Leading change
The Lead Sudden and Unexpected Deaths in Childhood (SUDC) nurse at Lancashire Care NHS Foundation Trust (LCFT) led on improvements to the nurse-led SUDC Service in collaboration with partner agencies. This service has led to improved outcomes, experiences and use of resources locally.
Where to look
The SUDC Service leads on the implementation and co-ordination of the Rapid Response processes following the unexpected death of a child. It is a national process, outlined in statutory guidance, undertaken by local services (Cabinet Office, 2018). The Child Death Review, Statutory and Operational Guidance in England states that the death of a child is a devastating loss that profoundly affects bereaved parents as well as siblings, grandparents, extended family, friends and professionals who were involved in caring for the child. It recommends that families should be met with empathy and compassion through clear and sensitive communication. Following an unexpected death, there are formal investigations to find the cause of death as part of wider integrated child death review processes (Garstang et al., 2014). These processes have a clear aim of establishing the cause of death, but it is less clear how bereaved families are supported.
In 2016, the Lancashire Child Death Overview Panel (CDOP) commissioned a review of the pan-Lancashire SUDC Service. The review found that two thirds of the child deaths locally occurred out of hours which meant that a full multi-agency response to an unexpected child death wasn’t consistently being undertaken. The findings highlighted that during ‘out of hours’ times, a collective understanding of the circumstances surrounding the death of a child was compromised as there was a reduced consistency in the response from nurse leadership. In addition, the quality of health support and provision of services to families was inequitable. The pan-Lancashire Lead SUDC Nurse identified an opportunity to address the unwarranted variation in ‘out-of-hours’ processes seen in practice, to strengthen and support these services.
What to change
The investigation following an unexpected child death involves the Police, a lead health professional, a Pathologist and the Coroner, all of whom liaise with multi-agency partners as part of the investigation. All professionals involved with child deaths should ensure that procedures are in place to support parents; to allow them to say goodbye to their child, to be able to understand why their child died and to offer the parents follow-up appointments with appropriate health-care professionals (Garstang et al, 2014).
The insight gained from the multi-agency response to any child death, endeavours to influence service design; provision and planning of services; improve practice, support, knowledge and expertise around caring for a child in death, care for the family; and help to identify themes and trends that can be translated into prevention strategies and Public Health messages/initiatives to work towards a reduction in the incidence of child death across Lancashire and nationally.
The lead SUDC nurse identified unwarranted variation in the Lancashire SUDC review regarding the access families had to the SUDC nurses who provided support and information to them throughout the process. The review also highlighted that, if the SUDC nurses were not present at the time of the child’s death, specific health and safeguarding details pertaining to the case were either not gathered, or were minimally gathered. Those families whose children died out of hours sometimes did not meet the SUDC nurses for some 3-4 days following the death of their child. By which time they often did want to engage with the SUDC nurse due to lack of understanding of their role. Thus, some families received a reduced service.
In Lancashire, a nurse-led model is implemented, and it was jointly agreed by the three pan-Lancashire Safeguarding Children’s Boards (LSCBs) to continue this, with CCG funding to expand the nurse-led service to a seven-day service. The aim being, through providing strong nurse leadership, and working closely with the Police and partner agencies, unwarranted variation would be reduced and standards met.
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