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Ministry reacts to James Whakaruru recommendations

26 June 2000 Media Statement
Ministry reacts to James Whakaruru recommendations

Health Minister Annette King said today the Ministry of Health has already put in place a number of initiatives to deal with health recommendations contained in the Commissioner for Children's report into the death of four-year-old James Whakaruru.

Mrs King said the tragic death of James has created a widespread sense of distress.

The Ministry of Health had provided her with a report (attached) detailing its response to the recommendations released by Commissioner for Children Roger McClay yesterday, she said.

"The commissioner's report shows clearly how often James was let down in his short life by so many different organisations.

"We owe it to him to act on the lessons learned from this tragedy, and to ensure systems are put in place that have a much better chance of protecting other children in the future."

MINISTRY OF HEALTH REPORT

BACKGROUND INFORMATION
1. James Whakaruru died on 4 April 1999 aged 4 years, as a result of violent beating from his mother (Te Rangi) and step-father (Benny Haewera). Benny Haewera had previously served a prison sentence for assault of James and Te Rangi. The Commissioner for Children’s report indicates multiple failures to protect James across many sectors, including health.

COMMENT

The following is a list of the recommendations made specifically to the Director-General of Health and the Ministry’s response.

2. Commissioner for Children’s Recommendations for the Director-General of Health

3. Recommendation 1: Develop a national child health information strategy which ensure that all health professionals are able to, according to established guidelines, access and record information about health services provided to a child on a common database. As part of the development of this strategy, ensure mechanisms are in place which indicate to child health service providers, if presentations are being made to a number of different primary care providers. This input will identify the need for further input and case co-ordination.

4. The findings of the report indicate there was a lack of information sharing between health professionals. This lack of information sharing was evident between primary care providers (General Practitioner (GP) to GP, and Plunket to GP), between primary and secondary care providers (hospital information to Plunket and GP), and within secondary care itself (information held in emergency departments not being shared with in-patient services).

5. To address the information concerns the Ministry of Health will:

continue with the development of the Child Health Information Strategy. In the most recent budget announcement $1.35m was announced for the further development of this strategy. Previously money was allocated to pilot a regional Child Health Information system

6. Recommendation 2: Implement the 1998 document Family Violence: Guidelines for Health Sector Providers to Develop Practice Protocols. Implementation should include a review of hospital based policies on the management of child abuse and a national policy on the use of skeletal surveys in cases of non-accidental injury. This implementation to include the development of national guidelines which ensure health professionals have ongoing training in the recognition and reporting of child abuse and neglect.

7. The report indicates that there was a lack of recognition of family violence and patterns of child abuse and neglect by the health agencies and professionals involved with James and his mother.

8. To address this the Ministry of Health:

has included reducing violence in interpersonal relationships is one of the objectives in the Draft New Zealand Health Strategy
has circulated the Family Violence: Guidelines for Health Sector Providers to Develop Practice Protocols and will further investigate what else can be done to encourage their implementation
will inform all Hospital and Health Services (HHS)  and primary care providers of the key findings in the report and recommend the review of policies and procedures regarding the recognition of family violence and child abuse and neglect
will liaise with the professional colleges to ensure the findings and recommendations of this report are known and implemented
is asking each HHS to review their child abuse policies.

9. Recommendation 3: As part of the current Primary Care Strategy ensure issues of provider and professional accountability and resourcing, for following up families with children who are not accessing routine child health services such as Well Child checks and immunisations, are addressed.

10. The report indicates that James was taken to a large number of GPs making it difficult for any one practitioner to gain an overview of his social circumstances.

11. To address this the Ministry:

has just completed consultation on the future shape of Primary Care Discussion Document. It proposed that providers have a population responsibility to enable access, (including children who are not receiving well child checks and immunisation). It is the clear intention of the Government that the Primary Care Strategy proceed.

12. Recommendation 4: Report on the Review of Maternity Services (1999) with respect to increased clarity of lead maternity carers.

13. Identifying the Lead Maternity Carer was an issue at the time that James was born in 1994. The 1999 National Health Committee Report on Maternity Services indicated this was no longer seen to be a problem as women indicted clearly they knew who their lead maternity carer was. There was a change in legislation in 1996 which provided the clarity to the lead maternity carer role. However, the 1999 National Health Committee report raised issues of transition and hand-over from lead maternity carer to primary care. The Health Funding Authority (HFA) is currently investigating the addition of an additional visit to ensure easier transition from lead maternity carer to primary care provider.

14. Recommendation 5: Ensure that contracts with Well-Child Care Providers include the requirement and resourcing to engage in inter-agency and community meetings.

15. The Ministry agrees that inter-agency communication by well child providers is crucial and encourages their involvement in local co-ordination case management meetings. The Ministry will work with the HFA and well child providers to enable this to happen.

16. The Family Start programme is an example of well child providers working collaboratively in an inter sectoral way.

IMPLICATIONS FOR CLOSING THE GAPS

17. This report raises many issues for closing the gaps for Maori. Primarily no health professional was able to establish an on-going one to one relationship of trust with Te Rangi, James, or the wider whanau. The family believes the professionals’ individual focus marginalised James further from his whanau. All James’s whanau (Whakaruru, Haewera, and Campus - biological father’s family) expressed a mistrust of government agencies.
18. Ongoing development and monitoring of existing measures to address barriers imposed by the structural arrangements of health sector agencies and health service providers, as well as improvements in the cultural appropriateness of health professionals in interacting with Mäori whänau, should reduce the likelihood that another tragedy like James Whakaruru occurs. These measures and improvements are critical factors for the health sector to realise, to ensure positive health gains for Mäori, and closure of the gap between Mäori and non-Mäori.


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