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Archived Transcript for 16 November 2001: Pages
1 to 50
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1 Friday, November 16th 2001
2 (9.00 am)
3 THE CHAIRMAN: Good morning ladies and gentlemen.
4 MR SHELDON: Sir, may I recall Mrs Fletcher please.
5 MRS ELIZABETH FLETCHER (continued)
6 MR SHELDON: Good morning Mrs Fletcher.
7 MRS FLETCHER: Good morning.
8 MR SHELDON: You are still under the oath that you took
9 yesterday evening as I am sure you are aware. We
10 finished yesterday by discussing some of the aspects of
11 communication between you and North Middlesex Hospital.
12 MRS FLETCHER: Could I say a few more words about that,
13 unless you wanted to ask me another question
14 specifically about that?
15 MR SHELDON: This arises out of the matter we were
16 discussing at the end of yesterday evening, does it?
17 MRS FLETCHER: Yes, it does.
18 MR SHELDON: Please do.
19 MRS FLETCHER: I think on reflection over the course of the
20 last few hours, I would like to actually clarify some of
21 what I was trying to say yesterday afternoon. I think
22 it would be fairer to say that the reason that I did not
23 communicate with the named nurse at the North Middlesex
24 was that I do not believe there actually was a named
25 nurse at the North Middlesex at the time and I feel that
2
1 the criticism would be better to say that I should have
2 been proactive in endeavouring to ensure there was
3 a named nurse in North Middlesex rather than saying
4 that -- rather than the criticism of there being poor
5 communication. I do see that there is a subtle
6 difference and I would like to make that point.
7 MR SHELDON: Thank you very much. It is a point that
8 I would have thought might be well taken and it is one
9 that has been suggested to me as well overnight, but
10 just so I am clear about what you say about it, it is
11 this: The ideal arrangements or by far the best
12 arrangement is for there to be regular contact between
13 the named child protection nurse in the hospital and the
14 designated professional in the community.
15 MRS FLETCHER: Yes.
16 MR SHELDON: You as the designated professional should have
17 attempted to persuade North Middlesex Hospital to
18 appoint such a named nurse so that that communication
19 could occur, is that correct?
20 MRS FLETCHER: I certainly think that now. I was not as
21 forward thinking of that at the time. It was not that
22 I failed to do it, it did not occur to me. I took the
23 structure that was in place and worked with that
24 structure and I now realise that actually it would have
25 been useful and appropriate for me to actually have
3
1 looked more thoroughly at the proposed or the suggested
2 structure and what value that has and now that we do
3 have a wider range of named professionals, both in the
4 community and at the hospital, it is obvious to me how
5 much better that is.
6 MR SHELDON: Thank you very much for that, that is extremely
7 helpful. If I could move on to another aspect of
8 communication between the hospital and the Community
9 Trust and that is the weekly meeting that you describe
10 in your statement. Firstly, if we can review who would
11 attend those weekly meetings. As I understand it from
12 your statement, Dr Rossiter would normally be there.
13 MRS FLETCHER: Can we just make sure, I am fairly certain
14 you do mean the Tuesday child protection meetings.
15 MR SHELDON: That was going to be my next question, because
16 if we could have a look at paragraph 4.3 of your
17 statement, it is not entirely clear. About four lines
18 down you say:
19 "There are also weekly meetings at the hospital
20 between the Designated Paediatrician; Liaison Health
21 Visitors; Specialist Health Visitor/Child Protection ...
22 and a variety of other hospital staff ..."
23 MRS FLETCHER: Yes, that is the Tuesday one.
24 MR SHELDON: That refers to the Tuesday non-accidental
25 injury forum, does it?
4
1 MRS FLETCHER: Yes.
2 MR SHELDON: According to Dr Rossiter, there was also
3 a meeting that took place on Mondays called
4 a psychosocial meeting.
5 MRS FLETCHER: Yes.
6 MR SHELDON: And according to her statement -- and for your
7 note sir it is page 226 of volume 6, she suggests that
8 there was a liaison health visitor representative at the
9 psychosocial meeting as well. Do you know whether or
10 not that is true?
11 MRS FLETCHER: I believe it is true. I am concerned that
12 during the vast majority of 1999, that is from around
13 about February of that year through to October, there
14 was not a regular permanent liaison health visitor in
15 post. I find it hard to believe that the covering
16 arrangements that were in place at the time, that anyone
17 who was doing that liaison cover actually did attend the
18 Monday psychosocial meetings, but I do not know that
19 they did not. I just would imagine that they did not.
20 MR SHELDON: I see. That would be a problem, would it not,
21 particularly in view of the suspension of the Tuesday
22 meeting, because the Monday meeting then becomes the
23 principal route by which concerns felt in the hospital
24 might make their way out into the community?
25 MRS FLETCHER: Totally, and I completely agree. It is only
5
1 my not wide knowledge that tells me it is unlikely that
2 they went to the psychosocial meetings. But they may
3 well have done. I cannot be sure.
4 MR SHELDON: You were not managing liaison health visitors
5 at that stage?
6 MRS FLETCHER: Not at all.
7 MR SHELDON: But after you did take on management of liaison
8 health visitors, did you attempt to ensure there was
9 a liaison health visitor representative at the
10 psychosocial meetings?
11 MRS FLETCHER: Once the permanent health visitor took up
12 post on 4th October I certainly did. I did not ensure
13 it during September.
14 MR SHELDON: You are confident, are you, about the point you
15 make in your statement in paragraph 4.3 that those
16 Tuesday meetings were suspended during the period that
17 you indicate?
18 MRS FLETCHER: I am fairly confident. I am not 100 per cent
19 confident. The reason I am confident is that
20 traditionally the meetings were documented in a book
21 held within the liaison office and one of the two
22 liaison health visitors would actually make notes of the
23 children -- of children that were discussed at Tuesday
24 lunchtime in that book. That book for that period that
25 I have quoted in my statement from the 8th June through
6
1 to the 14th is actually blank. I have looked at it.
2 I also have looked at my diary for that period and I --
3 there is not any indication in my diary for that time
4 that I attended Tuesday lunchtime child protection
5 meetings.
6 MR SHELDON: Would you normally though?
7 MRS FLETCHER: I had been doing certainly, yes. That does
8 not mean to say I did not go because entering things
9 into one's diary that one has done retrospectively does
10 not always happen and I always used to go to the
11 one o'clock Tuesday meetings if I was easily available.
12 That varied on a weekly basis, but I did used to go
13 fairly regularly.
14 MR SHELDON: There is a potential explanation for the first
15 of the two points you mention, namely the absence of any
16 record in the book, because there was no regular liaison
17 health visitor there. The post was being covered on an
18 ad hoc rota basis, so it may simply have been that the
19 fill-in liaison health visitors were not aware of the
20 need to write the notes in a book.
21 MRS FLETCHER: I am not convinced about that because the
22 Enfield liaison health visitor was in post and the
23 working arrangements between the Enfield health visitor
24 and any health visitor that may be representing Haringey
25 were actually quite good and I know very well that Kate
7
1 would have ensured that if the meetings were happening,
2 that they were documented in the same fashion as they
3 had been. I do not think the meetings happened but
4 I cannot be one hundred per cent certain of it.
5 MR SHELDON: The reason I sought to press you on it was
6 because Dr Rossiter when she gave her evidence, and it
7 is Day 20 line 166, seemed to be of the view these
8 meetings were going on and indeed she says that she
9 thought it was a conversation with a liaison health
10 visitor at one of those meetings that prompted her to
11 write to Petra Kitchman on 13th August, which is within
12 this period. Again, to be fair, she was not one hundred
13 per cent certain about it either but it seems as if we
14 cannot do any better than that.
15 MRS FLETCHER: No. I will leave it at that. I cannot be
16 certain. There is no way of proving it conclusively.
17 MR SHELDON: Very well. You say that despite the lack of
18 meetings though it was possible to maintain informal
19 contact between liaison health visitors, Dr Rossiter and
20 whoever else might need to be spoken to at the hospital?
21 MRS FLETCHER: I think it is important that the Inquiry team
22 realise that one of the many attributes of Mary Rossiter
23 is that she does actually communicate quite extensively
24 with quite a wide range of people, and to be fair quite
25 a lot of that communication is actually done informally
8
1 on the hoof, and although that has problems attached to
2 it, it does happen, and I undoubtedly believe that she
3 will have talked to a liaison health visitor at some
4 stage and will have got those indicators she said about
5 school nursing input and GP input from a health visitor.
6 MR SHELDON: The difficulty about that sort of informal
7 contact though, however useful it may sometimes be in
8 practice, is illustrated in this case, is it not, by the
9 fact that we do not know whether such contact took place
10 or not and you have no way of knowing now whether such
11 contact took place or not?
12 MRS FLETCHER: No.
13 MR SHELDON: So can I be clear before we move on, by what
14 mechanisms do you say in July and August 1999
15 information about child protection cases was being fed
16 out of North Middlesex Hospital into the Trust and the
17 community?
18 MRS FLETCHER: The main mechanism at that time was actually
19 the system that has been described to you in that the
20 liaison health visitor, the covering liaison health
21 visitor would pick up information from the A&E
22 attendance that had happened in the previous 24 or 48
23 hours and would be feeding those out by phone and by
24 paper to the community -- appropriate community nurse.
25 That is a mechanism that had stood for a long time and
9
1 was continuing to work.
2 I indicated yesterday that the bit I found
3 surprising about Victoria's case was that despite the
4 fact that she was in hospital for two weeks, there was
5 only one lot of information that came out, and because
6 that failed to arrive at the right place there was no
7 fall back, which normally we would pick it up a second
8 or third time around and that is the safety net, but it
9 did not happen and I do not understand why that did not
10 happen.
11 MR SHELDON: So on any view the mechanisms were inadequate
12 at that point?
13 MRS FLETCHER: For Victoria certainly.
14 MR SHELDON: And now the position has been improved by
15 regular communication between the designated
16 professional in the Trust, namely you and a named nurse
17 on the ward in North Middlesex Hospital, and by the
18 appointment of a full-time regular liaison health
19 visiting service at the hospital and the presence of
20 that liaison health visitor on key meetings such as the
21 ones we have been talking about. Is that fair?
22 MRS FLETCHER: All of those things and more.
23 MR SHELDON: And more, what else.
24 MRS FLETCHER: Having a regular liaison health visitor at
25 the hospital is, or the value of that is very difficult
10
1 to describe simply. The value of having a person that
2 staff visually identify and can have regular contact
3 with is -- what is the word -- tremendously valuable, it
4 is huge. And that in itself is probably the biggest
5 advantage really. The things that we have also done is
6 that we have increased the health visitor's time. She
7 now works whole time, as opposed to what was half
8 a week, a .5 post originally. We have increased the
9 clerical support to that health visitor so actually the
10 health visitor is freed up more to actually be out,
11 about, meeting and working with hospital staff, as
12 opposed to sitting in an office processing paper, which
13 was the tradition in the past. That is not to say there
14 were no links out into the hospital, but that has
15 improved enormously, particularly in the last few months
16 where we have actually increased the clerical input yet
17 again.
18 MR SHELDON: It sounds from what you are saying that this
19 liaison health visitor post is absolutely vital in the
20 scheme of things.
21 MRS FLETCHER: It is enormously vital.
22 MR SHELDON: How did it come to be then that that post was
23 vacant for three months in the middle of 1999?
24 MRS FLETCHER: I do not have the answer to that question.
25 I do not know -- I do not even know, I cannot even
11
1 speculate and it would be inappropriate for me to say.
2 MR SHELDON: The reason I wondered if you might be able to
3 was because you took over responsibility for that
4 liaison health visiting function on 1st September 1999.
5 MRS FLETCHER: Yes.
6 MR SHELDON: And we see from your statement that the liaison
7 health visitor took up post on 4th September 1999. What
8 I wondered was whether you had come into post, got
9 things moving and therefore got a liaison health visitor
10 in sharp contrast to three months of people doing
11 nothing about it?
12 MRS FLETCHER: I would like to say that that is the case,
13 yes.
14 MR SHELDON: Is it the case?
15 MRS FLETCHER: I do not want to take all credit for that.
16 We had -- it would be appropriate for me to say that
17 during the course of the two years that I had been the
18 Senior Nurse Child Protection I had come to value
19 enormously the links that I had with our liaison health
20 visitor, and when she left in the February and there was
21 a gap I realised the value of the service and I asked in
22 the late summer of 1999 to actually take on the
23 management of that service in my -- within my new job
24 that I was hopefully going to acquire. I asked
25 deliberately because of the value, I saw it as a child
12
1 protection service and see it still as a child
2 protection service.
3 MR SHELDON: But you are not able to say now why that post
4 was allowed to be vacant for three months?
5 MRS FLETCHER: No, I cannot answer you that question, I do
6 not know.
7 MR SHELDON: But once you indicated to the relevant people
8 the importance of it and got things moving, it would
9 appear to have been filled very quickly?
10 MRS FLETCHER: Yes.
11 MR SHELDON: So one might assume from that that there was no
12 particularly good reason why it could not have been
13 filled throughout that three-month period?
14 MRS FLETCHER: I would like to point out that liaison health
15 visiting posts are not generally viewed within the
16 health visiting world as being particularly wonderful
17 jobs, and we do not get very many applicants for them.
18 We were very fortunate that we had a good applicant who
19 was actually available to start work, which is why we
20 were able to fill that post as rapidly as it appears
21 when you see the date. But we do -- Enfield Primary
22 Care Trust at the present time are trying to recruit two
23 liaison visitor posts at the moment and it is enormously
24 difficult to get applicants. It is not the job that
25 many health visitors want to do. It requires
13
1 a particular type of health visitor.
2 It is also -- it is often perceived as being
3 a clerical paper pushing exercise and not what health
4 visitors particularly want to do, which is why our
5 investment in the clerical support to the post is
6 actually tremendously important and makes the outcomes
7 for the job actually much more secure as well because it
8 is -- you know, you have two aspects, two different
9 people from different aspects actually looking at the
10 process. I would also like to say at that point that we
11 are also looking to see if we can actually do something
12 more with actually making a team within the hospital so
13 that we actually can broaden out the type of work that
14 the health visiting service can offer within the
15 hospital.
16 MR SHELDON: A team consisting of who?
17 MRS FLETCHER: For example, to actually have say a senior
18 health visitor and perhaps a paediatric nurse working
19 together within the hospital. We are looking at that at
20 the moment as another process or way forward.
21 MR SHELDON: You indicate in your statement that you work in
22 close association with Dr Rossiter and have done for
23 some time.
24 MRS FLETCHER: Yes.
25 MR SHELDON: And that that association involves regular and
14
1 frequent contact with her, I take it very often about
2 child protection matters?
3 MRS FLETCHER: Invariably about child protection matters.
4 MR SHELDON: Presumably in the context of those child
5 protection cases the matter for discussion will be the
6 follow up of a particular child within the community
7 because that is your particular area of responsibility?
8 MRS FLETCHER: Yes.
9 MR SHELDON: Have any of those conversations in the past
10 gone along the following lines: Dr Rossiter contacting
11 you saying, "There is a child in hospital about whom
12 I am concerned, she is going to be discharged in the
13 fairly near future and I want to be confident she is
14 going to be adequately followed up in the community.
15 Can you make sure that happens." That is a fairly
16 common type of scenario, is it?
17 MRS FLETCHER: Yes, it is.
18 MR SHELDON: Did she ever contact you in relation to
19 Victoria's case?
20 MRS FLETCHER: I do not remember discussing Victoria with
21 her. That does not mean to say it did not happen but
22 I do not remember it.
23 MR SHELDON: Is that the sort of conversation that typically
24 you would record if the named consultant at the hospital
25 says, "I am extremely concerned about a child who is
15
1 about to be discharged within your community, make sure
2 the right things happen"; is that something you would
3 note down?
4 MRS FLETCHER: It is if she had asked me to do something
5 specific or if she was giving me information that made
6 me think I needed to act on the case. Certainly with
7 other cases that has happened. I do not remember having
8 a conversation of any sort with her about Victoria.
9 MR SHELDON: She certainly does not say that she had one
10 with you about Victoria so it may well be that she did
11 not. If that is right, knowing what you know about the
12 case, do you find that surprising?
13 MRS FLETCHER: Totally.
14 MR SHELDON: You would have thought that you would have been
15 an obvious person to get on the phone to in order to
16 make sure follow-up was in place?
17 MRS FLETCHER: Yes, I completely agree. I also find it
18 surprising that she did not talk to me about it in an
19 informal way just in terms of, "Hey, we have got a child
20 on the ward who is really quite concerning", just in
21 a very informal way. I find that surprising but I do
22 not remember any conversation and have no record of any
23 conversation.
24 MR SHELDON: Can I deal briefly with the question of
25 strategy meetings. In what circumstances would a health
16
1 visitor attend a strategy meeting about a child held at
2 the hospital?
3 MRS FLETCHER: Health visitors would attend if it is the
4 health visitor that has made the initial referral and
5 the referrer attend, so if it is the health visitor,
6 that would be the case.
7 MR SHELDON: But in the common run of events where the
8 concerns have been identified in hospital by hospital
9 staff and a strategy meeting has been called either at
10 the hospital or at Social Services' offices, would you
11 expect a health visitor to be there?
12 MRS FLETCHER: Not at that stage, no. The strategy meeting
13 is deliberately designed to put in an instant plan, the
14 instant what we do next section, and that very rarely
15 includes health visiting at that stage.
16 MR SHELDON: What about predischarge meetings in hospital?
17 MRS FLETCHER: I would definitely expect the community nurse
18 to be involved.
19 MR SHELDON: And is it your understanding that it is common
20 practice and good practice to have a predischarge
21 meeting involving a health visitor if there is a child
22 about to be discharged about whom there are suspicions
23 of abuse?
24 MRS FLETCHER: Yes, it would be very good practice.
25 MR SHELDON: And the purpose of that discharge meeting would
17
1 be what?
2 MRS FLETCHER: I suppose to make sure that there are not any
3 gaps in the system really and that people take on the
4 task and responsibilities of making sure that the child
5 is adequately supported and cared for afterwards, so as
6 an information giving exercise as well as to what has
7 happened and what needs to be done to secure the child's
8 safety and good health.
9 MR SHELDON: Yes. Can we turn, please, now, to the liaison
10 health visiting procedures that were in force at the
11 time at the hospital. They are in volume 40, page 145.
12 Perhaps I can ask for some clarification of an
13 answer you gave just now about discharge meetings. You
14 said it would be good practice to have a discharge
15 meeting before the discharge of a child about whom there
16 were suspicions of abuse. Are we able to take it from
17 that that in your view it is a breach of good practice,
18 so positively bad practice, not to have one?
19 MRS FLETCHER: I suppose it is, yes, I suppose I would go
20 some way to agree with that. The reason I am hesitating
21 is that as I think we are discovering, in the course of
22 the last few days there is a limit to how many meetings
23 people can attend, and I suppose I do not want to give
24 the impression that I think discharge meetings need to
25 happen in every single case all of the time. I think
18
1 that they actually need to happen in specific cases for
2 quite specific reasons, you know, and I --
3 MR SHELDON: There should have been a discharge meeting in
4 this case?
5 MRS FLETCHER: I think there should have been in this case.
6 I think this is the type of case where it is appropriate
7 but certainly not for all child protection cases.
8 MR SHELDON: But the absence of one in this case is a breach
9 of good practice?
10 MRS FLETCHER: Yes, I think so.
11 MR SHELDON: Turning to the procedures page 144, we see the
12 date at the bottom January 1999, so I would be right in
13 saying these were current at the time?
14 MRS FLETCHER: Yes, they were.
15 MR SHELDON: I will not take you through them all in detail
16 but I would like you to look particularly at
17 paragraph 14 on page 146. That seems to suggest that
18 there is a, in addition to what has gone before,
19 a particular procedure for dealing with cases of NAI and
20 that in essence further failsafes are built into the
21 system by ensuring that the A&E card is sent to more
22 people than would otherwise be the case. Is that right?
23 MRS FLETCHER: Yes, that is right.
24 MR SHELDON: That is in order to avoid, as far as possible
25 in those cases, children falling through the net?
19
1 MRS FLETCHER: Yes.
2 MR SHELDON: Now, Rachel Crowe said in her evidence, and it
3 is perhaps understandable given her temporary fill-in
4 position at the time, that she was not aware of these
5 guidelines and that as a result she simply put one copy
6 of the A&E card in the file and sent one copy she says
7 to Launa Brown.
8 MRS FLETCHER: Yes.
9 MR SHELDON: She should have known what to do when faced
10 with an NAI case, should she not?
11 MRS FLETCHER: Yes, she should.
12 MR SHELDON: She should have been given a copy of these
13 procedures and had them explained to her if she was
14 going to do that job even temporarily?
15 MRS FLETCHER: Yes, she should.
16 MR SHELDON: Whose responsibility was it to ensure that they
17 knew what to do about this?
18 MRS FLETCHER: Well, the direct answer to that question
19 would have been the manager of the service at the time.
20 However, I would like to say that I know full well that
21 these procedures were written by the health visitor that
22 left the post in February specifically for the cover
23 arrangements and I do know that they were available on
24 the desk, which if I remember correctly actually, it
25 actually does comment about the desk and where things
20
1 were found. I think it is actually at the bottom of the
2 first page in point 9. Things were kept there and
3 I suppose in defence of the manager I would say that
4 these probably were available.
5 MR SHELDON: I see, so they were designed specifically
6 for --
7 MRS FLETCHER: They were.
8 MR SHELDON: They are idiot proof?
9 MRS FLETCHER: They are.
10 MR SHELDON: They go into exhaustive detail?
11 MRS FLETCHER: They are extremely detailed with even quite
12 odd things written in them.
13 MR SHELDON: So there was nothing to stop her -- I think the
14 point you are making is that there was nothing to stop
15 her from looking at these procedures which would have
16 been on the desk in plain view?
17 MRS FLETCHER: Yes, I mean, I have to be fair and say you
18 know I did not see them there on that morning, but I am
19 fairly confident that they were around because that is
20 what they were written for.
21 MR SHELDON: You were aware of them though, were you?
22 MRS FLETCHER: Yes.
23 MR SHELDON: So if Rachel Crowe phoned you, as she says she
24 did, to ask for advice about this case and what to do
25 and indicated, as she says she did, that it was an NAI
21
1 case, you would have told her, would you, in line with
2 paragraph 14, "Send a copy of the A&E card to me"?
3 MRS FLETCHER: I would not have, I did not tell her, no,
4 I would not have told her.
5 MR SHELDON: Why not? That is one of the things she is
6 supposed to do.
7 MRS FLETCHER: I suppose I made the assumption that I would
8 get a copy.
9 MR SHELDON: Because the course of action that she says you
10 recommended to her, which was send a copy to
11 Launa Brown, is the course of action that is appropriate
12 for the ordinary run of cases, is it not, rather than an
13 NAI case?
14 MRS FLETCHER: Launa Brown was actually a team leader at the
15 time so it would have been for that reason that I would
16 have suggested that Rachel contacted her, not
17 necessarily because she would have been the health
18 visitor responsible for that particular street which
19 I know we discovered on Tuesday afternoon was not
20 necessarily the case, but it would have been because she
21 was the team leader that I was suggesting that Rachel
22 actually rang her.
23 MR SHELDON: I see, so in doing that she would have covered
24 bullet points 2 and 3 of paragraph 14, killing 2 bullet
25 points with one stone.
22
1 MRS FLETCHER: Yes, definitely.
2 MR SHELDON: And in fact the only thing she did not do
3 according to that paragraph would have been sending
4 a copy to you?
5 MRS FLETCHER: Yes.
6 MR SHELDON: But you thought that was not necessary because
7 Launa Brown would be covering it?
8 MRS FLETCHER: What I meant was that I did not say, "Send me
9 a copy Rachel", I rather assumed she would. I would
10 have -- yes, I would have still expected a copy. I used
11 to get duplicate copies.
12 MR SHELDON: But you did not get a copy?
13 MRS FLETCHER: I did not get a copy of Victoria's admission
14 papers, no.
15 MR SHELDON: Can we turn back to the report of
16 Thirza Sawtell in volume 2 and particularly page 258.
17 As I am sure you are aware, one of the deficiencies that
18 has been identified in the handling of Victoria's case
19 from a health visiting perspective is that nobody seems
20 to have written anything down. That seems to be a view
21 taken by Miss Sawtell as well and would appear to form
22 the basis of recommendation 3, namely that the
23 documentation used by the liaison health visiting
24 service be reviewed to ensure that a record of
25 information and actions is kept by the service. You now
23
1 manage the liaison health visitors. What has been done
2 about that recommendation?
3 MRS FLETCHER: Back at that point when we did this internal
4 review we actually designed a very straightforward
5 action sheet which is now completed by the liaison
6 health visitor. It is worth pointing out to the Inquiry
7 team that the vast majority of A&E admissions that are
8 dealt with by the health visitor do not require anything
9 particularly special. They require scrutiny of the
10 information and then the sending out of a paper copy of
11 the basic information and that is the end of the
12 process. In cases where the health visitor actually
13 feels that some other action is required, such as
14 a phone call to hospital staff or a phone call out to
15 the health visitor or yet more action, as is sometimes
16 the case, then they are now asked and do fill in what
17 they have done on a quite simple document which we just
18 call an action sheet.
19 MR SHELDON: So for example Rachel Crowe's telephone calls
20 to you and Launa Brown would now be recorded?
21 MRS FLETCHER: Yes.
22 MR SHELDON: That is a system that operates satisfactorily
23 in your view?
24 MRS FLETCHER: Yes, and we retain a copy of that in the
25 office as well as sending the paperwork to the community
24
1 nurse.
2 MR SHELDON: It was the case that there was no requirement
3 or procedure to record those phone calls back in
4 mid-1999.
5 MRS FLETCHER: What I think used to go -- I am fairly
6 confident to say it used to go on -- those actions were
7 recorded on the back of the liaison sheet, and so they
8 were recorded but they were recorded on the back of what
9 in Victoria's case is now a missing piece of paper.
10 MR SHELDON: Yes, that they were recorded, the action was
11 recorded on the back of the sheet that was then sent on
12 to the health visitor.
13 MRS FLETCHER: Yes. In some cases a copy of those actions
14 would have been kept with the copy in the liaison
15 office. But obviously that is subject to yet more
16 photocopying and I do not know that it always happened.
17 MR SHELDON: Were you aware in mid-1999 that referrals which
18 came into the Lordship Lane clinic to be dealt with by
19 health visitors were not logged or documented anywhere
20 when they arrived?
21 MRS FLETCHER: Definitely, yes.
22 MR SHELDON: And you were aware there was no filing system
23 for such reference?
24 MRS FLETCHER: I think to defend health visiting about that
25 particular aspect, I noticed when Mrs Brown was giving
25
1 evidence the other day that it did sound a bit ad hoc.
2 In actual fact what happens within health visiting is
3 that the post arrives and it is either addressed to an
4 individual health visitor or it is addressed to the
5 health visitors in general and that is opened by any one
6 of the team.
7 In actual practice what happens is that the liaison
8 slips in this case are actually distributed directly to
9 the health visitor that would be picking up that case so
10 they understand the allocation system and they give it
11 deliberately to the specific health visitor, who from
12 that point onwards acts on that liaison slip. Okay. So
13 there has not been a need in any of our clinics and
14 there still is not a need for that logging-in of post in
15 the way that perhaps people out in the wider community,
16 in the lay community might imagine could happen.
17 MR SHELDON: The impression that one might have drawn from
18 Miss Brown's evidence about the way in which these bits
19 of paper, all of which look the same, are dealt with
20 within the Lordship Lane clinic is that it is not all
21 that surprising to hear that an individual bit of paper,
22 particularly in this case, that may have been addressed
23 to the wrong person or the person with no geographical
24 responsibility could have gone astray. Do you think
25 that is a fair assessment to make?
26
1 MRS FLETCHER: In as much as it is quite fair that any piece
2 of paper regarding anything actually goes astray within
3 people's filing systems and, you know, paperwork
4 systems.
5 MR SHELDON: And that the only way of finding out whether
6 this vital referral was made or not is by simply asking
7 around all the people in the office a year or so after
8 the event to see if any of them happened to remember it?
9 MRS FLETCHER: I suppose in essence you are right, yes.
10 MR SHELDON: Can I deal with Rachel Crowe's evidence insofar
11 as it deals with her phone call to you. You expressed
12 your recollection of this in paragraph 1.4 of your
13 statement and you say in the third line down:
14 "... the covering Liaison Health Visitor apparently
15 asked my advice about which community nurse to refer
16 Victoria to."
17 What does your use of the word "apparently" there
18 signify?
19 MRS FLETCHER: I am sure you have worked out that it means
20 that I do not remember that phone call.
21 MR SHELDON: Did you tell Thirza Sawtell that you did not
22 remember that phone call?
23 MRS FLETCHER: Yes.
24 MR SHELDON: Because she has interpreted that in a slightly
25 more definite manner. She says, and this is page 257
27
1 under the heading "Next Few Days", about six lines down:
2 "The health visitor sought advice from the
3 professional development nurse about the appropriate
4 actions to be taken with the information," which seems
5 to indicate that that is what happened. She does not
6 say "the health visitor claims she sought advice" or "we
7 are told sought advice". You are sure you told
8 Thirza Sawtell as you are telling us that you cannot
9 remember?
10 MRS FLETCHER: I definitely cannot remember it.
11 MR SHELDON: You could not remember it back when this report
12 was being compiled either.
13 MRS FLETCHER: No.
14 MR SHELDON: She says that she phoned you for help because
15 it was a school age child and it was school holidays.
16 MRS FLETCHER: Yes.
17 MR SHELDON: And that she was unsure what to do in terms of
18 procedure about children in that position. Can you
19 understand her confusion about that?
20 MRS FLETCHER: Yes.
21 MR SHELDON: That is because I think it is right to say, is
22 it not, that there was a gap in the procedure with those
23 children at the time?
24 MRS FLETCHER: Yes. It is also appropriate to say that
25 actually it was quite unusual to have the situation
28
1 arise whereby a school age child did need following up
2 at the point where we did not have a school nursing
3 service on duty. As strange as it may sound, in actual
4 practice it is not a very common event that we actually
5 have to follow school age children up during the holiday
6 time. It does happen but it is not that usual.
7 MR SHELDON: That seems surprising to a layman given that
8 children spend probably about a third of the year on
9 holiday.
10 MRS FLETCHER: I completely agree. I do not know what the
11 answer is. There are various speculations in that
12 children, you know, are away on holiday from the area
13 and things like that, but I do not know, but it is not
14 that common an event, but it does happen but it is not
15 that common.
16 MR SHELDON: One might also from a lay point of view think
17 that school holidays are a period where children might
18 be more at risk of abuse than at other times because for
19 example they are not being regularly supervised at
20 school, for example they are coming into more contact
21 with potentially abusive parents than might be the case.
22 MRS FLETCHER: I mean this lends itself to a lecture really
23 and I am not here to do that obviously but I think it is
24 fair to say that one of the protective things in
25 children's lives is actually attending school, and where
29
1 children's injuries or changes in behaviour are noticed
2 by people outside their family, you could speculate that
3 perhaps during the holidays children are not coming to
4 our attention so easily and so readily because they are
5 not having that extended contact outside of their family
6 circle.
7 MR SHELDON: I want to come on to new procedures for dealing
8 with school age children in a second but before I do, to
9 finish the conversation with Rachel Crowe, she says that
10 you told her to call the Lordship Lane clinic and talk
11 to a team leader Launa Brown. That sounds perfectly
12 plausible; that is what you would have told her to do?
13 MRS FLETCHER: Definitely, yes.
14 MR SHELDON: Would you have undertaken any assessment of the
15 case yourself before imparting that advice?
16 MRS FLETCHER: I do not think so. At the time of Victoria's
17 admission the information that would have been given to
18 me would have been that she had been admitted with
19 scalds to the head and possibly there were other
20 concerns about child protection. In the daily life of
21 a senior nurse for child protection that did not stand
22 out as a particularly unusual story at the time. I mean
23 hindsight now tells us a lot more, but at the time it
24 would not have been particularly extraordinary.
25 MR SHELDON: So it did not ring alarm bells in your mind
30
1 such as to make you think, "I had better keep an eye on
2 what happens to this case"?
3 MRS FLETCHER: No, not at all, no, not then.
4 MR SHELDON: Because in order for you to have done so, in
5 order for you to have checked to see that this temporary
6 stand-in liaison health visitor had actually managed to
7 get the right information to the right people would only
8 have taken a phone call, would it not, to Launa Brown?
9 MRS FLETCHER: Yes.
10 MR SHELDON: And one might think, in view of the fact that
11 Rachel Crowe said this was the only child protection
12 referral that she handled over her two-week stint, that
13 that would not be too onerous a requirement to put on
14 you?
15 MRS FLETCHER: No, not at all. It would have been easy to
16 do.
17 MR SHELDON: But you did not feel you needed to because
18 there was nothing that particularly concerned you about
19 the case?
20 MRS FLETCHER: No, no, because the health visitors that were
21 involved are senior nurses, they are G grade nurses and
22 I feel confident that they are more than able to -- that
23 they understand their responsibility and are more than
24 able to actually follow those through.
25 MR SHELDON: But of course your assessment of the fact that
31
1 it did not need follow-up by you because it was not
2 a particularly concerning case is based upon information
3 given to you in a phone call that you cannot remember?
4 MRS FLETCHER: Yes.
5 MR SHELDON: So how are you able to say that "the
6 information that I was given was such as to mean that
7 there was nothing further I needed to do"?
8 MRS FLETCHER: I am speculating that that was the
9 information that I was given because I do not remember
10 the call. Not remembering -- I know myself well enough
11 to know that there are certain things that I do remember
12 that always stick in one's mind and you remember those
13 things for a variety of reasons, not necessarily the
14 most obvious ones but for a variety of things. I do not
15 remember that phone call and I do believe it happened
16 but I do not remember it.
17 MR SHELDON: Let us turn to those school age children in
18 school holiday recommendations. They are in volume 41
19 at page 1. If you could have volume 2, the Sawtell
20 report, in front of you as well, that would be helpful.
21 These guidelines, as I understand it, were in response
22 to two of the recommendations that we see being made by
23 Miss Sawtell, namely recommendations 4 and 5; is that
24 your understanding? 4 involves school age children
25 during the school holidays and the other one is children
32
1 who attend with no record of their school.
2 MRS FLETCHER: Yes, they are, definitely.
3 MR SHELDON: It seems they are direct implementations of
4 that because the language used in the recommendation is
5 precisely echoed at the top of the sheets.
6 MRS FLETCHER: Yes.
7 MR SHELDON: Did you draft these?
8 MRS FLETCHER: The original draft I did, yes.
9 MR SHELDON: In the form that we see them in volume 41?
10 MRS FLETCHER: Yes, more or less. In fact Thirza Sawtell
11 actually made the final adjustments and arrangements to
12 them but in essence, yes, they were done by myself and
13 another primary care manager who takes a special
14 interest in school nursing.
15 MR SHELDON: Do you regard them as adequate to meet the
16 deficiency identified in Victoria's case and by
17 Miss Sawtell's report?
18 MRS FLETCHER: They certainly work, yes.
19 MR SHELDON: And we can see in relation to recommendation 4
20 a document at page 1 of volume 41 headed "School Age
21 Children Attending A&e Departments During School
22 Holidays" and we can see that the recommendation to have
23 specific reference or explicit reference to child
24 protection concerns is reflected in the third paragraph
25 down.
33
1 MRS FLETCHER: Yes.
2 MR SHELDON: Recommendation 5, children who attend with no
3 record of a school, would seem to be dealt with on
4 page 2 of volume 41. Is that right?
5 MRS FLETCHER: Yes.
6 MR SHELDON: Children attending A&E Department with no
7 identified school?
8 MRS FLETCHER: Yes, and also on the following page, 003.
9 MR SHELDON: That is a protocol for school nurses in
10 relation to attendance at A&E departments of a school
11 age child.
12 MRS FLETCHER: Yes, but they need to go together because it
13 deals with the aspects of children who perhaps do not
14 actually have a school.
15 MR SHELDON: I see.
16 MRS FLETCHER: So they actually all work together, those
17 particular documents.
18 MR SHELDON: The recommendation asks again in relation to
19 that second category, school age children with no
20 identified school, for explicit reference to identify
21 child protection concerns. Where do we find that
22 explicit reference?
23 MRS FLETCHER: Page 41/003, 2.3.
24 MR SHELDON: If the school remains unknown and the school
25 nursing team leader identifies any child protection
34
1 concerns, these should be discussed immediately with the
2 Specialist Health Visitor Child Protection and
3 a referral to social services considered?
4 MRS FLETCHER: Yes.
5 MR SHELDON: That is what the school nursing team leader
6 should do?
7 MRS FLETCHER: Yes.
8 MR SHELDON: That is after she has been referred or he has
9 been referred the case by the liaison health visitor?
10 MRS FLETCHER: That is right.
11 MR SHELDON: So that responsibility of the child protection
12 identification is passed on, delegated to the school
13 nursing team leader?
14 MRS FLETCHER: Yes. Can I just say that having a school
15 nursing service that actually tries to address some of
16 the issues of children who do not attend school is
17 actually unusual. It is actually a positive attribute
18 of our school nursing service. It is not something that
19 happens universally in other areas and I think that is
20 an important thing that the Inquiry might pick up on
21 because it is a nonsense not to be -- some of our
22 children who do not attend school are actually terribly
23 vulnerable and probably need school and community
24 nursing input more so than the children who do attend.
25 MR SHELDON: Page 41/3, is there any guidance there or
35
1 protocols or procedures relating to school nurses
2 dealing with children in the school holidays?
3 MRS FLETCHER: No.
4 MR SHELDON: Is that something that should exist?
5 MRS FLETCHER: Right. Yes, it should and does now. It is
6 not part of this documentation. This summer we actually
7 for the first time actually had school nurses on duty
8 during the summer holiday which is a new venture, done
9 for a variety of reasons, mainly for the child
10 protection reasons that we are here discussing. Also
11 for the other issue that is now arising is that because
12 of the time constraint within the social services to
13 call case conferences within a much shorter timeframe,
14 there is a problem with school age children and case
15 conferences happening over the long summer holiday. So
16 having school nurses around during the summer holiday is
17 useful for that point of view. It is also useful so
18 that in fact they can join in with summer schemes in
19 a health promotion sort of capacity.
20 MR SHELDON: So if a liaison health visitor now identifies
21 a child of school age in need of follow up during the
22 holidays, they will not have to go as a temporary
23 measure to the health visitor; they can go to the school
24 nurse?
25 MRS FLETCHER: Yes.
36
1 MR SHELDON: That is an improvement, is it?
2 MRS FLETCHER: That is a vast improvement and it is also
3 again not a universal thing that happens with other
4 school nursing services. I would -- you know it is
5 a real improvement.
6 MR SHELDON: Finally a couple of points arising out of the
7 procedures that you list in your statement, of which
8 there are many. The point may be illustrated by the
9 lack of inclusion in those procedures of the
10 clarification document I took you to last night, the NHS
11 Guidance.
12 MRS FLETCHER: Yes.
13 MR SHELDON: There is an enormous amount, a huge volume of
14 material to take in, is there not?
15 MRS FLETCHER: Huge.
16 MR SHELDON: Would you say there is too much for people to
17 be able to conveniently use, take in and manage?
18 MRS FLETCHER: Yes I think so, especially I think not
19 necessarily for the likes of myself but certainly for
20 field staff, yes.
21 MR SHELDON: They need one volume, you might think, that is
22 easily accessible and has all the important points in
23 it?
24 MRS FLETCHER: Yes, they do really.
25 MR SHELDON: Because having to jump between Trust, child
37
1 protection policies, ACPC policies, various other
2 documents, "Working Together", is virtually impossible
3 to do effectively, is it not?
4 MRS FLETCHER: It is, and it is difficult for those of us
5 who have a special interest but it is particularly
6 difficult I think for staff who actually, you know, have
7 other things to do as well as child protection.
8 MR SHELDON: Is there going to be any attempt from you or
9 anybody else in the near future to try and reduce some
10 of this voluminous guidance to a reasonably accessible
11 form?
12 MRS FLETCHER: We are trying. As I said yesterday, the
13 redrafting of local guidelines is happening but it is
14 inordinately difficult to do that quickly. Multiagency
15 working is difficult at the best of times, but in the
16 midst of what we are going through in Haringey it is
17 inordinately difficult to get things done in a short
18 timeframe. I also feel quite personally that actually
19 some of this guidance actually needs to come nationally
20 in a more succinct form really because it is difficult
21 on the ground, and at the end of the day the way that
22 child protection cases are handled by individuals within
23 local areas actually is not that different. It should
24 be done in a similar fashion everywhere.
25 MR SHELDON: Next on procedures, this is not supposed to be
38
1 a memory test and if you do not know or you cannot
2 remember then say so, but I have been unable to find
3 anything in the documents that you have referred to
4 which indicates the procedure a health professional
5 should follow when they discover a child is not
6 attending school and how they would go about ensuring
7 that that child gets registered at a school. Is there
8 anything?
9 MRS FLETCHER: Not in the stuff that you would have. The
10 nearest we get to it is the documentation that we have
11 referred to about what liaison health visitors and
12 school nurses do about children.
13 MR SHELDON: You have already emphasised in your answers
14 this morning the importance of attendance at school and
15 child protection.
16 MRS FLETCHER: Yes.
17 MR SHELDON: And that it may in some senses be the most
18 important element of child protection.
19 MRS FLETCHER: Yes.
20 MR SHELDON: Should there not be a simple, straightforward
21 procedure available to all health professionals to
22 enable them if they stumble across a child not
23 registered or not attending school to deal with it?
24 MRS FLETCHER: Not just health professionals. It should be
25 available for anybody that identifies children that are
39
1 not accessing mainstream education.
2 MR SHELDON: One short point returning to a matter we
3 covered earlier about predischarge meetings. You said
4 that in Victoria's case certainly and in lots of other
5 cases as well it is good practice to have a predischarge
6 meeting about a child about whom there are NAI concerns.
7 Who should organise those?
8 MRS FLETCHER: My instant reaction is the ward staff. The
9 people who have responsibility for the child at the
10 time.
11 MR SHELDON: You have spent some time as a paediatric nurse
12 and have some experience of paediatric wards.
13 MRS FLETCHER: Yes.
14 MR SHELDON: And now an enormous amount of experience of
15 child protection.
16 MRS FLETCHER: Yes.
17 MR SHELDON: Is there anything to stop a paediatric nurse on
18 the ward if they have concerns about a child going home
19 to say, "We ought to have a predischarge meeting and to
20 call one"?
21 MRS FLETCHER: No, not at all. They would be -- they should
22 if they feel that way.
23 MR SHELDON: It is not something that they say, "I could not
24 possibly do that unless a consultant suggested it"?
25 MRS FLETCHER: No, but a lot of that comes down to having
40
1 good working relationships and communication within the
2 ward team, does it not? It is difficult for a junior
3 nurse for example to say, "Hey, I am really worried,"
4 unless there are good communications going on within the
5 ward on a daily basis really.
6 MR SHELDON: You know Dr Rossiter, you work with her a lot.
7 We have seen her give her evidence here. She does not
8 look the sort of person that nurses might be terrified
9 of making a suggestion like that. Is that your
10 experience?
11 MRS FLETCHER: Totally. She is immensely approachable to
12 talk to about any concerns. She is very amenable to
13 actually having suggestions put to her, unlike many
14 other doctors and consultants that I have had the
15 pleasure of working with over the years. She is
16 terribly easy to work with and that is sometimes I think
17 as you might have detected actually means that she takes
18 on more than one person can possibly manage, but
19 nevertheless it is an important attribute particularly
20 for nurses because there is a difficulty for some
21 between a doctor/nurse communication. It is
22 traditional.
23 MR SHELDON: You will understand the last matter I have to
24 put to you is this: However it is eventually analysed,
25 what Victoria's case demonstrates is that there was
41
1 a breakdown in communication of some sort between the
2 hospital and the Trust such as to result in the fact
3 that Victoria was not visited by a health visitor when
4 she should have been. Is that fair?
5 MRS FLETCHER: Yes, definitely.
6 MR SHELDON: And that as the designated professional within
7 the community responsible to some extent for those lines
8 of communication and for ensuring such children are
9 followed up, you have to bear some responsibility for
10 that. Would you agree with me?
11 MRS FLETCHER: Yes.
12 MR SHELDON: Thank you very much. That is all.
13 THE CHAIRMAN: Miss Everson.
14 MISS EVERSON: Thank you very much. Mrs Fletcher, in giving
15 your evidence yesterday afternoon it was put to you at
16 the beginning of that evidence that your personal
17 relationship with North Middlesex Hospital was poor.
18 However, in response to that, partly in response to
19 that, you described your relationship with Dr Rossiter
20 as good and we have gone into a bit more detail about
21 that today. But could you help us with how often on
22 average you would say you had informal and formal
23 contact with Dr Rossiter in around 1999?
24 MRS FLETCHER: I have always had a very close working
25 relationship with Mary Rossiter, even extending as far
42
1 back as the 1980s and the 1990s. It was not just in my
2 current child protection jobs. We worked together when
3 I was travellers' health visitor for example, so I have
4 always had quite close links with her. It would be
5 unusual for me to go a whole week without having some
6 contact with her, very unusual. We invariably go to
7 meetings together, we invariably chat on the phone,
8 invariably have paper communication, and I certainly do
9 not go to the hospital every week but I do go there
10 quite regularly and will see her informally as well as
11 at formal meetings.
12 MISS EVERSON: Thank you. Also, in the course of your
13 evidence today you have mentioned quite a lot of changes
14 in relation to liaison health visiting which have been
15 implemented since you took over the management of that
16 service in September 1999, and it might be helpful for
17 the Inquiry if you could just briefly summarise for us
18 the main -- or the changes which you think are the most
19 important.
20 MRS FLETCHER: This is a bit of a memory test but if I can
21 remember them all, we have improved the documentation of
22 the liaison health visiting service. We have invested
23 in the liaison health visiting service in terms of the
24 amount of time that the health visitor works, the amount
25 of clerical support, and we are looking to actually see
43
1 if we can actually work more collaboratively with our
2 colleagues in Enfield to provide a more senior service
3 for liaison health visiting at the North Middlesex. We
4 have also invested in school nursing. School nursing
5 now endeavours to provide a service during the holiday
6 time. A minimal service but nevertheless a service. We
7 have also updated guidelines and made clearer the
8 guidelines in relation to liaison health visiting and
9 the issues of school age children, and I am sure there
10 are some others but I cannot remember them at the
11 moment.
12 MISS EVERSON: Thank you very much. Finally, are you able
13 to say anything about how liaison health visiting and
14 school nursing in the Haringey area compares with that
15 in other areas as it is now?
16 MRS FLETCHER: As we have discovered in the course of this
17 Inquiry, not every hospital has a liaison health
18 visitor. It is a fairly universal service but it
19 certainly is not in every hospital and the enormous
20 value that it places, you know, makes me surprised that
21 there are some areas that manage without. It is
22 a terribly valuable service that can only go from
23 strength to strength.
24 Our school nursing service actually compares
25 extremely well with other areas in that we do provide
44
1 a service and are endeavouring to improve the service we
2 provide to school age children who actually do not
3 attend school or are not enrolled at school, which is
4 again an unusual feature of the school nursing service,
5 they tend to work actually with kids who access
6 education. Certainly it is unusual for a school nursing
7 service to work during holiday time. Traditionally they
8 work term time only.
9 MISS EVERSON: Thank you very much. Thank you sir.
10 THE CHAIRMAN: Thank you indeed Miss Everson. Mrs Fletcher,
11 just three quick points if I may. The first is about
12 the referrals, at the time when Victoria was a patient,
13 of school age children in the community. You said it
14 was extremely unusual, you got very few school age
15 children. Could it be that that was primarily because
16 the system was just not geared up to receive such
17 referrals?
18 MRS FLETCHER: Yes, I suppose that is a possibility but
19 I have been around long enough to know that that was not
20 peculiar that year, just because we did not have
21 a watertight liaison health visiting service. I know
22 from my own professional practice that things go quiet
23 in the summer.
24 THE CHAIRMAN: If they go so quiet, why this year have you
25 gone to the trouble of getting school nursing service
45
1 available?
2 MRS FLETCHER: For the reasons that I did actually state at
3 the time, which are not just to do with following up
4 child protection. There is a big move now with ventures
5 such as Sure Start and On-Track to actually do much more
6 health promotion with a wider range of people and
7 schemes such as that are actually asking for school
8 nursing to be around and to do more health promotion,
9 more health education work with children, and that is
10 one of the avenues that we are following. It is
11 actually difficult for us to actually find the nurses
12 that are that available to work during times when they
13 have traditionally always been on holiday, so this is
14 something that requires yet more input and work but it
15 is not solely for the child protection purposes.
16 THE CHAIRMAN: No, but those initiatives are based upon
17 a recognition that there is a need?
18 MRS FLETCHER: Yes, there is.
19 THE CHAIRMAN: Finally, you said in your evidence to
20 Mr Sheldon that multidisciplinary work is always
21 difficult and time-consuming. This was in relation to
22 simplifying the procedures?
23 MRS FLETCHER: Yes.
24 THE CHAIRMAN: You went on to say, and I made a special note
25 of it, to say that what is going on in Haringey at
46
1 present makes it "inordinately difficult". What did you
2 have in mind?
3 MRS FLETCHER: I think it is very obvious to those who are
4 working in Haringey and our nearest and dearest that
5 actually it is a very difficult time working together
6 when we are under such public scrutiny and it does make
7 us as individuals and also as representatives of
8 different agencies actually quite tetchy, quite
9 vulnerable, and it is a testing time in terms of working
10 together and maintaining good sound working
11 relationships. It is certainly something that is
12 a valuable learning exercise but it is actually quite
13 difficult and quite hard.
14 Working together in a multiagency way has always
15 been difficult. It is not an easy thing because we
16 have -- we understand our own professions quite well but
17 do not necessarily understand each other's and that is
18 something that takes time and effort and enthusiasm,
19 energy, humour, all sorts of skills really, and I am
20 definitely privileged for having been through it but it
21 is difficult.
22 THE CHAIRMAN: Thank you very much indeed Mrs Fletcher.
23 MR SHELDON: Thank you, I have nothing further to ask
24 Mrs Fletcher.
25 MRS FLETCHER: Can I say before I leave, I have learned
47
1 myself an enormous amount from actually going through
2 the whole process of reviewing Victoria's case and
3 I know that the organisation that I work for has also
4 learned an enormous amount and we have gained enormously
5 from that and we will only continue to improve.
6 THE CHAIRMAN: Thank you. I am sure that we appreciate the
7 sincerity of those comments.
8 MR SHELDON: One brief point before the next witness. I was
9 asked by Ms Boye at the outset this morning to inform
10 you that the reason Mr and Mrs Climbie would be unable
11 to be here at 9 o'clock sharp was because of their
12 childcare commitments. I forgot to do that.
13 I apologise to them and to you.
14 THE CHAIRMAN: Thank you very much indeed. Thank you for
15 the courtesy, I appreciate it Ms Boye, and I fully
16 understand.
17 MR GARNHAM: My next witness is Dr Meates.
18 DR MAUREEN-ANN MEATES (sworn)
19 MR GARNHAM: Good morning, please sit down. Would you give
20 the Inquiry your full name.
21 DR MEATES: Maureen-Ann Meates.
22 MR GARNHAM: And your professional address.
23 DR MEATES: North Middlesex Hospital, Edmonton.
24 MR GARNHAM: Your professional qualifications?
25 DR MEATES: MBChB, MRCP, FRACP, FRPCPH.
48
1 MR GARNHAM: You have made one statement to the Inquiry
2 I think, a copy of it has now been put in front of you.
3 That is volume 6, page 173 in our bundles. You have
4 some other papers in front of you. Those notes are
5 something, are they?
6 DR MEATES: It is my statement and some other notes about
7 this case.
8 MR GARNHAM: Could I ask you not to refer to them unless you
9 inform us you are going to first?
10 DR MEATES: Certainly.
11 MR GARNHAM: I think it is right that you have been
12 a consultant paediatrician at the NMH since 1993?
13 DR MEATES: That is right.
14 MR GARNHAM: That was your first consultant post?
15 DR MEATES: Yes.
16 MR GARNHAM: You had had child protection training in junior
17 posts?
18 DR MEATES: Yes.
19 MR GARNHAM: Had you had child protection training during
20 the time you had been a consultant?
21 DR MEATES: Training in terms of dealing with cases?
22 MR GARNHAM: Attending courses.
23 DR MEATES: I have not attended a course as a consultant but
24 I have attended courses before becoming a consultant.
25 MR GARNHAM: You tell us that at the NMH Dr Rossiter takes
49
1 the lead with regard to child protection in general.
2 DR MEATES: Yes.
3 MR GARNHAM: I wonder if I can start by asking you a little
4 about the roles that you and Dr Rossiter played in
5 respect of Victoria. You look anxious.
6 DR MEATES: I am not anxious. I just wanted to say that
7 there is something in my statement that I would like to
8 amend.
9 MR GARNHAM: I should have asked you. Please tell us.
10 DR MEATES: In 11(a), the final sentence says:
11 "I did not receive any communication from any of the
12 social workers involved in this case."
13 At the time I made the statement that is what
14 I believed to be true. I did not have a copy but I have
15 since seen a copy of a communication from Karen Johns
16 about a procedural matter.
17 MR GARNHAM: Thank you very much. I will ask you about that
18 later. Thank you for the correction. Do I take it from
19 that correction that otherwise you are content with this
20 statement?
21 DR MEATES: Yes.
22 MR GARNHAM: That its contents are true?
23 DR MEATES: Yes.
24 MR GARNHAM: I was about to ask you about the role that you
25 and Dr Rossiter played in respect of Victoria. Could
50
1 I ask you to have a look please at volume 37, page 49.
2 We have there the paediatric rota for the NMH
3 for July 1999. Keep that open in front of you while
4 I ask you these questions, if you would. Victoria was
5 admitted we know on Saturday 24th July.
6 DR MEATES: That is correct.
7 MR GARNHAM: You are down as the on-call consultant for both
8 that Saturday and the following Sunday according to this
9 rota.
10 DR MEATES: That is right.
11 MR GARNHAM: Did you in fact perform those duties first of
12 all on the Saturday?
13 DR MEATES: On the Saturday I was on-call and had done ward
14 round in the morning. On the Sunday I had swapped with
15 Dr Rossiter. I obviously covered for her earlier in the
16 year and this was a pay-back if you like.
17 MR GARNHAM: Thank you. In that same volume go on four
18 pages to page 53. That is the first of the CP forms in
19 respect of Victoria.
20 DR MEATES: Yes.
21 MR GARNHAM: And the consultant is noted three quarters of
22 way down the page as being Dr Rossiter.
23 DR MEATES: Yes.
24 MR GARNHAM: That is Saturday the 24th when Victoria was
25 admitted but Rossiter is down as the consultant, not
|
