learning across Wales on a regular basis.

Des Mannion is head of service at NSPCC Wales

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