review to examine the circumstances of every child’s death in Scotland is
to become standard practice.
of a national Child Death Review System will help to identify factors that
could reduce preventable childhood deaths and ensure any lessons to be learned
are passed to the relevant professionals and services.
The move comes as
the Scottish Government accepted the recommendations in a report from the Child
Death Review Working Group, published on Thursday.
reviews are carried out in certain circumstances, there is no consistent
process for reviewing a child’s death across Scotland, and no consistent
multiagency groups which review all child deaths. In addition, data collection
and the sharing of any lessons learned is limited.
The new system
will address this position and is designed to identify any factors that could
reduce preventable deaths, i.e. ill health or accident. In criminal or
unexplained circumstances, multi-agency reviews already occur and this will
continue under the new recommendations.
for Health and Wellbeing, Alex Neil, said: “The death of a child is
always a tragedy for the families and it’s only right that the reasons
for that death are explored thoroughly to enable us to put in place measures
that can help prevent any future tragedies. Setting up this standardised review
system will help us to identify what, as a government, we can do to further
reduce the rates of child mortality in Scotland and work more closely with
families to support them through difficult times.
keen to ensure, through this process, that bereaved families are at the centre
of the review process and that they are given all the information they need in
a timely and sensitive manner. Through involving families in each review, they
will have the opportunity to feed in their views and will, hopefully, feel
reassured that all is being done to help prevent the likelihood of similar
deaths happening again.”
between 350 and 450 deaths in those aged under 18 occur each year, with the
most deaths occurring in children aged under 1. Of the other age-groups, 15-18
has the largest number of deaths: each of the 1-4, 5-9 and 10-14 age-groups has
relatively few deaths. The causes of death in the 0-1 age range bracket are
usually related to prematurity and birth defects. Causes in the 15-18 age range
relate largely to trauma including road traffic accidents and teenage
The new Child
Death Review System in Scotland would collect and distribute local and national
data among key partners to identify common themes on avoidable deaths and spot
any emerging trends.
A strategic group
will oversee this work and make appropriate recommendations to policy makers in
public health. In addition it will also establish standards of communication
with bereaved families to ensure they are always dealt with in an appropriate
and sensitive way by police and health workers.
A steering group
will now be set up to develop this Scottish review system, which will be
informed by a pilot programme currently being undertaken in Tayside.
Compared with all
other European countries, the UK is in the bottom third for infant mortality
rates [UNICEF: “Child Wellbeing in rich
The Child Death
Review Working Group was established to explore Scotland’s current
practice in the review of child deaths and look at the possibility of
introducing a national review system in order to identify preventable causes of
death. It included representatives from the Scottish Government, Health Boards,
Royal College of Paediatrics & Child Health, Scottish Cot Death Trust,
Police Scotland, University of Dundee, Crown Office and Procurator
Group’s report, ‘Child Death Review Report’ is available on
the Scottish Government website http://www.scotland.gov.uk/Publications.
Investigation and Review Studies team (FIRST) at University of Dundee, in
collaboration with the School of Medicine and with the support of NHS Tayside,
are piloting a model of child fatality review in Tayside between January and
April 2014. The project is jointly funded by the Scottish Government and the
University of Dundee Alumni Fund.
multi-agency meeting review each death and determines whether it was
preventable and what recommendations, if any, can be made to reduce the
likelihood of similar deaths. A family liaison worker is also employed to
support the recently bereaved families who are contributing to the pilot,
ensuring their views and recommendations are being fed back into the review