HC Deb 22 November 1974 vol 881 cc1774-86

4.1 p.m.

Mr. Eric Moonman (Basildon)

The name Max Piazzani has gained a significance far beyond the boundaries of Wick-ford or even of Essex, but in a short debate of this kind it is impossible to tell Max's story from the beginning, for it is very complex. I shall, therefore, to be fair on the House, refer to only three documents: first, the joint report of the committee set up by the Essex Area Health Authority and the Essex County Council, published on 17th October; second, my own alternative report, which was published on 28th October; third, the "Piazzani File" series published by the Evening Echo newspaper in its issues of 29th October to 1st November.

What emerges clearly from any study of those documents is that the inquiry into Max Piazzani's circumstances and his death cannot be allowed to end officially with the joint committee's report. As a first step towards enlarging the area of inquiry, the joint committee should be required to publish a list of witnesses whom it interviewed and of the documents it studied. Also, it should be required to publish the evidence in full. This has been lacking so far. The joint report is totally worthless without that evidence, and its publication might begin to illuminate some of the many discrepancies which anyone taking an interest in the case soon encounters.

What is clear is that by its categorical statement that the main responsibility lay with the parents the joint committee has effectively absolved the authorities which it represented. In fact, those authorities were sitting in judgment on themselves. Yet neither they nor the Chelmsford Crown Court heard any evidence from Mr. or Mrs. Piazzani. The Piazzanis accepted their solicitor's advice to plead guilty to neglect by not calling for medical assistance for Max three weeks sooner than they did.

Mrs. Piazzani, whom I interviewed in prison recently, said that she and her husband were horrified to find that the charge was wilful neglect, and that they were unable to change their plea or give any evidence to defend themselves.

This was, as I say, a complex case. It is even more extraordinary that the only person who has actually spoken to the Piazzanis throughout the whole of this period has been myself recently in the prison. There are many discrepancies in the stories. There are discrepancies between what is told by Mrs. Piazzani and what is told by the health visitors and social workers. A great deal of attention has been paid to the dropping of the case by the social services department in December 1970, but little attention has so far been given to whether or not the health visitor service did its job properly.

In particular, there are many doubts and queries relating to the calls made by Mrs. Coleman, the health visitor, as to their frequency, the extent to which she actually saw the two children, the advice she gave to Mrs. Piazzani, and the reports which she made to her superiors. For example, Mrs. Coleman is said to have told a colleague that she was concerned about Max's condition, yet Mrs. Piazzani says that she was continually assured by Mrs. Coleman that Max was "fine", and that these assurances were confirmed by Dr. Runes of the Basildon Child Guidance Centre, who told Mrs. Piazzani not to worry, that Max was "just small", and that he could not do anything for Max until he reached the school assessment age of five. Is that consistent with the picture of neglect which the judge at first instance painted and which the joint committee accepted, but which was, apparently, rejected by the Court of Appeal?

This raises the whole question not only of the individual people, the service and the quality of the staff concerned, but of the basis of management control of the service. I shall say in a moment how I believe there to be a complete lack of management control. The result of this was not just that something went wrong on the assembly line but that a child died. What is worrying my constituents and the many people who have written to me from all over the country and abroad is to make sure that this kind of child neglect does not continue. The Minister may argue that we shall have cases of child battering and that these things may be inevitable. I want him to know that I do not accept that. I believe that he has a responsibility, like my right hon. Friend the Secretary of State, to go into every place of this sort and to insist that he has sufficient assurance that these isolated instances of the past are not going to increase. Therefore, I would say certainly that the whole question of management control—and whether there was management control—needs very close examination.

I come now to the central point which is relevant to this debate. It seems to me that for her part in Max's death Mrs. Piazzani is now serving a prison sentence. She has a responsibility for something and she is paying the price. She was given a two-year sentence, like her husband, and it has been reduced to 18 months. There is, therefore, no doubt that Mrs. Piazzani is paying some price, but if her version is the truth the welfare services failed her as well as Max because it is to help mothers in such a situation as this that these services exist.

There is a further discrepancy in the health visitors' reports in relation to action taken by the health visitor, Mrs. Anne Fynn, on 31st July. Did she leave a message with Dr. Anderson to call that day, or was it not until 2nd August that he was asked to call, as he alleges.

The case is depressing, and at times, looking at the evidence, it is bizarre, and, therefore, it is difficult to find the truth. That makes it all the more important to have a public inquiry at national level which will make it clear that those people who are trained to assess this type of evidence are capable of doing so. Those of us who care about the social services and the welfare of children will not be satisfied without that.

The Minister should take heed of the evidence of the parents which was previously not available. So seriously do I take this evidence that I have provided the Home Secretary with an additional brief, and, therefore, there are many new witnesses to be called. I would argue that a retrial cannot be ruled out. Whilst no one denies the parents' responsibility, there is an equal responsibility to be accepted by the local authorities, the social workers and the medical officer of health, who throughout the whole of this question has been extraordinarily silent. There is also the responsibility of the Department of Health.

Although the Minister was most concerned about the matter and discussed with me the fact that a local and regional inquiry was the next best thing to a national inquiry, I would hope that he would have the humility to say, with me, that this experiment has not worked. He tried it but it failed. Perhaps we were asking for a great deal. We were asking for a health authority and a local authority which had themselves erred, resulting in the death of a child, to sit in judgment on themselves. Perhaps we were ambitious, but it has not worked. Still no action has been hinted at to show that these authorities or their staffs have even been admonished. To put it frankly, we cannot allow a judicial-social system to penalise the parents to an 18-months' sentence when that system has escaped clean as a whistle.

Let me turn to broader questions, because the case which I have described, like many of the cases drawn to my attention, has two common elements. One is parental abuse, neglect or ignorance, and the other is administrative blunder. To cope with the first an early warning system should be instituted in every local authority, but the work has to be done by specialist teams.

A recent project conducted by Dr. Selwyn Smith, at Birmingham University, shows that child-care agencies and local authorities rely for the assessment of such children on social workers who are often inexperienced and possibly inadequately trained. He also revealed in a very fine piece of work that The past year has again witnessed a depressing number of children who have been battered to death after decisions by social workers to return them to their homes. As Dr. Smith says: Our findings indicate that such authority should be curtailed. There is another study, which has not been mentioned, by June Neil and others of the National Institute for Social Work. That study, which has been buried, found that the majority of field workers thought that since the integration of the social services the standards of service to clients had deteriorated. In other words, it is said that since the development of Seebohm there has not been an improvement of the services but new problems have been created. The report says that the major frustrations among the field workers are the feelings that senior management staff appear to know very little about managing—this is a national feeling not just a local one. The clamouring for higher salaries and top positions has been very disillusioning. The 'better deal for the clients' is rarely spoken of these days. The second element which is common in cases of child neglect demands that management systems should be established to improve communication. In addition, case loads are far too high. The social workers are expected to be Jills-of-all trades involved in their work, and are rarely given the chance to specialise. The whole social services structure leads to good field workers being lost to the management side within two to three years of training, or leaving the service altogether because they can no longer cope with the stressful conditions they encounter.

I have other questions which I hope my hon. Friend will answer in due course. There are other worrying cases besides the case of Max Piazzani and Maria Colwell. My right hon. Friend the Secretary of State has said that she is giving high priority to improving the child-care service. At what level within the social work service is there an officer with sole responsibility for child-care matters? Is it true that in a pending reorganisation effective responsibility for children is to be reduced to a lower level?

Another question that is worrying many people is whether the personal qualifications of the Assistant Director with nominal responsibility for child welfare will figure in this structure, and whether the inspectorial powers and teeth of the social work service will be of any value.

I appreciate the Minister's concern and determination to help. He and I have been good colleagues for many years. I acknowledge the difficulty he faces in this case, but I am sure that he will accept that the 10,000 people who signed Councillor John Costello's petition want an outside appraisal of the evidence in Max Piazzani's case, not only to help remove their angry doubts but to support social workers within the Essex County Council.

There is no doubt that the extraordinary behaviour of the county council in preferring silence to communication, and in letting the Department of Health and Social Security set up a committee and then disagreeing with the terms of reference for which it had asked, must raise serious doubts about the credibility of social services in the Essex County Council.

An independent inquiry might tell the Department more about the apparent muddle arising in the social services since Seebohm.

There are two areas of responsibility. One, involving my hon. Friend's Department, is to make it clear that we need an outside assessor and an outside inquiry. The other, about which my hon. Friend will be in touch with my right hon. Friend the Home Secretary, relates to my request for a retrial. This is a serious step. I realise that all evidence can be challenged in a court of law, but what makes this case so difficult and worthy of retrial is that the mother and father concerned were given advice, well-meaning perhaps, which meant that they were precluded from making the sort of explanations which I have started to give here and which I have passed on to my right hon. Friend the Home Secretary.

Many doubts and anxieties have been expressed. In addition to the 10,000 people who have taken sufficient interest to sign a petition, others have written to the Department of Health and Social Security. It is clear that my hon. Friend must have good reason for saying that he wants to let the county council get on with the sort of inquiry which has already started. There are people in the Public Gallery associated with that inquiry. From the evidence I have, it seems that we shall get no further than the original report. We want to find that we have not made a martyr of Max Piazzani but have made him live, by taking seriously the way in which the case was dealt with and the fact that it was the first real breakdown in social services in the county.

4.15 p.m.

The Minister of State, Department of Health and Social Security (Dr. David Owen)

My hon. Friend the Member for Basildon (Mr. Moonman) has taken a deep and genuine interest in this most disturbing and depressing case. Unlike some hon. Members and people in many walks of life, he has not just taken such an interest for a passing moment. In fact, he has given a tremendous amount of time, effort and energy in pursuing his interest. I am certain that he will not rest until he is satisfied in his mind that a case like this cannot happen again in his constituency. None of us can look at this case without being deeply concerned as in many ways it is a strange case.

Max Piazzani was not typical of the battered baby syndrome. His cause of death was twofold—namely, subdural haematoma and malnutrition. We do not know the cause of the malnutrition. Even if this case is not typical, and it certainly is not, some of the gaps in the services found by the inquiry committee set up to draw conclusions from this case were very typical. As in so many cases of child abuse, there is undoubtedly a feeling that perhaps this need not have happened and that it was in some respects an unnecessary tragedy. That is the problem that faces us in this House, social workers throughout the country and everyone else. We must consider how we can achieve a system of child care that can avoid these sorts of cases happening. Further, we must consider how we can develop a sensitive mechanism whereby doctors, health visitors, social workers, teachers and neighbours—I stress neighbours—when they first pick up the signs, can be heeded so that this network of information which my hon. Friend mentioned can be brought together and made to result in action.

The working party's report, which to some extent has been the main focus of the debate, is worth studying. I think it points to some areas in which we can look to the future, where I think we can reasonably ask ourselves what is now being done to see that this sort of thing will not happen again. The committee urged the expansion of primary health care teams to encourage close consultation between doctors and health visitors and to bring in general practitioners to cases at an early stage. A majority of community nurses in Essex are now attached to a practice, and the area team of officers recommended a review of primary health care arrangements. In this very important area significant advances have been made.

Case conferences are an important part of the committee's recommendations. They stem from the Departmental circular which was sent out earlier this year. Of course, it cannot be said that a case conference would have saved Max Piazzani, but it can be said that good practice would demand that such a conference should be held in all similar cases.

I believe that in Essex no case like that of Max Piazzani could occur in future or it certainly should not occur, without a case conference being convened. I hope that case conferences will become a normal part of our procedure for dealing with the problems of children at risk. Social services normally have responsibility for convening such a conference when they have been concerned in a case. They also have the responsibility to include other professions.

Health visitors are themselves expected to participate in case conferences. Instructions to health visitors are an important part of this case. They have already received fuller advice in Essex on dealing with children injured or at risk. That includes always taking medical advice, taking a child to hospital if urgent and in all cases keeping a general practitioner informed. Doctors are now recommended to see even less urgent cases within 18 hours.

There is also the recommendation always to contact a senior officer and representatives of any other agencies involved such as the social services, the NSPCC and the police. They are responsible for knowing and visiting all the children in their area on observation and "at-risk" registers and continuing to visit until specifically informed that other arrangements have been made. That, coupled with instructions to attend case conferences, should avoid a situation in which the well-being of a child depends so heavily on one worker that that person's absence can have serious repercussions on the child's safety. In this particular case that is an area of concern.

The question of training and recruitment is a central point. My hon. Friend raised the question of the Seebohm Report. I remind him that, when my right hon. Friend made a statement following the Maria Colwell report, she pointed out that, since the reorganisation of local authority social services, the average social worker with a wide range of cases has inevitably less experience of child care than her predecessors in children's departments. It is therefore essential that those working with children should be helped to acquire and develop skills in communicating with children and interpreting their actions.

We have reminded social service departments of the need to ensure that the best possible use is made of experienced social workers with specialised skills in child care to help and advise colleagues dealing with children. I attach great importance to this.

Management training also is crucially important in social services. A certain amount of training of this kind has been undertaken in a number of places, including Essex, but I agree that this is an important area where much more could and should be done to promote skill in the deployment of professional social worker resources.

A working party on manpower and training for the social services has been established by the Department, to include representatives of the employing authorities, social workers, police, the Central Council for Education and Training in Social Work, and Government Departments. Its task is to consider the need for trained manpower for the personal social services in the light of the present state and prospective development of these services. The need for the training of senior social services staff and for better deployment of resources will be among the matters for urgent consideration in the coming months.

I attach considerable importance to the work of this working party, on which it will be reporting to Ministers and others concerned, and if the working party feels the need to report very urgently to us, I hope that it will do so. We should look at all management skills, not only in the social services but over a wider area, to ensure that we get the degree of expertise needed.

There is also a great deal of importance in the need to ensure that we have the resources available in this sort of case. This, again, is particularly important. In Essex, joint training programmes between the area health authority and the social services on the "team approach" to child abuse cases started this month in Chelmsford, involving doctors, social workers, nurses—including health visitors—police, teachers and probation officers.

These are important matters, but I want now to talk about staffing, because it is also very important. It is no use us expecting people to be able to take up these heavy work loads if there is not the staffing. We in this House must accept responsibility for the question of the financial support, both in capital resources and in revenue, made available for the social services.

Another very important question concerns the "at-risk" register. This is a register of children in possible danger. It was started in Essex in June and is monitored through the management system. Already, in the Basildon area—the area where Max died—80 children have been referred to the register. This means more information and, through case conferences, more co-ordinated steps to protect these children.

A working party of all agencies involved has met a number of times to discuss arrangements for setting up an area review committee on the lines suggested in our April memorandum. This has now had its final meeting and has determined arrangements for the first meeting of the review committee, to whose early meetings a member of my Department has been invited as an observer.

A great deal has been done in Essex, but I want now to turn to some of the more controversial aspects of the matter. We face a genuine problem. We in this House talk about democracy, but apart from the central Government and their major responsibilities, there are also the responsibilities of local democracy. There is no need at all for a local inquiry to be a whitewash. I believe, too, that the elected councillors, who have responsibilities accordingly, must in cases like this be prepared to re-assess the work of their officers. If accountability in a democratic system is to mean anything, local councillors must be prepared to take the responsibility and to analyse a case where things have gone wrong.

One of the features of this inquiry that I welcome is that the controversy, the argument and the discussion have taken place in Essex. It is easy to establish a national inquiry, and so often what happens is that a matter becomes a national issue and too often does not make an impact in the area with which it is most concerned.

I have read with great interest in the Evening Echo reports of this case. They have been a remarkable case of investigative reporting. They have meant that the people of Basildon and elsewhere in Essex have been deeply involved themselves. They have queried the social services and it is they who will ask themselves whether through their rates they are supporting the social services and the county. The Essex County Council has decided to set up a review committee of councillors and the area health authority has set up a review of the findings of this committee of inquiry. Copies of the report have gone to community health councils and I hope that the discussion will continue. My hon. Friend asked me what further review was taking place. As he knows, when I discussed the issue of setting up this inquiry with the county council and the area health authority, I attached some importance to having someone from the Department in this particular difficult case as an observer. This has meant that my Department has known what went on during that investigation and has known all the evidence that has been given to the inquiry. I have asked my senior professional advisers in social work, nursing and medicine to review this evidence to ensure that not only can we be in a better position to advise Essex County Council, but that we as a Government Department can draw what lessons need to be drawn from the Max Piazzani case and see that the information is made available for the nation as a whole.

My hon. Friend will be aware that our circular on non-accidental injury was unique in that it was sent by the Department's chief medical officer, the chief nursing officer and the social work service. Thus, we are dealing with a multidisciplinary approach, and this is very expert advice and the Department and I will consider it along with the response at area and council level and from the nation as a whole.

Mr. Moonman

I am sure that this review will be of some value and I do not deny that it will go some of the way to meet the problem. However, I make the point that although my hon. Friend says that this is an area matter and was kept very much within the county, he ought to concede that many people, newspapers, councillors, Members of Parliament and the general public have achieved this degree of unity and determination, but may reach the point when they need to look to the Department of Health, a national authority, for guidance and support. While that degree of agreement was reached in Essex, there will come a point when all the implications will have to be taken up by the Department.

Dr. Owen

I do not deny that for a moment. One of the advantages of this tragic case has been that it has brought together many different people of many different disciplines. Nationally we have been able to draw lessons from what has happened in Essex and I should be very surprised if in any subsequent advice from the Department we did not lean very heavily on the experience gained from this tragic case.

Of course I am prepared to change my mind about the form of the inquiry. The whole subject of inquiries into cases of this sort raises important questions of civil liberties. The Maria Colwell case was subject to that criticism and the result was a major inquiry that took a long time. I do not think that we have yet found the best form of inquiry for these cases that will protect the natural rights of those most closely involved while showing sufficient understanding of the very difficult tasks that have to be faced, often with inadequate resources, by people with far too heavy a case load. The public need to have some sympathy and understanding for those who have to deal with these problems.

We need to be able to understand these cases if we are ever to prevent them in future. What my hon. Friend has done and what he is right to do is to make certain that we take each and every one of these tragic cases when a child has died—some would say "has been killed" and some would use even stronger language—and learn the lessons from it. These cases occur day by day up and down the country and none of us can feel confident that there is any one complete answer to this most difficult problem.

I assure my hon. Friend that we do not deny that we have a major responsibility in the Department of Health and Social Security and we shall exercise it, but there is also a local democracy at county level, at social services level and even at district level, and I hope that they, too, particularly the elected councillors, will ensure that any criticisms they may have are made clear in any subsequent review.

The chairman of the inquiry came in from outside—I pay tribute to his great services to the Committee—and was thus independent. With my knowledge of this inquiry, I believe that it has been a great deal more thorough than it has been given credit for being and—

The Question having been proposed after Four o'clock and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at twenty-nine minutes to Five o'clock.