Children's services failed in Doncaster child deaths

The first review, into the death of a 16-month-old girl known as Child B, who was killed by her father in 2007, found that children's agencies missed three key opportunities to intervene. They also failed to follow basic safeguarding procedures.

Doncaster Primary Care Trust's health visiting team and Doncaster Council's community and schools social work service came in for particular criticism for failing to safeguard Child B as well as her brother, known in the report as Child C, who is still alive.

Among the missed opportunities was a failure by Doncaster Council's duty assessment service to properly follow up a domestic violence notification from South Yorkshire Police early in 2007.

Other blunders included a failure by staff at Child C's school to inform social workers about the father's aggression. Health visitors were also critcised for failing to assess the risks to the children after a third abortive attempt to visit the family.

Among recommendations made were improvements to information sharing between agencies and better training and resources for the duty assessment service within six months.

All school teachers need safeguarding training within the next year as do youth offending team members, who were involved in Child C's case but failed to spot signs of child abuse.

Doncaster council's interim director of children's services Gareth Williams has admitted there are still problems recruiting experienced permanent staff to the duty and assessment team.

The second review, into the death of Alfie Goddard, who was three-months-old when his father killed him last year, also criticised a lack of information sharing between children's organisations. The review highlights poor communication between health visitors, housing support officers and social workers.

Julie Bolus, director of quality and clinical assurance at NHS Doncaster, said: "We have developed a detailed action plan as a result of this serious case review and are ahead of schedule in implementing the improvements we need to make."