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The pain and misery that go unheeded

Reva Klein reports on the growing realisation that the social services are failing neglected children. Paul's life was short and anything but sweet. At the age of 15 months, it came to a torturous end: at the time of his death, he suffered severe pneumonia, complicated by septicaemia. His body was covered in burns caused by being left in his urine-soaked clothes for days on end and his fingers and toes were covered in septic lesions.

It is, says the report on his short life, "impossible to imagine the level of suffering that this little boy experienced as death slowly occurred". Paul died of neglect almost exactly three years ago in the London borough of Islington.

It's a place where posh homes like Tony Blair's and the quite ordinary homes of working people sit almost within screaming distance of families living in material and spiritual impoverishment - people who don't understand what needs their children have, people whose humanity and sense of responsibility have been ground down by poverty or drug and alcohol abuse.

Paul lived with his parents and six brothers and sisters who went to Islington schools. According to Renuka Jeyarajah Dent, an educational psychologist and education adviser from The Bridge child-care consultancy service appointed by Islington council to carry out an inquiry into Paul's death, the children had been known to 30 different council agencies over a period of 15 years.

But even though they fitted into the category of "children in need" under the Children Act, they were not put on the child protection register nor did any of the agencies involved, including the schools, know what to do about their neediness.

The schools had contacted the education welfare service and social services many times about the children over a long period. But, according to Ms Dent, "the overriding perception held by teachers and other professionals was of the children being dirty and smelly but happy". This was despite the fact that one of the children, a three-year-old boy who attended a nursery, was not walking. The family was seen to be in financial, housing and social need. However, the parents were able to convince the agencies involved that social services involvement would be "unhelpful".

The schools that the obviously needy children attended were caring, going out of their way to help by giving them access to showers at school, providing them with extra food at lunchtime and offering them clean, warm clothes.

But when, as Ms Dent puts it, "there is no structured criteria for when you intervene", they backed away from generating a crisis for fear of the even more negative effects on the children. Nobody knew where to draw the line. In the end, Paul's siblings were put into local authority care only when their baby brother's death was revealed.

The findings of the inquiry, a report entitled Paul: Death by Neglect, is one of the subjects of a conference organised today by Islington Area Child Protection Committee and The Bridge. The title of the conference, Neglect - A 50 Year Search for Answers, points to the continuing difficulty faced by professionals in dealing with what continues to be one of the greyest areas in child protection but one which is growing.

A 1995 Department of Health report, Studies in Child Protection, indicates that children are being neglected not only by their parents. The study found that while 21 per cent of referrals to social services were for neglect (as distinct from physical or sexual abuse), only 7 per cent of those cases actually made it on to the child protection register. This compares with 14 per cent of cases for physical abuse and 16 per cent for sexual abuse.

One of the problems with child neglect is that, unlike physical and sexual abuse, it is not based on specific incidents. "Neglect is on a continuum. It is a process that may take place over a long period of time," explains Olive Stevenson, professor of social work studies at the University of Nottingham and chair of the Nottingham Area Child Protection Committee, who is working on a book about the neglect of neglect in the social work canon.

The process of neglect is usually a complex mix of factors that can be interpreted in a variety of ways. A key question, as Professor Stevenson says, is: "When is it so bad that society can't put up with it anymore?" While all local authorities have procedures for child protection modelled on Working Together, the Government's guide to arrangements for inter-agency co-operation for child protection under the Children Act, there are no benchmarks for how badly or for how long a child is neglected before you intervene. As Professor Stevenson puts it: "We don't know what to do, so we don't do anything."

But that isn't always the case. Schools are uniquely placed among all agencies to be able to identify children who are being neglected. No other service sees children as frequently, at such close quarters and in as wide a range of activities. According to David Sassoon, former director for school support in the London borough of Brent and now co-director of Schools Support Services Ltd, an educational consultancy: "It is through schools' alertness that problems of neglect and abuse are brought to the attention of child-protection agencies".

Judith Milner of the University of Huddersfield found in her snapshot survey of Carlisle and Sheffield over the period of a day that one-quarter of referrals to social services for child neglect and both types of abuse came from schools.

That headteachers and teachers feel confident enough to make social services referrals is commendable, given the attendant difficulties and ambiguities. Mr Sassoon, excusing the mixed metaphor, describes it as "like walking on eggshells through a minefield". The Children Act calls on schools to make judgments on each possible child-protection case based on observation, as in special needs. "This means that every time there is a suspicion of child neglect, schools aren't meant to run off to social services. They are expected to be vigilant, watch carefully, see how things go," says Mr Sassoon. He suggests that heads talk things over with a senior education officer at their local education authority before taking any action.

While every school has a designated child-protection co-ordinator whose role is to liaise with social services and the education welfare officer, the commitment to start that ball rolling is one that is not taken lightly - or easily. First, teachers may fear that drawing social services' attention to a family could lead to a child being taken into care. This fear is largely unfounded, since very few neglected children wind up in local authority care.

The emphasis of the Department of Health and local authorities is on family support rather than care orders, in line with its much-vaunted and much-discredited "care in the community" ethos. Social services departments are increasingly focusing on working in partnership with parents, helping them to acquire parenting skills and giving them access to other support networks and agencies that will lighten their burden. But it does not always work out that way. "While no social worker in their right mind would deny the benefit of working with parents, they're very scared about not being supported appropriately because of public expenditure cuts," says Professor Stevenson.

A much more real problem for schools is the effect that local management has had on child-protection work. Previously, LEAs had arrangements in place for co-ordination with other agencies, the provision of training for schools' child-protection officers and resources to take care of cover costs when a teacher had to go to a case conference. Now, however, individual schools are having to make their own arrangements for training, for working with the multi-agency area child-protection committee and for teacher cover for case conferences.

While the Department for Education and Employment is awarding education authorities a one-off GEST (Grants for Education Support and Training), payment to train teachers designated as child protection officers, the amount being paid - Pounds 3 million - is considered by many working in the field to be inadequate.

Clearly, though, the need for training is there. As far as Mr Sassoon is concerned, teachers need help not just with identifying child neglect and abuse but with working as part of a team with different agencies. "Each agency has a different culture, a different focus," he says. "In social services, the focus is on the family. With the police, it's on catching rogues. In education, it's on the child. It's not unusual for a teacher to go to a case conference to talk about a child who they think needs multi-agency help and to hear the other agencies saying 'there's nothing to worry about'. Most teachers in that situation will defer to the majority view. They see others as the professionals and they will take it lying down. Our people need to be trained in assertiveness to deal effectively with these situations."

Whether referral to social services takes place or not, it is clear to everyone involved in child protection that a positive, secure school environment can mitigate some of the effects of neglect at home. Ms Milner says: "With mild neglect, the best thing you can do is provide a good school environment that offers love, attention, facilities for homework, extra helpings at lunch, to show these children that there are these adults who care."

How to identify the neglected child

* Failure to thrive. If a child suffers an unexpected drop in weight, schools should begin to worry. Measurements of height and weight are important indicators. A neglected child is often taller and thinner than you would expect for their weight.

* Quality of hair and skin. Neglected children will often have matted, unwashed and dull-looking hair. The skin is mottled, with a pasty face. They may have scabies.

* Eyes look anxious. Unattended eye problems are common.

* Problems with literacy and numeracy are often manifested, possibly accompanied by listlessness. The neglected child will consume his or her lunch ravenously.

* Inappropriate clothing, such as a light cardigan and sandals in winter, can indicate neglect.

What schools can do

Research shows that schools can have a striking effect on the vulnerable child, helping to ameliorate the ravages of neglect by acting as a parent substitute. By getting the whole picture of a child from the class teacher, the school nurse or even the dinner supervisor, schools can offer the love, humanity and care that the child is deprived of at home.

Strategies could include: * A free breakfast scheme.

* Making showers available either before school or early in the day, to help combat teasing and stigmatising. If this is awkward, schedule PE for early in the day to allow morning showers.

* Free school uniforms or street clothes.

* Ensuring that dinner supervisors give extra helpings to hungry children.

* Offer children kindness and attention and the space to talk.

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