– in the Senedd at 3:26 pm on 12 July 2016.
We move on to the next item, which is a statement by the Cabinet Secretary for Communities and Children on the child practice review into the death of Dylan Seabridge. I call on the Cabinet Secretary, Carl Sargeant, to make his statement.
Thank you, Presiding Officer. The publication last week of the child practice review into the death in 2011 of Dylan Seabridge once again brought to our attention the circumstances in which a young boy’s life was cut needlessly short. Dylan was just eight years old and died of an avoidable and treatable vitamin deficiency. He died invisible to the services and professionals who could possibly have saved him. It is unacceptable that, in a modern society, a child should be invisible in this way. This case highlights the challenges faced when people individually, or as part of families, withdraw from traditional or common patterns of family life, and from the safeguarding and protection provided by and through our universal services.
The purpose of the child practice review is to improve our services and help us learn what needs to change. This is exactly what we intend to do in the light of this report: learn lessons and improve services.
The landscape has changed since 2011. The Social Services and Well-being (Wales) Act, in particular, strengthens the statutory and practice framework for safeguarding children and adults. It introduces a new duty on statutory partners to report to their local authority concerns that a child or adult is experiencing or is at risk of experiencing abuse, neglect or harm. The Act is supported by the revised statutory guidance that has been subject to significant cross-sector engagement. We have invested significantly, through dedicated training, to support practitioners to deliver the strengthened framework and have published those training resources on the care council website.
Of course, while the Act provides a stronger base for greater confidence that a case like Dylan’s could not happen again, it does not and cannot provide all of the answers. Much is made in the report of the issues of elective home education, and there is no doubt that this is part of the picture here, but it is far from the whole picture. Dylan died because he was invisible to the services and professionals who could have been able to help and protect him.
There was a criminal investigation into Dylan’s death, and the Crown Prosecution Service took a decision that the prosecution of the parents was not in the best public interest. What is clear to me from the CPR is that no single service or professional let down Dylan but that, as a society, as a system, he was let down and allowed to remain invisible and unreachable.
I’m working closely with my colleagues the Cabinet Secretary for Education, the Cabinet Secretary for Health, Well-being and Sport and the Minister for Social Services and Public Health to consider the lessons from this case. Our response will be inclusive and seek to address the key issues of how services work together, how they pool their information and think family rather than individual in isolation, and about how we can prevent any child or young person from being so hidden from view that we cannot spot and address any risk of harm. ‘Think family’ is now more prevalent across professionals and agencies as part of approaches such as team around the family.
We will now consider how we can encourage and support professionals to act on their professional curiosity and have greater confidence to work effectively with families and be confident to escalate issues when needed, such as where the evidence for cause for concern might be, in fact, the lack of evidence of well-being. And we will consider the guidance and regulation in place for all adult and children’s services. Such consideration will, of course, include that around elective home education, but also in relation to the key milestones where parents and children would be anticipated to engage with health and other universal services, for example for vaccinations, the role of the health visitor, primary care teams, school nurses, GPs, and so on.
Dylan was not seen by any health, education, social or children’s services professionals between the age of 13 months and his death at the age of eight. In the final 18 months of Dylan’s life, efforts were made to engage with the family, and with Dylan, but with little success. We’ll never know how things may have turned out if those efforts had resulted in direct contact with Dylan. What we do know is that despite a level of concern, professionals were not able to gain access to a young and vulnerable child who died from a treatable condition.
This is a highly complex case, and you would not expect me, or my Cabinet colleagues, to respond in anything other than a considered manner. That said, I can report that whilst it is not routine practice to report to CPRs, I and my Cabinet colleagues feel that the unique issues raised by this case warrant us writing immediately to all safeguarding boards in Wales, and the national independent safeguarding board, drawing their attention to the issues raised and the findings of this report. I will be working closely with my colleagues to get to the heart of the issues raised by this case, and the CPR, and I will update the Chamber in due course of our intended actions.
Thank you, Cabinet Secretary, for this statement this afternoon. The death of Dylan Seabridge has, of course, been appalling for us all, and it’s a duty upon us as an Assembly and you as a Government to do everything possible to avoid any possibility of similar cases arising in the future. We can’t say that there are no similar cases out there. You mention in your statement that we need to consider the lessons to be learnt. You mention the need to weigh up a number of elements, and I agree that there shouldn’t be a knee-jerk reaction to what has happened, but, of course, we must move this process forward as a matter of urgency, and there’s no mention of a timetable within your statement. Therefore, I would like to ask you to give us some idea of when you want this process to be completed and when we can be confident that the deficiencies that allowed these circumstances that led to the death of Dylan could not happen again.
You state that among the things you want to consider is that you will encourage and support professionals in the relevant areas to act on what you could call ‘professional curiosity’, and for them to have more confidence in working effectively with families, but, of course, also to feel more confident in taking action, as you say, not necessarily when there is evidence of cause for concern, but when there is lack of evidence of well-being. Well, that’s a significant change, in my view, in terms of the way in which professionals in this area approach such a situation. It changes the burden of proof required, and I would anticipate that there would be wide-reaching implications for services in light of such change. I would appreciate it if you could just expand in responding to my comments on that, because I do think that such a fundamental change deserves more than a sentence in a statement. Now, what does it mean in practice? How will it actually make a real difference to services, and what implications could there be in terms of resourcing and the number of cases that will have to be considered? It’s not to say that I oppose this—certainly not—but I do think that we need to weigh up the change of emphasis very carefully.
You also say that you will consider the guidance and regulations in place for service providers and for adults and children, and that in itself is quite an undertaking. But, of course, that includes, as you say, some of those who choose to home-school their children. Now, I’d like to know what else you need to allow you to make a decision on this, because, of course, we’ve had two consultations—one during the term of the last Government back in 2012 on required enforcement and monitoring, and then one last year on non-statutory guidance in this area. I would like to know what your view is as Cabinet Secretary, and if you feel that you don’t have enough evidence to come to a decision, well, tell us what additional evidence you need because this issues has been discussed over a number of years, and I do think that the Government now needs to come to some decision as to the direction of travel on this issue.
Yr agwedd olaf yr hoffwn sôn amdani yw’r un yn ymwneud â'r ffaith na wnaeth y rhieni yma, wrth gwrs, geisio sylw meddygol, gan nad oeddent yn teimlo bod ei angen. Ac er nad ydym ni’n gwybod y rhesymau am hyn yn yr achos penodol hwn, rydym yn gwybod, wrth gwrs, am achosion eraill lle ysgogodd drwgdybiaeth o feddygaeth rhieni i geisio triniaeth amhriodol gan ymarferwyr meddygaeth amgen, ac mae plant wedi marw, wrth gwrs, mewn achosion eraill, o ganlyniad. Ac a fyddech chi’n cytuno, yn gyffredinol, ei bod yn bwysig i rieni ymgysylltu â gweithwyr iechyd proffesiynol, ac y gall fod peryglon wrth geisio triniaeth gan ymarferwyr meddygaeth amgen heb ei reoleiddio, yn enwedig y rhai sy’n ddrwgdybus o feddygaeth seiliedig ar dystiolaeth? A hoffwn glywed gennych chi, Ysgrifennydd Cabinet, pa gamau y bydd y Llywodraeth yn eu cymryd nawr i sicrhau dealltwriaeth o’r peryglon hynny hefyd?
I thank the Member for his questions this afternoon. It would be fair to say that, while the reviewers took quite a significant amount of time to make sure that we cover all ground, and the CPR is the final element of that reporting structure, it would also be fair to say that my team, and the Government previously, was already working on opportunities to improve the system. The social care and well-being programme has already improved that procedure, since this terrible event happened, so the duty to report, the training and guidance for authorities and individuals are rolling out. And, as I said in my statement, the importance of now looking at the family unit, as opposed to an individual who may be under some sort of scrutiny or reporting, is an important change in the way that we operate.
This is always going to be challenging, in terms of the burden of proof, and I listened very carefully to the Member. I am minded, though, on the basis that I would rather protect an individual, to take some risk in that process, rather than erring on the very strong lobbies, on both sides, about the rights of the child or the rights of the parent. But, to me, the vulnerable person has to come out on top here, and maybe, as a Government, we have to be much more robust in our approach to that—giving powers to individuals who fear there is some risk, without evidence always, but there may be that gut feeling that there’s something not quite right. We need to be able to support individuals in that process.
The Member’s right about the resourcing of that, and that’s why it’s really important, from this CPR, that I work with my colleagues across Cabinet, to fully understand—the home-education element is just one part of this particular case, but there are many other young people, I would suggest, who don’t access a system around healthcare or education, so people who opt out of education until the age of three, and may be in a similar situation, where we just don’t have a contact process. But I do think what we have to do as a Government is look collectively around an individual, think about how we’re going to operate trigger points, what the opportunities are there for us to understand that somebody is safe. And that’s what this question is about. There are many people, in many circumstances, in very, very good families. But, in this case, we have to question our failure as a system not to have the contact, and the ability to contact, individuals in this very process.
In terms of home schooling, I’ve already met with the Minister responsible for that decision, and we are, again, looking at the whole principle of well-being, about how that will look, and I’ll continue those discussions. I had a team meeting today, across the departments, to start looking about what we are going to do about this particular case, and what the lessons learnt will be, and how we will interpret them, in terms of legislation or otherwise, if we need to do that.
The Member is quite right to recognise also the unregulated issues around health and seeking medicines that actually aren’t regulated. That does concern me. But I think what I’d like to do is come back to the Chamber once we’ve had more of a collective discussion around our opportunities for success around the safeguarding. And, as I said, we have put many in place. There are still constant things that we can learn, and we should learn from these case reviews all the time, and it’s something that I’m very keen to do.
Minister, thank you for your statement. This was an absolutely appalling case, which has shocked everybody, I think, in this Chamber, and, indeed, across Wales. When people hear that, in modern-day Wales, a young boy, aged eight, died as a result of scurvy—a condition that everybody here hoped was consigned to the bin of history—I think we should all be ashamed of ourselves that this boy was allowed to get into such a shocking condition. When you think about how somebody dies from scurvy—the pain, the bleeding, the soft-tissue damage, the awful discomfort that this boy must have been in towards the end of his life—it really is absolutely appalling. I’ve read the report. It’s a shocking report that does point to the fact that different agencies didn’t have the opportunity to see Dylan at home because of the lack of co-operation from his parents, and the father in particular. I think it does merit wider consideration, really, in terms of a whole-Government response, and the response of Welsh local authorities and our education and health services as well. So, I am pleased, Minister, that you are taking time to get that right rather than rushing into decisions, and that you are doing so not independently of your other Cabinet colleagues, but in conjunction with them.
I think it is fair to give the opportunity for the new guidance and statutory framework that has recently been introduced to bed down, because I think it does put a much greater emphasis on the need for a multi-agency approach in these sorts of situations in the future. Hopefully, that will close some of the holes in the net that young Dylan unfortunately fell through. I was pleased, Minister, to hear you refer to a ‘think family’ response so that, yes, when there are needs that are presented as a result of the mother’s health in this particular case, the wider impact on the family—on the husband, on Dylan and, of course, his sibling, who has not been mentioned in the Chamber today—are actually considered in the round. Of course, had those things been more widely considered, it is perfectly possible that not just curiosity would have been aroused among those care professionals, but that they may well have taken action that could have led to Dylan being saved from this precarious situation that he found himself in.
I have to say that I am appalled by the Crown Prosecution Service decision not to want to prosecute in this particular case. I have looked at the reasons that they cited, which were all about the health and well-being of the parents, it seems to me—not about the lack of evidence of criminal neglect, but all about the welfare of the parents. Frankly, given that those same individuals went on to take a court case with the former employer of the mother of Dylan and were able to contest that, I would have suggested that their health was in perfectly reasonable shape to be able to be taken though the courts. I think we need to make an example of this case. These are exactly the sorts of cases that should be pursued in the public interest, not dropped or sidelined. So, I would be grateful, Minister, if you could tell us what discussions you as a Minister, and the Government more widely, are having with the Crown Prosecution Service in order to see whether this case can be picked back up by them, given the additional evidence that of course has now been brought to everybody’s attention as a result of the child practice review report.
I wonder, Minister, as well, whether you can tell us whether you might consider giving some sort of statutory access to children for those vaccinations and for health visits, particularly in those early years and primary school years. Everybody knows that visits from the school nurse or community nurse are a regular feature of school life these days. But, quite clearly, had Dylan had access to a health practitioner, it is perfectly possible that his condition might have been identified, and he may well have been identified as a as a vulnerable individual. I have to say that I am not persuaded that we necessarily need a register for those children who are home-schooled. It’s quite clear from the report that home schooling in itself is not a risk factor for individuals. But I do think that if additional access to those children is presented in other ways, perhaps through the health system, then that is a much more preferable route, I think, which safeguards the rights of the child that we have all legislated on in this National Assembly, including the right to health, a healthy lifestyle and health services.
In addition, Minister, I wonder what support the Government might be putting in place for parents who might not have the capacity to be able to raise their children in a way that society feels is fit. There are positive parenting programmes that I know the Government has supported, but how do we secure the engagement of people who are on the fringes, perhaps, of society and communities that don’t wish to engage? Is there any compulsion, perhaps, that can be used where there might be individuals like this in these sorts of situations?
Just finally, when it comes to the UN rights of the child, we have all said in this Chamber that we want to ensure that those rights are central to the approach that is taken to public services here in Wales, and as you know, as a Cabinet Secretary, those duties are placed on you as a Cabinet Secretary to have regard to those rights in every action that you take. But, the due-regard principle is not applied to local authorities at present in Wales, and I wonder, Minister, whether you will be prepared to consider, in conjunction with your Cabinet colleagues, a review of the Rights of Children and Young Persons (Wales) Measure 2011 that we passed during the third Assembly to see whether there is scope to extend those due-regard obligations to local authorities and, indeed, all public services across Wales. Because I think if those rights had been very clearly considered, and this is brought out from the report—the right to a health service, the right to a decent education—then it is perfectly possible once again that individuals may have had access to Dylan in a different way, and another route to access to Dylan in a different way, that could have identified his situation sooner and perhaps saved a very young life that was extinguished completely unnecessarily as a result of an entirely preventable disease.
I thank the Member for his contribution. I think what we need to do in this Chamber on this particular case is, it’s not partisan, it’s about learning from opportunities and from all suggestions. His views will be noted by my team and we’ll take forward those views. This is a very sad case, and it’s vital everybody working with children and adults learns lessons from the review. We will consider carefully the findings of the child practice review and the areas highlighted for improvement.
Dylan’s invisibility to services and the need to recognise and follow up on potential prompts is an important one and the Member raised that particularly. Missing immunisations is a significant issue that needs to be explored on an inter-agency approach, and that’s why it’s important not just for—. I lead on this programme, but it’s important that my team colleagues understand about their actions and interventions with young people at a very early age, and how we have that multi-agency approach, and it works. It wasn’t that Dylan didn’t have access to medical services; there was a choice not to have access to medical services, and I have to question that on the ability of my role as Minister with responsibility for the rights of children. So, it is always a difficult discussion to have about proportionality and intervention, but it’s something that we shouldn’t shy away from, where there is an issue of a young person’s life at risk. I won’t offer any view on the CPS, but the Member made his view very clear. I will ask my team to give me further briefing on that particularly.
The Member also asked about interventions around parents who were less able, in terms of their ability or needing more support. We have many programmes in place: Families First, Flying Start, Communities First, Positive Parenting, and this is something that I’ve also asked my team to look at, again, across departments, about interventions—whether they come from social services, health, education or the communities division. What are we doing to support vulnerable families in communities? It is something that we have some great successes from, but it can be hugely challenging in the engagement process. We’ve got to get people over the doorstep in order for this to happen.
But there are next steps. I touched on issues of what we intend to do internally, and I said about writing to the regional and national safeguarding boards. We will also be considering guidance and the availability of adult and children’s services that are relevant. In changes as part this we’ll look at the key milestones where parents and children would be anticipated to engage with health or other universal services—not exclusively, but things around pregnancy and midwifery services, child vaccinations at 2, 3, 4 and 12 months, and pre-school vaccinations at 40 months. These are all key triggers, and when people are out of the system, we should have some concerns about that. It may be a missed appointment, but it may be something more important that we should follow up on on a multi-agency, multidiscipline approach.
Thank you. Can I just remind Members this is a statement, and therefore these are questions to the Cabinet Secretary? I am going to be very tight now. I’ve got a number of speakers who want to speak, and spokespeople have had their opportunity. Some of them took a little bit too long and I’ll be speaking to them a bit later, but can we just ask questions of the Minister now? Jenny Rathbone, please.
I think, just to say, that we all have a responsibility to all our children. Whether we have children or not, they are our future. And the best way in which society looks out for children, once they’re of a school age, is in school. So, it seems to me that, while it doesn’t mean to say that just because a child is being home educated that they are at risk, the fact that they are not in school means there needs to be extra special attention paid to ensure that somebody is seeing that child. This clearly didn’t happen in this case.
The Minister has already talked about the opportunities lost when vaccinations were due to occur. I’m not arguing and saying that the state has a right to insist that a vaccination occurs, but if the vaccination isn’t going to take place, then the child needs to be seen anyway just to make sure that the well-being of the child isn’t compromised.
The child is entitled to nursery education aged three. So, the local authority—I wonder why they weren’t wondering why this child wasn’t putting their name down for a free nursery place. If not, why not? Because every local authority needs to be planning for that and, if the parent doesn’t wish to take it up, that can be recorded. But, at least the question needs to be asked for those who maybe don’t know about that entitlement. When a child doesn’t present in a reception class when rising five that, surely, is another opportunity for the local authority to check that the child is either registered at school or is registered as being home educated. So, I’m concerned that there is not an express requirement in the 1996 education Act for LEAs to investigate whether parents are complying with the obligation for all children to be educated. I hope that that is one of the—
Are you coming to your final question, please?
My final question is: when, in June 2010, it was acknowledged that there were children involved and two officers actually visited the house and were then denied access, why were statutory powers then not used to actually ensure that the child was seen?
I thank the Member for her succinct questions. The Member raises some very important questions, which Cabinet colleagues are considering in their approach to resolving some of the evidence that’s been presented with this CPR. With that being around elective home tuition is a question that we need to resolve too, about the inferred risk that this may increase. The Member presents a very logical approach to the solutions to this problem of what happened here. But it certainly didn’t flow like that in that process. The Member will be knowledgeable around the express requirements in the Act. It is about registration for young people at school age; it’s something that we have to address. We have to make sure that we understand trigger points and when or where these should be acted upon by individuals.
There was a clear failure in the system and this young boy lost his life and we have to learn lessons from that. It’s something, as I said earlier, that the four Cabinet colleagues are working on with me, to resolve some of these loopholes in the system. Most young people in these circumstances will be fine, but there will be one or two as we evidenced here. I cannot stand here today saying there are no more Dylans in our community, and that worries me. That’s something where we have to make sure that, collectively, we try to close those loopholes.
Basically, the case of Dylan Seabridge is absolutely heartbreaking. Those of us who have children feel that way about this, especially the fact that the people who were charged with protecting him are the ones who failed him. I know many live-in families who have home schooled their children with great success and those children have turned out well and well-rounded and have actually gone on to have good careers and gone to university.
In contrast, we can look at the case of little Daniel Pelka, who died at the hands of his parents in 2012, who was going through the traditional system and was found rummaging in bins for food at school because he was being horribly mistreated at home. Now, despite this, and the fact that he’d missed 28 days of school, the abuse was not picked up by the teachers or by any of the people who were charged with looking after him.
My plea is that, as you have said, you do not have a knee-jerk reaction to Dylan’s case and that home-schooling is not made more difficult or challenging for those who choose this path. How is it that you can ensure that vulnerable children are seen regularly by those charged with their protection and that no more children slip through the safety net, and that parents who home-school are not going to be vilified? And also, will you ensure that there is a balance between the right of parents to raise their children in the way that they see fit and the right of the child to education and health?
Just one last point: you’ve raised many times, now, vaccination; are you saying that people who don’t vaccinate their children—? Is it that this is a trigger by which you think that there may be abuse going on at home? What was the relationship to which you were raising vaccination? Could you just make that clear?
I thank the Member for his questions. This is an extremely sad case, as I said—a child invisible to universal services. I think what is important, and I stated this from the start of this discussion, is that I don’t think elective home education is the only issue here. I think we’ve got a collection of problems that have come together with a very bad outcome of a young person losing his life, and we have to get underneath that. There will be some difficult discussions with all sectors about what we do about this. It’s not about vilifying one or the other, but it is about making the right decision. The Member raises the issue of the balance of the right of the child and the right of a parent, and I understand that, but I must come down always for the rights of the vulnerable. If the young person is the vulnerable person here, I will, at all costs, protect that process.
I’m quite happy to clarify the issue of vaccination. This wasn’t about making all parents vaccinate their children; it is still about parental choice, and I am fully happy with that process. What I was suggesting was, at a point in time when vaccination is due for an individual, the health service should understand that as a trigger point—whether the parent makes a choice either for against, and that’s completely reasonable—to make sure that the child in question is in a safe condition. I don’t think that’s unreasonable, to make sure we keep an eye on our young people, who sometimes find themselves in very vulnerable situations.
The Member raised another, awful, case of a young boy in traditional circumstances, but found in a neglectful situation, and I accept and acknowledge that, too. The problems we have here are there are some individuals falling through the system, and we have to understand how that works better. The multi-agency approach is what we need to have, where actually, even in Dylan’s case, if you stacked up some of the individual aspects of it, it may—. Well, it clearly wasn’t picked up, but when you stack them together, this makes a real case where, actually, we should be making strong interventions. That’s what we need to ensure happens in the future, and it’s something that we’ve learned from the CPR and are continuing to learn.
I must say, I’m quite disappointed with this statement today, Minister. When I asked an urgent question back in January, I was told to wait for the child practice review; now the child practice review has been published, I’m told to wait some inordinate amount of time again, without any timetable or idea of what the Government is going to do.
I don’t share your confidence, Minister, regarding the Social Services and Well-being (Wales) Act 2014. Can you confirm to me that, although this Act introduces new duties and more training, it does not introduce new powers and therefore the situation could indeed arise again? With Dylan Seabridge, there were attempts to see him by education officials in the last year of his life; that was not a statutory right, to see a child that is home-educated, and that is what’s been addressed in the child practice review in a clear recommendation for a register of home-schooled children—not an interference in home-schooling, but a register and a right to ensure that those children are being educated and are being looked after. This is a missing piece from your statement that you have not addressed. Are you kicking it, again, into the long grass, or are you going to actually face up to the need to ensure that all children in Wales, in whichever situation they’re educated—including private schools in Wales—are properly accounted for for their education and their welfare?
And the final point is that the child practice review says very clearly that the way that Dylan Seabridge was treated by the authorities was not in accord with the UN Convention on the Rights of the Child. Is that castigating Welsh Government or is it castigating the authorities concerned, and what action have you taken?
I thank the Member for his contribution. He will acknowledge that I’ve been in post for just over six weeks and I’ve picked up this terrible file that he is very familiar with. I am confident that the social services and well-being Act is a very positive piece of work that does include the right to report by statutory bodies and individuals. The Member will also recognise that the issue around the CPR making recommendations in there—this shouldn’t be the issue for laying blame at somebody, this should be about a learning opportunity for us all and making sure that this doesn’t happen again.
I wasn’t shy about coming forward earlier on about saying that I cannot guarantee that there aren’t any more Dylans in the system. What I can guarantee is that my team, working across Cabinet, will be looking to close those loopholes, whether that be on registers or not registers. Actually, my personal view is that I don’t think a register will fix this problem. It may be part of a solution, but it’s not the only fix here and that’s what we’ve got to understand better to make sure that Dylan’s scenario doesn’t happen to any child again.
Minister, I’m going to make my statement short and sharp and to the point. As you know, I live in Pembrokeshire and I have read many case reviews, and some of them pretty tragic, from that authority. My question to you is this—it’s sharp and it’s pointed—have you looked at how they dealt with this case, have you looked at any learning that has come out of it? Because I can think that this is the third tragic case that has come out of Pembrokeshire, and I can also think that each time we’re told something’s going to happen and something’s going to be learnt, and I’m sure that is the case. But what I really want to know here, and this is what really hurts, I think, in this whole case, is that one full year before this child died, somebody reported it and no action was able to be taken. That to me is what really hurts. Because, if that action had been taken at that time, the outcome could have been completely different. The other issue was that the person who reported it lived in Ceredigion and the child resided in Pembrokeshire. That’s an artificial boundary of authorities. I’m sure that there isn’t a single soul here that would agree that an artificial boundary allows people to put up a hand and say, ‘Not my problem; I’ve done my bit. I’ve reported it but it’s another authority that should deal with it’. I don’t think any of us ever want to be back here again in a situation where you can say, ‘I’ve reported it’, but you don’t follow it through, and that it is reported and you don’t take any action because there’s a bit of legislation that gets in the way of that happening.
I thank the Member for her comments and again I recognise the work she’s done locally on this particular issue, and others, indeed. I will be asking the national board to follow up and share the further improvements the Mid and West Wales Safeguarding Board have identified for themselves to further develop multi-agency safeguarding arrangements that reflect on this particular case. Indeed, the issue of the cross-border issue shouldn’t be an issue at all but clearly was in this process. The system recording failure is evident in this CPR. It’s a very sad indictment that, actually, we have to learn the lessons from such a sad case, but it’s important that we do. Pembrokeshire, as the Member will be aware, was in special measures. It’s something that we have to take, that, in essence, there were identified failures. We have supported the authority to move into a better space, but the safeguarding board—it’s the responsibility of all individuals, and, as Jenny said earlier on, we have to make sure, collectively, that we look after the future of our children. This is just one example where the system failed completely and we must make sure that we get this right for the future.
Okay, thank you. And, finally, Angela Burns.
Thank you very much, Deputy Presiding Officer. Minister, I’m delighted to see this report today. I called for an independent review of this case and was excoriated—not by the Minister, who gently let me down in this Chamber, but by members of Ceredigion and Pembrokeshire county councils—for calling for an independent review. My reason for calling for an independent review was because of the very point that was raised here: multi-agency communication and working together. Joyce Watson has raised a part of it, but let’s be really clear, Minister, there was a ministerial advisory group in place, Pembrokeshire County Council was in special measures, it had been crawled all over by Estyn, it had been crawled all over by the Care and Social Services Inspectorate Wales, and none of those organisations thought, ‘Oh gosh, there is the death of a child and no-one’s conducting any review on it’. No-one thought that was out of the ordinary; no-one thought that was extraordinary.
Finally, Dylan Seabridge is the saddest victim in this case, but there is another victim and that is the whistleblower, who should’ve been protected by all the whistleblowing policies and protocols that we have in place. A whistleblower who has been, again, excoriated themselves—and it’s mainly one, but there is a second—who’s had a terrible time of it in their job. I can’t mention their name. They were treated quite badly as well by this very review body, which gave them a very limited amount of time—offered to meet, withdrew the offer to meet, and all this kind of nonsense. We’re here to protect our whistleblowers; we need whistleblowers to operate in all large organisations, public and private, to tell us when we’re doing wrong. Somebody tried to tell us we were doing wrong; we didn’t listen.
I listened to the Member’s contribution; I can’t offer any further points to that. But my final point, Deputy Presiding Officer: we cannot change what has happened to Dylan and the proposals that took us to this point, but what we can do in the legacy of Dylan is to learn what not to do or the right things to do for the future. The Member can offer much guidance to Government in terms of what she thinks may be able to improve our systems and I’d welcome having that discussion, as with all Members of the Chamber. We must learn to make sure we have systems in place that protect vulnerable individuals—children or adults—in all situations across Wales, and it’s something my team and my ministerial colleagues take very seriously.
Thank you very much, Minister.