Published: 30/01/2003, Volume II3, No. 5840 Page 4 5

Widespread organisational malaise was at the root of the failure to protect Victoria Climbié, the eight-year-old-child murdered by her carers three years ago, the inquiry into her death has found.

The Climbié inquiry, chaired by Lord Laming and published on Tuesday, found that although frontline staff had not provided an acceptable standard of work, most criticism should be directed at senior social services managers.

In response, health secretary Alan Milburn invited health and social services organisations to become part of the first generation of childrens trusts.He warned that 'no existing organisation, no existing structures - should be allowed to stand in the way' of the interests of children.Mr Milburn promised guidance would be out soon.

HSJ sources say about 50 organisations have already expressed some interest in becoming children's trusts, with most interest coming from social services rather than their partners in health.

Mr Milburn also promised that the first part of the delayed national service framework for children - on hospitals - will be published next month. And he said guidance on child protection would be reviewed - within the next three months - and the wider Children Act guidance would be replaced by a volume one-tenth the size of the current guidance.

The government's substantive response to the report will come as part of its green paper on children at risk, due this spring.

The Climbié inquiry made 108 recommendations, the majority of which should be implemented within six months. Of those, 27 relate to healthcare, including improvements in information exchange between hospitals, and discharge procedures for children considered to be at risk.

The report says that all doctors caring for children where there are concerns about deliberate harm must provide social services with written evidence of their concern.

It makes a number of recommendations aimed at improving the recording of treatment of at-risk children and it calls on the Department of Health to consider bringing the treatment of children, about whom there are concerns about deliberate harm within the framework of clinical governance.

In order to prevent patterns of behaviour being disguised by taking children to different hospitals for treatment, any doctor or nurse admitting a child where deliberate harm is suspected must inquire about previous admissions to hospital. The consultant in charge of the case must review this information before making decisions about the child's future care, and hospital trust chief executives must introduce systems to ensure this happens.

The inquiry calls for hospital trust chief executives to introduce systems to ensure that children about whom there are concerns are not discharged without the permission of the consultant in charge or a paediatrician above the grade of senior house officer. The discharge must also be accompanied with a care plan.

Crucially, it also says a responsible consultant must ensure the child has an identified GP.