|
|
|
Paragraphs: 14.1 - 14.7
| 14.8 - 14.16 | 14.17 - 14.31
| 14.32 - 14.46 | 14.47 -
14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.1
|
At the time it came to deal with Victoria's case, Haringey Child
Protection Team (CPT) was housed in Highgate police station. The
accommodation provided for the team, in common with many CPTs in
the capital, was poor quality. In addition, I was told that the
team was insufficiently equipped with staff, vehicles and IT equipment.
|
|
14.2
|
I have dealt with my concerns about the priority and resources
given to CPTs by the Metropolitan Police Service (MPS) elsewhere
in section 13. I will not repeat them here, except to say that I
have some sympathy for the view expressed by Sergeant (Sgt) Alan
Hodges, one of the officers on the Haringey team. He said, "I do
not want to sound pathetic, but it all adds up, and it was just
another indication of the way we were treated as a unit." I found
no direct link between the standard of the service offered to Victoria
by Haringey CPT and the adequacy of its resources, but I believe
it would be wrong to discount the corrosive effect that a long period
of neglect and under-resourcing can have on the morale and effectiveness
of a team like Haringey CPT.
|
|
|
|
14.3
|
One of the particular deficiencies in the team that was drawn to
my attention was the lack of officers with detective training. In
view of the importance that I attach to this issue, I detail the
training and experience of the officers who had some direct involvement
in Victoria's case.
|
|
|
|
14.4
|
Detective Inspector (DI) David Howard joined the police service
in 1978 and became the officer in charge at Haringey CPT in May
1998. During his 20 years of service before taking up that post,
he held a wide range of roles within the uniformed branch. These
included beat patrol, public disorder policing, custody sergeant,
and management of community beat officers. He had a little experience
in mainstream CID work at Kilburn police station, where he was an
inspector for about 15 months, but he had never attended the CID
foundation course. In 1997, he attended a one-week Management of
Serious Crime (MSC) course, which he said was the only investigative
training he had received since leaving recruit school. He said,
"During my short time in the CID, other than one murder inquiry
I really did not investigate fully other crimes. So although I had
probably more awareness than some, I certainly did not have the
practical skills to really supervise or take on child protection
work."
|
|
14.5
|
He had no previous experience in a child protection team, and it
was not until he had been in his post a year that he attended a
one-week Working Together course. That was the only child
protection training he ever did. Overall, I do not consider DI Howard
to have been sufficiently trained and qualified to manage a group
of staff undertaking serious criminal investigations, particularly
relating to children.
|
|
|
|
14.6
|
Sgt Cooper-Bland was, together with Sgt Richard Bird, responsible
for the day- to- day supervision of PC Karen Jones at the time the
first referral concerning Victoria was received in late July 1999.
He joined the police service in 1977 and spent the first 12 years
as a uniformed patrol officer. He was promoted to sergeant in 1989
and afterwards worked in various uniformed supervisory roles until
1994 when he joined Haringey CPT. He therefore had no CID experience,
nor any training or experience in serious crime investigation. However,
by 1999 he had five years of child protection work under his belt
and he had attended several courses relating to his child protection
work, including a two-week Initial Child Protection course. This
made him something of a rarity among the officers from whom I heard
evidence.
|
|
|
|
14.7
|
Sgt Bird became a police officer in 1977 and spent the first 13
years as a uniformed patrol officer with the Hertfordshire constabulary.
He transferred to the MPS in May 1989, and was promoted to sergeant
two years later, continuing to serve in uniformed police roles.
When he joined Haringey CPT in March 1999, he had no experience
of dealing with serious crime investigations, let alone supervising
them, and he had received no advanced investigative training. He
made the point in his written statement to the Inquiry that, even
up to the point of leaving the CPT in 2001, he had still not received
any investigative or procedural training for CPT officers, nor any
joint investigation training with social services. He said he had
specifically asked DI Howard about this, but was told that the training
courses had been stopped on the North West Crime Operational Command
Unit (OCU) and that there were none now available.
|
|
Paragraphs: 14.1 - 14.7
| 14.8 - 14.16 | 14.17 - 14.31
| 14.32 - 14.46 | 14.47 -
14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.8
|
Sgt Hodges completes the supervision team at Haringey. He arrived
in the team during October 1999, effectively replacing Sgt Cooper-Bland
in the middle of the relevant period. Before this, he had 16 years'
police service, nine years of which had been as a sergeant. Like
his colleagues, Sgt Hodges had never held a detective's post or
received any training in serious crime investigation. Just before
joining the CPT, he was fortunate enough to attend a five-day
Working Together course, which at least gave him a basic insight
into the main roles of the agencies involved in child protection.
|
|
14.9
|
The level of detective experience among the supervising officers
in Haringey CPT is a matter that causes me some concern. In my view,
it is extremely important that the first-line supervisors of child
protection officers are either fully trained detectives, or have
received sufficient training and experience to enable them effectively
to oversee serious crime investigations.
|
|
14.10
|
It would seem that my concern was shared by some of the officers
themselves. For example, Sgt Bird expressed his feelings rather
forcefully when he said, "I applied for a post as police sergeant
in the hope that I would gain the knowledge, experience and training
to become a detective. There was no training. The Child Protection
Manual was deemed to be out of date and, even though senior
management had been tasked to rewrite and update it, this had not
happened by the time I left two years later. I was put in the position
of detective sergeant without the experience or the training to
prepare me for the seriousness of the investigations I found myself
dealing with.
|
|
14.11
|
The situation among the constables was no better. When he arrived
on the CPT, Sgt Bird said he was comforted by the fact that there
was at least one detective constable on the team in the form of
Detective Constable (DC) Braithwaite. However, DC Braithwaite was
transferred to other duties in March 1999, which meant that, by
the time Victoria arrived in the borough, there were no detectives
in Haringey CPT.
|
|
|
|
14.12
|
PC Jones was one of the most experienced constables left in the
team, and she was to be the investigating officer on each of the
two occasions that Victoria was referred to the team. She joined
the police force in 1987 and carried out uniformed patrol duties
until her appointment to Haringey CPT in 1996. She spent two years
with the Clubs and Vice Unit but had never been a detective officer
nor undertaken the CID foundation course, nor any other course involving
serious crime investigation. However, in 1996, she did undertake
the two-week child protection course that was in existence at that
time. This course included the identification of possible signs
of deliberate harm to a child and the evidence required. Within
the first month of her being posted to Harrow CPT, she also attended
a Memorandum of Good Practice Interviewing course and a five-day
Working Together course. Therefore, by August 1999, PC
Jones was both experienced in child protection work and, by comparison
with other members of the team, was well trained as far as child
protection work was concerned.
|
|
14.13
|
Having looked at the background of these officers, the picture
which emerges is similar to that of Brent CPT. There were some very
experienced police officers on Harrow CPT, but none had any relevant
training or experience in dealing with the investigation of serious
crimes.
|
|
|
|
14.14
|
Again, a comparison with adult victims of crime is instructive.
Sgt Bird said that no officer in his previous posting (the Vulnerable
Persons Unit, which deals with domestic violence) would investigate
such serious crimes as Grievous Bodily Harm (GBH) or rape, unless
they were a detective. Such crimes, he said, would be passed on
to CID. However, he confirmed that in Haringey CPT, a crime of equal
seriousness committed against a child would be dealt with by an
officer with no detective training at all.
|
|
14.15
|
This is a dangerous and illogical approach. It is wrong that victims
of crime are disadvantaged in terms of the training and expertise
of the investigating officer, simply because they are children.
I heard worrying evidence to suggest that the culture of some police
forces was such that child protection team work was seen as something
less than the investigation of often very serious crimes. In order
to address this issue, I make the following recommendation:
|
|
|
Recommendation
|
|
|
Chief constables must ensure that the investigation of crime against
children is as important as the investigation of any other form
of serious crime. Any suggestion that child protection policing
is of a lower status than other forms of policing must be eradicated.
|
|
14.16
|
Following Victoria's death, Haringey CPT was reviewed. The team
was increased to contain three sergeants and eight constables, five
of whom were detectives.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.17
|
In a report written after Victoria's death (to which I return in
more detail at paragraph 14.127), Detective Chief Inspector (DCI)
Philip Wheeler wrote, "Haringey Social Services itself seems to
have its own particular culture and ways of working within the child
protection framework. It seems that they are extremely powerful
within the protection network and some social workers work hard
to actually prevent police involvement." The validity of this comment
was tested during the course of the evidence of the officers on
the team.
|
|
14.18
|
Sgt Hodges was one of those who thought all was not well. He said
that some members of Haringey Social Services were "aggressive"
towards the police. In particular, he said that he detected a feeling
among a minority of his social services counterparts that the police
tended to take too heavy-handed an approach towards joint investigations,
seeking to obtain a conviction at all costs rather than focusing
on the interests of the child. The result was a feeling that the
two agencies were working to different agendas.
|
|
14.19
|
In order to establish the practical effects of this difference
in outlook, Sgt Hodges was asked whether he had been held back from
doing what he wanted to do in terms of investigating a crime because
of the approach of social services. He replied, "Not holding back,
no, maybe more delayed, things were a lot slower. We could not just
go off and do it, we had to consult with social services before.
I remember having arguments over different investigations with different
social workers and managers. I would not say I allowed them to dictate
totally, but it did present me with a problem of how to progress
investigations when they were our main conduit or access to that
child or the family."
|
|
14.20
|
Sgt Hodges' perception was echoed to some degree by Sgt Cooper-Bland.
When asked to comment on the state of the relationship between Haringey
CPT and social services, he replied, "I would say that on an individual
basis, social worker to police officer, there were many, many examples
of good working relationships. There were, conversely, examples
of poor working relationships, and in very few cases downright rudeness.
I think the perception that the police are heavy-handed and only
interested in securing convictions and not always focusing on the
child, is a stereotypical view held by some people in social services.
I would say the minority."
|
|
14.21
|
When asked for his views on this issue, DI Howard agreed there
were difficulties. Although he thought that DCI Wheeler had exaggerated
the problem, he did state that social services were "robust" and
"inflexible". He gave an example of this inflexibility by saying,
"I made a suggestion, just a suggestion once, that maybe strategy
meetings could be held at Highgate [police station]. I felt that
would be something that would be progressive, the staff maybe could
get to know some of their staff, but it was just a total look of
amazement, as if it would take place at the social services offices
or nowhere.
|
|
14.22
|
If this was true, and I found no reason to doubt DI Howard, then
this is inappropriate behaviour on the part of Haringey Social Services.
The strategy meeting ought to be viewed as a shared, multi-agency
meeting. It is not a social services meeting to which others are
invited, and it should be the cornerstone of a joint investigation.
There is absolutely no reason why the other agencies involved in
child protection should always go to the social services offices.
|
|
14.23
|
The evidence of Sgt Hodges was illuminating on this issue. He told
me, "There was a problem with time delays of having strategy meetings
on occasions. Whether it was because of us or because of social
services, I think it was a bit of both in many respects, a lot of
times we would get phone calls quite late in the day saying, 'We
need to have a strategy meeting now', and we would have nobody in
the office to actually go all the way to Tottenham to have a strategy
meeting. Social services appeared to be loath to have telephone
strategy discussions, which maybe would have resolved that problem.
On other occasions, you would arrive at the social services for
a strategy meeting and then be asked to attend another strategy
meeting immediately after. That caused problems because we would
not actually know anything about the initial referral, and we would
not have had the opportunity to actually do any of our checks as
such."
|
|
14.24
|
In her statement to the Inquiry, Rosemarie Kozinos, an acting senior
practitioner at Haringey Social Services, said that because there
was a difficulty with police attendance, social services would hold
strategy meetings one after the other to help the police officers.
It does not seem to have occurred to her that it would have been
much more convenient to the police if the burden of travelling had
been shared more equally between the agencies, perhaps by sometimes
holding strategy meetings at police premises where appropriate.
|
|
14.25
|
The strategy meeting should be the forum in which the strategic
and operational direction of the criminal investigation is discussed
and agreed. It is pointless to ask whichever police officer happens
to be at the office for an earlier meeting to attend, just to make
up the numbers. For the police to be properly represented at a strategy
meeting, the officer who is going to deal with the case, and his
or her supervisor, should be present.
|
|
14.26
|
There appeared to me to be no sense of equal partnership between
the two agencies. The police must accept criticism for allowing
this unhealthy regime to develop without challenging it at the highest
level. This is a good example of why the Metropolitan Police Service
(MPS) should have ensured it sent a delegate to the Area Child Protection
Committee (ACPC) meetings of sufficient rank to challenge such arrangements.
This should certainly have been dealt with at superintendent/assistant
director level, but it was the practice in the MPS to send the local
CPT detective inspector.
|
|
14.27
|
Echoes of this tension were heard in the evidence given by some
of the social services witnesses. For example, Lisa Arthurworrey
said that Angella Mairs did not like police officers coming into
the social services office. When I asked her if there was a general
feeling within Haringey Social Services of hostility towards the
police or other agencies, she said, "Yes there was."
|
|
14.28
|
The matter was put directly to Ms Mairs, but her response was confused
and unhelpful. At one point she stated that she found it difficult
to work with some Haringey police officers, citing "institutional
racism" as the reason. Later, however, she tried to distance herself
from this statement by suggesting that all such problems had long
disappeared by the time Victoria's case was being dealt with.
|
|
14.29
|
Ms Mairs aside, I heard enough evidence from other witnesses to
conclude that the police in Haringey allowed themselves to be 'led
by the nose' by Haringey Social Services. This subservient approach
seriously compromised their ability to carry out robust, speedy
and effective criminal investigations.
|
|
14.30
|
Obviously, effective multi-agency working will require some give
and take by the various agencies involved. However, if the situation
in Haringey is representative, it suggests to me that a careful
re-evaluation of Working Together is needed to make sure
that the particular roles and responsibilities of the various agencies
involved in child protection are not blurred. In particular, I believe
that although there should be a constant and thorough sharing of
information between the agencies involved, it is the police who
should keep sole responsibility for the evidence-gathering process.
This includes the forensic interview (known as a memorandum interview)
with a child victim of crime, conducted in accordance with the government
guidance Achieving Best Evidence in Criminal Proceedings
(2001).
|
|
14.31
|
The police should be in no doubt that their primary responsibility
is the detection and prevention of crime, and when a crime is suspected,
they are responsible for its efficient and prompt investigation.
As I set out below, I take the view that Haringey CPT lost sight
of the unique and specific role it had to play in dealing with the
two referrals concerning Victoria. In doing so, they effectively
allowed social services to dictate the speed and depth of the investigations
that were carried out. If this type of 'joint working' is being
replicated nationally, then new guidelines are urgently needed to
ensure that each agency knows precisely the role it is to play in
the investigation of possible deliberate harm to a child.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
|
|
14.32
|
The police in Haringey first became aware of Victoria when Sgt
Cooper-Bland received a telephone call from Shanthi Jacob at 11am
on 28 July 1999.
|
|
14.33
|
Sgt Cooper-Bland recalled that the information he received concerned
a young girl who had been admitted to the North Middlesex Hospital
four days earlier with burns to her face and head. He was told that
the girl's carer, Kouao, had told medical staff that the girl had
poured hot water over herself. Sgt Cooper-Bland also remembers being
told that a nurse had noticed old marks on the child's body that
resembled belt buckle marks.
|
|
14.34
|
In view of the fact that belt buckle marks were expressly mentioned,
Sgt Cooper-Bland must have known that he was being told about possible
deliberate harm to a child. It is clear from what he was later to
write in the entry on the crime-recording computer database, CRIS,
that he also suspected that Victoria's burns had been deliberately
caused. According to the CRIS report, his understanding at the time
was that Victoria's burns had been caused "by the suspect, as yet
unknown, pouring hot water over a child's head". In response to
a question from me, he agreed that he was, at that stage, working
on the assumption that the burns had been deliberately caused.
|
|
14.35
|
Sgt Cooper-Bland agreed that, in light of this information, the
referral constituted a serious case which called for prompt investigation.
He classified the allegation on CRIS as "actual bodily harm", an
offence under section 47 of the Offences Against the Person Act
1861. Therefore, for the second time in two weeks, a CPT was faced
with a clear indication that a serious crime may have been committed
against Victoria.
|
|
14.36
|
Sgt Cooper-Bland recalled that Ms Jacob told him that social services
had arranged a strategy meeting for 2.30pm on the afternoon of 28
July 1999 and that police attendance was required. It appears that
little thought was given by social services as to whether this arrangement
was convenient for the police, and this may be an example of social
services' inconsiderate action that I criticised above at paragraph
14.24.
|
|
|
|
14.37
|
Rather than simply informing the police that a strategy meeting
was to take place, a social services manager should have spoken
to a manager in the CPT to agree whether a strategy meeting was
needed. If so, they could then have agreed on an appropriate and
mutually convenient time and place for it to be held (which, according
to the local procedures in force at the time, should have been in
the hospital). In the event, the manner in which the strategy meeting
was arranged determined who would represent the police at the meeting.
|
|
14.38
|
Sgt Cooper-Bland said that his original intention had been to allocate
the case to PC Sean Mangan, but because that officer was not able
to attend the strategy meeting at the time set by social services,
the case was given to another officer, PC Jones, who just happened
to be at the North Tottenham District Office on that day, attending
another meeting.
|
|
14.39
|
In my view, the decision as to which constable is allocated a particular
case should be determined according to who is best placed to conduct
the necessary criminal inquiry. Once that decision had been made
in Victoria's case, Sgt Cooper-Bland should have arranged with his
counterpart in social services to hold the strategy meeting at a
time which would have enabled that officer to attend. Despite the
fact she was not his first choice, Sgt Cooper-Bland considered that
PC Jones (as the most experienced officer on the team) would be
able to deal with the case properly.
|
|
14.40
|
It is unclear whether Sgt Cooper-Bland, by instructing her to attend
the strategy meeting, also expected PC Jones to take responsibility
for the investigation. But there was little point in her attending
the meeting if that was not to be the case. She certainly received
little in the way of briefing from her sergeant before she arrived
at the meeting. As Sgt Cooper-Bland put it, "I was not able to give
her a detailed briefing at all. It would have been a telephone conversation
asking her to attend the strategy meeting, outlining the briefest
facts of the case."
|
|
|
|
14.41
|
This was the unsatisfactory chain of events which led to PC Jones
attending the strategy meeting about Victoria at Haringey Social
Services' offices on 28 July 1999. At the end of the meeting, it
appears that PC Jones assumed that responsibility for the case was
to be hers, a state of affairs which plainly found favour with Sgt
Cooper-Bland who said, "The following day, I was at Haringey CPT.
It appeared that PC Karen Jones had allocated the investigation
involving Victoria Climbié to herself. I confirmed with her
that this was acceptable and that she was assuming responsibility
for the investigation.
|
|
14.42
|
Before dealing in detail with PC Jones's investigation of Victoria's
case from this point on, it is helpful to note what she believed
herself to be dealing with at the point that she entered the strategy
meeting.
|
|
14.43
|
PC Jones told me that she remembered little about her telephone
conversation with Sgt Cooper-Bland, but when reminded what he wrote
on CRIS, PC Jones said that nothing there was in conflict with her
memory of what she had been told. It is safe to assume, therefore,
that she knew that Victoria, a seven-year-old girl, had been taken
to hospital with burns to her face and head, that she believed the
hospital was accepting the explanation given by her 'mother' that
Victoria poured the water over herself, and that medical concerns
were raised when a nurse found what looked like belt buckle marks
on her body. When asked whether it seemed to her to be the sort
of case that merited a full investigation, she unhesitatingly answered
that it did. She also confirmed that she felt equipped, in terms
of training and experience, to deal with it.
|
|
14.44
|
It is important to note that four days had passed between Victoria's
admission to hospital and the referral to the police. Wasting time
at the outset can seriously damage the effectiveness of a criminal
investigation. In this case, it gave Kouao an opportunity to talk
to and influence Victoria, for Victoria's injuries to change appearance
and for forensic evidence to be lost. Sgt Cooper-Bland did not raise
the issue of the delay in bringing Victoria's case to the attention
of the police when he took the referral on 28 July 1999. His explanation
was worrying: "It is not something I had considered. I have to say
that while not common, it was not uncommon for cases to become -
to be brought to our notice some time after the suspected offences
had occurred."
|
|
14.45
|
In my view, this was an issue that should have been considered,
not just by Sgt Cooper-Bland when he took the referral, but also
by PC Jones when she entered the strategy meeting. At the forefront
of her mind should have been the fact that there was a victim in
hospital to whom the main suspect had unrestricted access. She should
also have been aware that, somewhere, there might be a belt buckle
that matched the marks on Victoria's body. There might also be witnesses
able to give helpful evidence.
|
|
14.46
|
PC Jones should have been concerned that there had been a delay
of four days between Victoria's admission to hospital and the police
being informed that she may have been the victim of deliberate harm.
The damaging effect that such a delay could have on the effectiveness
of a criminal investigation is obvious. The fact that she would
not seem to have raised this issue with her colleagues at the strategy
meeting is perhaps indicative of a general approach to investigations
of this kind where the police neither receive nor insist upon the
immediate notification of potential crimes. In my view, it is vital
that the police are involved at the earliest possible opportunity.
In order to encourage this practice, I make the following recommendation:
|
|
|
Recommendation
|
|
|
The guideline set out at paragraph 5.8 of Working Together
must be strictly adhered to: whenever social services receive
a referral which may constitute a criminal offence against a child,
they must inform the police at the earliest opportunity.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.47
|
In view of the delay that had already occurred since Victoria's
admission to hospital, these were all matters which should have
been at the forefront of PC Jones's mind when she attended the meeting.
She should have left the other participants of the strategy meeting
in no doubt that the police needed to try and recover the time lost
by the late referral and urgently commence a full investigation.
Instead, PC Jones would seem to have done little more than somewhat
passively accept a list of tasks from the chairperson at the meeting,
who was Ms Kozinos.
|
|
14.48
|
I regard this as wholly unsatisfactory. However competent PC Jones
believed Ms Kozinos to be, she was not qualified to direct the course
of an investigation into a serious crime. That PC Jones allowed
her to do so adds further weight to the recommendation I made at
paragraph 13.52 that a police manager should be involved both at
the referral stage and in initial strategy discussions in order
to make sure, if nothing else, that the investigation gets off on
the right foot.
|
|
14.49
|
The strategy meeting lasted half an hour. At the end of the meeting,
PC Jones had gained more information, mainly from Karen Johns, a
social worker at Enfield. She discovered that Victoria had been
presented as unkempt, in a dirty dress and with no underwear, that
there were 11 scars in total, including the two buckle marks, and
that the injuries caused by the scalding appeared to be "bad". PC
Jones should have been in no doubt from this extra information that
she was dealing with a serious allegation of crime, as well as a
potential case of neglect. PC Jones confirmed the she understood
herself to be investigating a possible case of Actual Bodily Harm
(ABH).
|
|
14.50
|
The tasks specifically allocated to PC Jones at the strategy meeting
were:
|
|
•
|
to carry out a check with the immigration service;
|
|
•
|
once medical reports had been obtained, to arrange a joint visit
with social services to the child's home in order to explain child
protection procedures to the mother;
|
|
•
|
to take the necessary steps should Kouao attempt to remove Victoria
from hospital.
|
|
|
|
14.51
|
What concerned me most about the action plan agreed at the strategy
meeting was not what the police agreed to do themselves, but what
they were content to let others do on their behalf. Two of the most
basic steps in investigating this crime should have been the obtaining
of statements from the doctors and nurses concerned, and ensuring
that Victoria's injuries were photographed.
|
|
14.52
|
PC Jones did neither. In explanation, she told me that she expected
Ms Johns to obtain the medical report. This, in my view, is grossly
inadequate. PC Jones should have arranged for full witness statements
to be obtained from the consultant paediatrician, Dr Mary Rossiter,
and the other doctors and nurses who had examined Victoria. A medical
report is worthless in a criminal investigation, and someone with
PC Jones's experience should have known that proper witness statements
were required.
|
|
14.53
|
As to the photographs, although hospital photographs had been ordered
(and were eventually taken on 29 July 1999) and arrangements were
put in place at the strategy meeting for police and social services
to be given a copy, PC Jones should have arranged for a police photographer
to record the injuries. A police photographer would approach the
matter from an evidential point of view, ensuring that all injuries
and marks were photographed, and using special techniques where
necessary, such as ultraviolet photography. We now know that the
hospital photographer got basic instructions from a doctor about
which areas to photograph, by a square being drawn on a body map.
The area included the main burn injuries but many of the smaller
injuries were not photographed, and the recording of such injuries
may have been crucial in a criminal investigation.
|
|
14.54
|
There was a long and depressing exchange between Counsel to the
Inquiry and PC Jones when he questioned her on her failure to take
positive action at the beginning of what should have been her investigation
of the case. Despite the ample evidence of physical abuse and neglect
available to her at that stage, she doggedly stuck to her position
that, because the doctors believed Kouao's story about the scalding,
it must be true. She did not see it as her role to question the
doctors' views, or even to check that it was indeed the concluded
medical view, given that she had only received this information
second-hand from Ms Johns. To discover that an experienced police
officer and child protection 'expert' such as PC Jones would not
even consider the possibility that Kouao might be lying is incredible.
Once again, I repeat that if a competent police manager had been
at the strategy meeting, he or she might have applied some independent
thought and critical analysis to the available information.
|
|
14.55
|
I believe that there were minimum steps which PC Jones should have
informed Ms Kozinos the police would be undertaking:
|
|
•
|
The scene of the crime should have been identified and searched
for any clues that deliberate harm was taking place, and in particular
for the actual belt which matched the buckle marks on Victoria's
body.
|
|
•
|
Statements should have been arranged and obtained from all doctors
and nurses concerned.
|
|
•
|
Police photographs should have been obtained, or at the very least
the hospital photographs should have been checked to ensure all
injuries reported by medical staff had been recorded.
|
|
•
|
A full forensic medical examination, by a forensically trained
paediatrician or doctor, should have been carried out.
|
|
•
|
The likely suspects should have been identified (the prime carers
being the most obvious), and a strategy agreed for their arrest
and interview in accordance with the Police and Criminal Evidence
Act 1984.
|
|
•
|
Arrangements should have been made to speak immediately to Victoria,
independently of any of the suspects, to allow her to speak freely
about what had happened to her. This should have been done with
an interpreter and, as far as possible, in accordance with the
Memorandum of Good Practice.
|
|
14.56
|
I heard no satisfactory explanation from any of the officers from
Haringey CPT who gave evidence to the Inquiry as to why these basic
investigative steps were not taken. PC Jones's response to the question
of why she did not carry out these basic tasks was simply to avoid
and refuse to accept even her most obvious failings, saying that
medical staff were responsible for identifying the crime scene and
that she was not able to speak to Victoria because a doctor needed
to examine her. Quite what she thought the doctors had been doing
for the previous four days was never established. She even suggested
that the police could not really do anything because they had not
established that a crime had taken place. It was put to her that
surely part of the role of the police is to establish exactly that,
but she seemed not to grasp the logic of the argument.
|
|
14.57
|
The fundamental flaw in PC Jones's view of her handling of Victoria's
case, and her role as a child protection officer, seems to me to
be expressed in the following answer, which is representative of
many she gave during the course of her evidence: "Child protection
and ordinary policing are completely different things." I believe
that they are not different things and that it is absolutely vital
that police officers engaged in joint investigations into possible
deliberate harm realise that they are responsible for making sure
that an effective investigation is carried out. In order to encourage
this perception among police officers, I make the following recommendation:
|
|
|
Recommendation
|
|
|
The Working Together arrangements must be amended to
ensure the police carry out completely, and exclusively, any criminal
investigation elements in a case of suspected injury or harm to
a child, including the evidential interview with a child victim.
This will remove any confusion about which agency takes the 'lead'
or is responsible for certain actions.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
14.58
|
As to the three tasks allocated to her by Ms Kozinos at the strategy
meeting, PC Jones said she carried out the immigration check which
came back as "no trace" and she decided that no steps were necessary
to prevent Kouao removing Victoria from hospital. This left just
the 'home visit' to Kouao. As far as she was concerned, this was
going to be arranged by the allocated social worker and the timing
would be dictated by social services, leaving her to do no more
than wait to be told when to turn up at Kouao's home.
|
|
14.59
|
With the exception of the immigration check and a check of the
police computer system, PC Jones did nothing more on the case for
a further six days. In my view, she neglected her duty as a police
officer, and Victoria was let down by this inaction.
|
|
|
|
14.60
|
On 3 August 1999, PC Jones happened to be at the North Tottenham
District Office for meetings in relation to other cases. She said
that she saw Lisa Arthurworrey in reception, and that Ms Arthurworrey
had got a statement, or statements, back from the hospital indicating
that one doctor had described the marks on Victoria's body as belt
buckle marks. This was the crucial document which PC Jones said
she was waiting for to begin further investigations. This was the
confirmation she thought she needed that a crime had taken place.
Ms Arthurworrey apparently told PC Jones that she did not have the
statement in her possession because she was dealing with another
matter at the time, but that she would fax it to the CPT office
later. PC Jones said she was not "unduly concerned" that the document
was not faxed that day, or indeed the next day.
|
|
14.61
|
Ms Arthurworrey had arranged with PC Jones to carry out the 'home
visit' on 4 August 1999. PC Jones said that she saw this visit as
being for social services (as the lead agency) to assess whether
it was suitable for Victoria to return there. If that is right,
then it is unclear why it should have been necessary for PC Jones
to attend at all. However, when PC Jones was asked what she thought
the purpose of her attendance was, her answer was revealing. She
said, "Because of the suspicion there was a crime, somebody had
made an allegation."
|
|
14.62
|
Plainly, that was correct. An allegation had been made, a crime
was indicated, and Kouao was the principal suspect. That being so,
PC Jones, rather than passively attending a social services-led
home visit, should have arrested Kouao and interviewed her formally.
|
|
14.63
|
In reality, the home visit never took place. PC Jones recalled
that, at the strategy meeting, it had been suggested that Victoria
had suffered from scabies. On the day of the proposed home visit,
she told me that she telephoned the casualty department at the North
Middlesex Hospital and asked for advice relating to scabies. According
to her, a casualty nurse (whose name she was unable to supply) warned
her to wear protective clothing, not to remain in the infected area
for long, and certainly no longer than an hour. She also said that
she was advised to destroy her clothing, and wash and shower in
disinfectant afterwards. Because of this advice, she said she had
concerns for her own family and she therefore telephoned Ms Arthurworrey
that morning to say she refused to go to the house.
|
|
14.64
|
The question of whether PC Jones really did receive advice to this
effect from a nurse at the North Middlesex Hospital was one which
occupied the Inquiry for some time. A number of nurses were asked
directly whether they had given such advice. All of them answered
"no". Meriel Clarke, lead nurse in the accident and emergency department
at the hospital, told me that she had undertaken an investigation
among all the nurses in the casualty department. The investigation
revealed that none of them could recall a conversation with PC Jones
during which advice concerning scabies had been given.
|
|
14.65
|
In any event, it was unequivocally stated by all those medical
staff who gave evidence on this issue, that the advice PC Jones
claims to have been given was plainly wrong. Ms Clarke said that
she could not believe that any of her nurses could have given such
advice. In addition, Dr Thomas Mann, a consultant dermatologist
at the hospital, said in his statement to the Inquiry that, had
he been asked for advice by PC Jones, he would have told her not
to worry about scabies because Victoria had been successfully treated
by this stage.
|
|
14.66
|
Had PC Jones received the advice that she claims she did and genuinely
thought that Victoria's home posed a risk of scabies infection,
then plainly she should have objected strongly to Victoria being
returned there before the risk had been eliminated. No satisfactory
explanation was given as to why she took no such action. I am also
left to wonder why PC Jones made no attempt to obtain protective
clothing from the police stores, and why she did not consider that
meeting Kouao at social services' offices also exposed her to a
risk of infection. Finally, I consider that had PC Jones been advised
by an individual at the hospital, she would have recorded the name
of that person and the exact advice given, particularly bearing
in mind her otherwise meticulous note keeping on CRIS.
|
|
14.67
|
On balance, I conclude that there was no conversation between PC
Jones and a casualty nurse during which she was advised to take
the precautions she claims. I consider it to be more likely that
PC Jones decided for herself that she would not attend the home
visit, and that she invented the story about seeking advice from
the casualty department as a way to avoid criticism.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.68
|
On 5 August 1999, PC Jones went to the North Tottenham District
Office for the arranged meeting with Kouao. It was at this point
that she finally saw the 'statement' that Ms Arthurworrey said she
had from a doctor. In fact, this turned out to consist of no more
than a letter from Nurse Isobel Quinn. The effect of this letter
was to put a stop to the police investigation in the same way that
the third- hand report from Dr Schwartz had caused PC Dewar to abandon
her investigation a few weeks earlier. The reason for this, according
to PC Jones, was that the letter did not specifically say that Dr
Rossiter (the named doctor for child protection) thought Victoria
had been deliberately physically harmed.
|
|
14.69
|
The only mention of Dr Rossiter was the comment "Dr Rossiter ward
round notes, evidence of emotional abuse". This comment was, at
best, ambiguous. By no stretch of the imagination did this rule
out deliberate physical harm as well. Apart from anything else,
the glaring thing that was missing was an explanation for the belt
buckle marks. For PC Jones to decide that there was no crime because
of this letter was extraordinary.
|
|
14.70
|
The only basis upon which the investigation could properly have
been stopped at this point would have been a clear statement from
Dr Rossiter to the effect that she was sure that all of the injuries
to Victoria, including the belt buckle marks, had innocent explanations.
At the outset of her 'investigation', PC Jones had identified the
need for a doctor's report. She closed the investigation without
ever having received such a report, and without ever having ascertained
exactly what the doctor's diagnosis of Victoria's injuries was.
|
|
14.71
|
PC Jones refused to accept that it was her role to make any inquiries
herself with the doctors. She maintained the line that it was the
doctors who should have told her if there was evidence of deliberate
physical harm, and because Nurse Quinn's letter did not address
the belt buckle marks at all, PC Jones assumed they were no longer
an issue.
|
|
14.72
|
She failed to appreciate, because she never bothered to find out,
that the letter from Nurse Quinn was simply a response to the task
set at the strategy meeting for social services to get more information
on the issue of emotional abuse. It was never intended that this
letter should be taken as a full diagnosis of Victoria's condition
and, as Dr Rossiter told the Inquiry, she actually thought that
Victoria had suffered from "serious and appalling physical abuse",
which is what she would have made clear had she been asked directly.
Once again, a simple telephone call from a police officer to the
doctor concerned may well have cleared up the misunderstanding.
|
|
14.73
|
The parallels with the experience of PC Rachel Dewar in Brent when
dealing with the admission of Victoria to the Central Middlesex
Hospital are clear. In both cases, there seems to have been an unwillingness
by the officers concerned to evaluate the information fed to them
concerning the diagnosis of the consultants concerned. The reason
may well be a general reluctance, among junior officers in particular,
to challenge the diagnoses of what they consider to be eminent medical
practitioners. I have already indicated that I regard specialist
child protection officers as bringing distinct and invaluable skills
to the multi-agency investigation of possible crimes against children.
They should not feel inhibited in questioning or challenging the
diagnoses of paediatricians. To address this issue, I make the following
recommendation:
|
|
|
Recommendation
|
|
|
Training for child protection officers must equip them with the
confidence to question the views of professionals in other agencies,
including doctors, no matter how eminent those professionals appear
to be.
|
|
|
|
14.74
|
Returning to the meeting with Kouao on 5 August 1999, PC Jones
said that the original purpose for her attendance, despite her view
that there was no need to carry out a criminal investigation, was
to explain to Kouao the child protection procedures and the purpose
of police involvement. She said that the meeting, from her perspective,
was no more than a "fishing expedition". This would seem to have
been contrary to the view of Ms Arthurworrey, who said, "I understood
Constable Jones's role as to investigate potential crimes against
Victoria." That, of course, is precisely what PC Jones should have
been doing.
|
|
14.75
|
In addition to her failure to get to the bottom of the belt buckle
marks observed on Victoria's body, PC Jones failed throughout her
involvement with the case to address the two to five-hour time delay
between Victoria suffering the burns, and her being taken to hospital
by Kouao. She told me that she had simply overlooked this important
discrepancy - as had Sgt Cooper-Bland when he took the referral
on 28 July 1999.
|
|
14.76
|
This was regrettable because, when they met, Kouao repeated to
her and Ms Arthurworrey that the scalding incident occurred at 3pm.
This would have been the ideal opportunity to ask why they did not
arrive at the hospital until after 5pm. Indeed, the CRIS report,
which was PC Jones's main working document, said the scalding incident
happened at midday, so there was a potential five-hour delay which
should have been uppermost in her mind. I got the impression that
PC Jones had by now completely closed her mind to the possibility
that Victoria had been deliberately harmed, because it seems the
meeting with Kouao was conducted in a very passive, non-interrogatory
way.
|
|
14.77
|
This seemed to be confirmed by PC Jones when she said of Kouao,
"She was not a suspect, she was a lady we were speaking to, to try
to find things out about her circumstances, what had happened to
her. It was not like a criminal interview, where I would be checking
every detail that she said."
|
|
14.78
|
I believe that the police should bring to the child protection
arena a healthy scepticism, an open mind and, where necessary, an
investigative approach. By the time that she first met her on 5
August 1999, PC Jones seemed to be ready to accept anything she
was told by Kouao, which meant that her presence during the interview
was worthless. When asked why, during the course of a later home
visit, she did not challenge any of the inconsistencies in Kouao's
story, Ms Arthurworrey replied, "I am a social worker and I work
with the facts as they are presented to me. As I have said to you,
I was more trusting of Kouao when I went on that visit. I am not
a detective. I had no reason to question what I saw and what I was
being told at that point." If the unquestioning acceptance of information
given by a carer is undesirable in a social worker, it is unacceptable
in a police officer.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.79
|
During the interview, Kouao gave permission for PC Jones and Ms
Arthurworrey to speak to Victoria. As a result, they went to the
North Middlesex Hospital the following afternoon. Their failure
to go immediately gave Kouao enough time to visit Victoria and possibly
coach her about what to say during the interview. However, given
that PC Jones had effectively abandoned any pretence at investigation
at this stage, one can well understand why this consideration failed
to occur to her.
|
|
14.80
|
PC Jones has little recollection of the questions they asked, and
she told the Inquiry that she did not take any notes. In broad terms,
she said Victoria's account was similar to that given by Kouao and
that she made no allegations of crime. They spent about half an
hour with Victoria. Apart from writing up, and 'no-criming' the
CRIS entry when she got back to her office, that was the last action
PC Jones took in connection with the referral received by the police
on 28 July 1999.
|
|
14.81
|
In particular, both she and Ms Arthurworrey did not take any steps
to obtain copies of the photographs taken by the hospital, which
were so powerful and disturbing when they were shown during Phase
One of the Inquiry. This meant that the respective managers in each
agency, who should have been reviewing the work carried out by the
two front-line staff, were not given the opportunity to see for
themselves the extent of Victoria's dreadful injuries, and so possibly
challenge some of the assumptions made.
|
|
14.82
|
In my view, PC Jones failed to conduct an adequate investigation
of the crime committed against Victoria of which she became aware
on 28 July 1999. In the process, she displayed what I consider to
be gross incompetence.
|
|
|
|
|
|
14.83
|
At around 4.30pm on 1 November 1999, Paula Waldron, a civilian
administration assistant at Haringey CPT, took a referral from Ms
Arthurworrey to the effect that Victoria had been indecently assaulted.
Ms Waldron began the CRIS entry and recorded that, early that morning,
Kouao had telephoned Ms Arthurworrey to allege that Manning had
sexually assaulted Victoria. She then allocated the case to PC Jones,
because she had dealt with the family before. PC Jones was not on
duty at this time, having left the office over an hour earlier.
The first time she became aware that she was the investigating officer
for this report of crime was the following morning when she came
on duty.
|
|
|
|
14.84
|
The following morning, PC Jones discovered that the matter had
been allocated to her. She took no action to commence an investigation
and, at some point during her shift, was informed by Ms Waldron
that Kouao had withdrawn the allegation. Thereafter she did nothing
to progress the case until the strategy meeting convened by social
services took place.
|
|
14.85
|
When it was put to PC Jones that her entire investigation of the
alleged crime committed against Victoria, up to and including 5
November 1999, amounted to no more than her attendance at this strategy
meeting, she candidly replied "yes".
|
|
|
|
14.86
|
As to the strategy meeting itself, it is worth repeating that this
was a vital step in the conduct of the inquiry at which its future
management was to be decided. As such, the need for the meeting
should have been agreed between the key agencies involved and it
should have taken place as soon as reasonably possible.
|
|
14.87
|
However, it appears that the police had no say in the timing or
location of the strategy meeting and, once again, they simply turned
up at North Tottenham District Office when they were told to. From
the point of view of a criminal investigation, this was three days
too late. A full inquiry should have been under way by 2 November
1999, if not on the afternoon of 1 November. The meeting was arranged
for 5 November because Ms Arthurworrey was on a training course
for a few days. This is certainly not a valid reason for holding
up an investigation into a possible serious crime, and the police
should have objected most strongly to the delay. These issues are
discussed further in paragraphs 14.104 and 14.105.
|
|
14.88
|
The strategy meeting was chaired once again by Ms Kozinos. PC Jones
again had no manager with her to take the lead in formulating police
action, but she was accompanied by PC Pauline Ricketts, who happened
to be at the North Tottenham District Office on other business.
Ms Kozinos outlined the circumstances of the allegation by Victoria
and the fact that Kouao had withdrawn it on Victoria's behalf.
|
|
14.89
|
During the course of the meeting, 15 separate tasks were identified
and recorded by Ms Kozinos, of which the following five were assigned
to PC Jones:
|
|
•
|
Check with immigration.
|
|
•
|
Carry out a check on Manning.
|
|
•
|
Obtain a police statement from Kouao.
|
|
•
|
Speak to Victoria.
|
|
•
|
Possibly carry out a joint home visit with social services.
|
|
|
|
14.90
|
As for speaking to Victoria, the minutes of the strategy meeting
record that there was an agreement not to carry out a formal 'memorandum'
interview or medical examination with Victoria at that stage. In
other words, PC Jones agreed that, despite four days having elapsed
since the original allegation, there was to be a further delay of
unspecified length before she would have any opportunity to speak
to the potential victim.
|
|
14.91
|
As far as the other action points allocated to her are concerned,
PC Jones told me that she completed the relevant checks with the
immigration service and the police national computer (presumably
in respect of Manning) "during the course of the next few days".
I would imagine that the work there consisted of two telephone calls.
|
|
14.92
|
She then decided to write to Kouao, in order to arrange an interview.
Unbelievably, it was not until 12 January 2000, a period of about
nine weeks after the strategy meeting, that this five-line letter
inviting her into the office had been translated into French and
posted to Kouao. PC Jones fully accepted that the delay was unacceptable
and that she should simply have made a telephone call to Kouao or
visited her at her house.
|
|
14.93
|
In the event, the nine weeks spent preparing the letter were wasted.
Simply inviting Kouao to attend the police station on either 26
or 31 January 2000, was completely inadequate. Unsurprisingly, Kouao
failed to keep either appointment and, on 7 February 2000, PC Jones
contacted Ms Arthurworrey one last time about the case. She was
told that social services had not made any contact with the family
either, and so she decided to close the police case completely.
The CRIS entry was updated accordingly.
|
|
14.94
|
In respect of this second referral, the suggestion was again made
to PC Jones that she should have done more to progress the investigation.
In particular, it was put to her that she should have arranged a
memorandum interview of Victoria immediately upon hearing of this
serious allegation of sexual assault. PC Jones disagreed that this
step was appropriate, but I am certain that it was fundamental in
establishing what was really going on in Victoria's life.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.95
|
I heard a large volume of evidence about the supervision, or lack
of it, provided to PC Jones during the course of her involvement
with Victoria. I was left with a remarkably similar impression to
that of Brent CPT, with blurred lines of accountability and managers
with little idea as to what their front-line staff were doing.
|
|
14.96
|
The importance of this issue cannot be overstated. Although I have
been critical of PC Jones, I believe she was let down completely
by her managers. The system of supervision by managers at Haringey
CPT was totally ineffective. I address these comments not only in
respect of her immediate managers, but also of more senior managers,
including DCI Wheeler, Detective Superintendent Susan Akers and
Detective Chief Superintendent David Cox. These three senior police
officers presided over child protection teams in the north west
crime OCU, which lacked proper management systems and where overworked
front-line staff were left to muddle through as best they could,
sometimes making grave mistakes which were never identified and
corrected.
|
|
14.97
|
I feel strongly that, incompetent though they were, both PC Jones
(Haringey) and PC Dewar (Brent), have borne the brunt of criticism
both in the media and during this Inquiry, much of which should
rightfully have been attributed to their line managers. These individual
constables would not have been able to make such elementary mistakes
if they had been properly supervised and guided by senior officers.
|
|
|
|
14.98
|
I have dealt specifically with the supervision provided in Brent
CPT in section 13. I turn now to the situation in Haringey, as revealed
by the evidence put before me.
|
|
14.99
|
According to the statement she submitted to the Inquiry, PC Jones
reported directly to DI Howard during the period with which I am
concerned, calling upon the assistance of whichever sergeant happened
to be around as and when necessary.
|
|
14.100
|
I believe this to be an unsatisfactory arrangement. In order for
managers to be held accountable, it is important that there is clarity
about line management arrangements. It became clear that PC Jones,
and presumably her colleagues, would just speak to whoever was around
out of the inspector and two sergeants in the team. Obviously, there
will be times when immediate advice is needed and it is appropriate
to seek it from whoever is most readily available. However, if nobody
has 'ownership' of the supervision of a particular officer or case,
important issues can be missed and conflicting advice given. In
any event, it seems as though there was no 'intrusive supervision'
offered to PC Jones at all. In other words, if PC Jones did not
ask for advice, she was just left to her own devices.
|
|
14.101
|
Before I deal with each investigation in turn, I want to make the
point that, unlike their colleagues at Brent CPT (and, indeed, unlike
the majority of managers from all the other agencies involved with
Victoria), the inspector and sergeants from Haringey CPT fully accepted
that they had badly let down Victoria, her family and PC Jones.
Their acceptance of their management failures certainly gives me
hope that at least some officers will genuinely learn from this
dreadful case and, faced with a similar situation in the future,
will take a different course of action. I was impressed by the manner
in which they gave their evidence and wish to give them credit for
their honesty and frankness before me.
|
|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
|
|
|
|
14.102
|
On 28 July 1999, Sgt Cooper-Bland received the telephone referral
from social services to say that Victoria had been admitted to hospital
with serious injuries. I have already expressed my view that it
is important that a supervisor is aware of all referrals as they
come in and, whether by luck or design, that was the case here.
|
|
14.103
|
However, almost immediately, things started to go wrong. Sgt Cooper-Bland
explained his decision to send PC Jones to the July strategy meeting
in the following way: "I decided that as PC Jones was already at
the social services office on another matter, it would be a sensible
use of resources to ask that she attends the strategy meeting.
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14.104
|
I have already indicated that I regard such an approach to be inadequate,
and expressed my preference for social services and the police jointly
to agree on the location and timing of strategy meetings. In order
for such a system to work, there needs to be a relationship of mutual
co-operation with social services so that strategy meetings are
held at times and in places of mutual convenience. It may well be
that the dominant status afforded by the police to Haringey Social
Services may have influenced Sgt Cooper-Bland in his decision to
send the officer who would enable the strategy meeting to go ahead
as scheduled.
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14.105
|
I also repeat my firm belief that all strategy meetings or discussions
should include a manager from the key agencies. In this case, either
Sgt Cooper-Bland or one of his senior colleagues should have gone
with PC Jones to support her, and to ensure that operational decisions
were made which would enhance the investigation into this serious
crime.
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14.106
|
In effect, PC Jones ended up allocating Victoria's case to herself
by virtue of the fact that she happened to be at the North Tottenham
District Office at a time convenient for social services. In my
view, it is not appropriate for junior officers in PC Jones's position
simply to allocate cases to themselves. It must be seen as part
of the function of supervising officers in a CPT carefully to allocate
work to their junior officers, and afterwards to assume specific
and direct responsibility for the supervision of the case. Neither
of these key steps were taken in Victoria's case.
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14.107
|
Having instructed PC Jones to attend the strategy meeting on behalf
of the police, Sgt Cooper-Bland failed to ask her for an update
after the meeting had taken place and he had approved PC Jones's
decision to deal with the case herself. In my view, this was a critical
omission as it clearly indicates that Sgt Cooper-Bland had no intention
of playing any further part in the case from this point onwards.
When it was put to him that his inactivity in this regard pointed
"to a total lack of supervision in this case", he candidly replied
that it did.
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14.108
|
In fact, Sgt Cooper-Bland had brief involvement with Victoria's
case on two further occasions. The first was on 4 August 1999, when
he recalled having a conversation with PC Jones about a contagious
disease and she informed him that she was cancelling a home visit.
He would not appear to have questioned or challenged this decision
of PC Jones, and he certainly failed to ask the obvious question
of why she was prepared to allow Victoria to return to a house that
she was not prepared to visit herself.
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14.109
|
Second, on 8 August 1999, Sgt Cooper-Bland endorsed the CRIS entry
to indicate that he was content with the way the investigation was
progressing. However, in reality he knew nothing about the conduct
of the investigation or the fact it had effectively ceased several
days previously. Far from constituting supervision, his involvement
on this occasion amounted to no more than the unquestioning assumption
that all must be well. I agreed entirely with his own assessment
of his involvement at this stage when he said, "Regrettably my last
supervision occurred at a stage when Karen Jones was still carrying
out inquiries into the case. My supervision on that occasion, on
8 August, was not rigorous and I can honestly say that I did not
look at the crime in sufficient detail to take in all the information."
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14.110
|
Sgt Bird was also briefly involved in the case on 4 August 1999.
Despite the fact that he knew nothing whatsoever about the background
to the case, PC Jones apparently expressed concerns to him, as well,
about carrying out the home visit as "the child had scabies". Sgt
Bird recalled that he advised her to seek advice from the Metropolitan
Police occupational health service. Crucially, he said that he "fully
expected her to carry out the home visit at some stage in the near
future". As subsequent events demonstrated, this assumption was
incorrect and would suggest that he should have specifically directed
PC Jones to carry out the visit once the appropriate advice had
been obtained.
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14.111
|
The next tier of supervision consisted of DI Howard. In his supervision
of the first investigation carried out by PC Jones, DI Howard looked
at the CRIS entries on 29 July and 9 August 1999. It should have
been obvious to him, certainly by 9 August, that this investigation
was not being carried out adequately. Nonetheless, he endorsed the
CRIS entry in such a way as to indicate he was content. I do not
believe he would have done so if he had taken anything more than
the most superficial interest in the case. At the very least, he
should have spoken to PC Jones about the investigation which, as
he understood it, was still ongoing.
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14.112
|
He admitted frankly that his supervision of PC Jones's handling
of the first referral concerning Victoria was inadequate. I agree
with his assessment.
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14.113
|
I was told that, after DCI Wheeler conducted his review, a new
system of supervision was introduced in the team, whereby each sergeant
supervises the cases of a particular group of officers. When asked
if this was an improvement, Sgt Bird replied, "It is far better
because it focuses your mind on that particular officer's investigations.
There were also bi-weekly, or fortnightly meetings arranged as well,
to sit down with that officer and go through any difficult cases.
In practice, we tried to go through all cases. The outcome of that
was we took a lot less investigations on ourselves and that freed
us up to do the job that we were employed to do, which was supervise."
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14.114
|
I welcome the change and believe its effectiveness illustrates
the inadequacy of the arrangements in place when Victoria's case
came to be dealt with by Haringey CPT.
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|
Paragraphs: 14.1 -
14.7 | 14.8 - 14.16 | 14.17
- 14.31 | 14.32 - 14.46 | 14.47
- 14.57 | 14.58 - 14.67 | 14.68
- 14.78 | 14.79 - 14.94 | 14.95
- 14.101 | 14.102 - 14.114 | 14.115
- 14.124 | 14.125 - 14.132
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|
|
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14.115
|
Turning now to the second referral, in November 1999, I see no
reason why an administrative assistant such as Ms Waldron should
not have taken the referral and made the initial CRIS entry. However,
arrangements should have been in place to ensure that any discussion
with social services about the timing of the beginning of the investigation,
or the deploying of a particular officer, was carried out by a police
manager. The fact that PC Jones had previously dealt with the family
was no basis for automatically allocating this case to her. Regardless
of the merits of the decision to do so, the decision itself should
have been taken by one of the supervising officers following a consideration
of all available information.
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14.116
|
It would appear that the first time any supervisor became aware
of this investigation was 11 November 1999, when Sgt Hodges carried
out a routine check of CRIS. This was now 10 days after the original
allegation by Victoria, and five days after the strategy meeting.
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14.117
|
Like his colleagues, Sgt Hodges did nothing but note the CRIS entry,
paying no attention to the fact that PC Jones was failing to carry
out the tasks allocated to her at the strategy meeting. When asked
how his failure to supervise could be explained, he said, "I have
to accept responsibility for the actions of my staff. What we did
not have at the time was this robust intrusive level of supervision,
because the supervisors were relying on the staff to tell them how
to do the job and this was a problem for us because we did not have
the experience."
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14.118
|
While I accept that there may have been elements of his role that
remained unfamiliar to Sgt Hodges at this stage (he had, after all,
only been in post for 13 days), he had been a sergeant for nine
years. As such, he should have been entirely familiar with the basic
principles of good supervision, one of which, in my opinion, is
the need to satisfy oneself that the basic steps in an inv |
