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Child death review procedures

Child Death Review Processes: Local Authority Children's Services Funding 2008-09, 2009-10 and 2010-11

Number of deaths in children aged 0 to 17 years by local authority in England, in the years 2003-2007
The attached data, shows the number of deaths of children according to place of residence, by local authority in the years 2003-2007. Source: Office for National Statistics

Removal of Human Tissue from Deceased Children - Briefing Note

List of Child Death Overview Panel Contacts for all Child Death Notifications - Updated December 2008

Chapter 7 of Working Together to Safeguard Children sets out the procedures to be followed when a child dies. There are two interrelated processes for reviewing child deaths (either of which can trigger a serious case review):

  • a rapid response by a group of key professionals who come together for the purpose of enquiring into and evaluating each unexpected death of a child

  • an overview of all child deaths (under 18 years) in the Local Safeguarding Children's Board (LSCB) area(s), undertaken by a panel.

Child Death Overview Panels are responsible for reviewing information on all child deaths, and are accountable to the LSCB Chair. Child Death Overview Panels may serve more than one LCSB. Child death review processes became mandatory in April 2008, though LSCBs have been able to implement these functions since April 2006.

Work and resources to support the child death review processes

Providing LSCBs with appropriate support and guidance to enable them to fulfil their statutory duties has been tremendously important.

  • We have recently published a multi-agency training resource to support LSCBs in implementing the Child Death Review Processes. These detailed materials will enable key professionals and, where appropriate, their managers to understand and implement the child death review processes.

  • We have developed a 'familiarisation DVD' - Why Jason Died (DCSF, 2007) to illustrate the roles and responsibilities of those responding to unexpected deaths within the context of the LSCBs responsibilities. This engaging drama is accompanied by a set of frequently asked questions (FAQs). 

  • In order to learn from those LSCBs who began to implement the child death processes from 2006, DCSF commissioned Warwick University to undertake a research study. The study, Preventing Childhood Deaths A study of 'Early Starter' Child Death Overview Panels in England , looked at the experience of LSCBs in implementing the child death review processes.

  • In collaboration with Warwick University and CEMACH (Confidential Enquiry into Maternal and Child Heath), the DCSF have developed a set of templates for LSCBs to use when collecting data about child deaths . This dataset will assist LSCBs in recording information about each child's death as set out in Working Together (paragraph 7.7). The data set builds on that used in a study undertaken by CEMACH (the Confidential Enquiry into Maternal and Child Health), which was published in May 2008.

  • The Coroners (Amendment) Rules 2008. The Coroners Rules 1984 have recently been amended to place a duty on coroners to notify LSCBs of all child deaths over which they take jurisdiction. The amended rule places a duty on coroners to inform an LSCB for the area in which the child died of the fact of an inquest or post mortem. It also gives coroners a general power to supply information (such as reports from post-mortem examinations and documents given in evidence at an inquest) to LSCBs. These changes, which came into effect on 17 July 2008, will enable LSCBs to better meet their statutory obligations, including the conduct of child death reviews. The accompanying guidance for coroners and LSCBs is available on the Ministry of Justice website.

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This page was last updated on 04 December 2008