Serious Case Review – Aalihya Jordon-Fellows

By on 09/08/2012 in News

Birmingham Safeguarding Children Board today (August 9) publishes a serious case review into the death in 2008 of four-month-old Aalihya Jordon-Fellows.

Aalihya died after suffering serious head injuries and following a court case last year her uncle was convicted of manslaughter and jailed. Aalihya's mother and her partner were charged with child cruelty; the mother was found guilty and the partner acquitted.

The review found that the death could and should have been prevented by a more robust application of safeguarding procedures by all agencies involved.

Jane Held, independent chair of the multi-agency safeguarding board, said: “It is always with sadness that we publish a review into the death of a child, and my sympathies are with those who knew her. We want to apologise unreservedly for the fact that the Local Authority, Health Services and West Midlands Police did not do enough to protect her. The people directly responsible for her death have been held to account.

“It is our duty as well as responsibility to ensure that we do everything we can to learn from this tragedy and to use that learning to improve how we protect children. All the recommendations have been fully implemented by the relevant agencies and over the next six months the board will be checking that practice has changed as a consequence.”

Aalihya's parents were aged 18 and 19 at the time of her death. They had both been in the care of Birmingham City Council and were receiving support from the leaving care service. A number of care placements had ended due to violent or disruptive behaviour, particularly on the part of the mother. The review found their move from care to independence was not managed as robustly as it should have been and that all agencies involved struggled to maintain meaningful contact with the couple, as the parents often failed to keep appointments. It also finds flaws in the way assessments were done, and in how professionals talked to each other.

Ms Held added: “The report also highlights important learning for the police, health and social care professionals about the degree to which they have to identify risk and exercise 'respectful uncertainty' in their work with young and vulnerable parents, especially when those parents are themselves the responsibility of the local council, as well as the need to be robust in challenging each other professionally.”

Key recommendations in the Serious Case Review are:

•    BSCB should ensure through their partner agencies that front line professionals comply with the requirements in our safeguarding policies to escalate their concerns when risks increase
•    BSCB works on ways to increase the understanding of parents and practitioners about the impact on children of domestic violence and the risks that this can pose to the child's safety
•    South Primary Care Trust and Heart of Birmingham PCT to ensure all health visitors receive training in domestic violence and the potential impact on children
•    Birmingham City Council's leaving care service to be clear about the provision of support to vulnerable young people and have a well trained and qualified workforce to deliver it
•    All looked after children with a substance misuse problem can access support and treatment
•    Children's social care puts in place strong quality assurance systems to enable managers to directly influence the quality of assessments

Notes to Editors

The Executive summary, Recommendations and Action Plans for the case have been made public via the BSCB website. In line with national guidance the report has been anonymised to protect the identity of the bereaved family.

The reviewing of all child deaths by local safeguarding boards became mandatory in April 2008; the key purpose of these reviews is to learn why children die and reduce the number of preventable deaths. There is a statutory requirement for a child death overview panel to review all deaths of children and young people up to the age of 18, with an evaluation of each unexpected death.

Last year (1st April 2011 - 31st March 2012) there were 160 child deaths from all causes in Birmingham. A very small number of unexpected deaths are the consequence of abuse or neglect. These cases are subject to a serious case review, which in Birmingham is approx four or five a year.


For further information contact; Janet Priestley Head of Birmingham City Council press office 0121 303 3531 who is assisting the Birmingham Safeguarding Children Board in co-ordinating and responding to media enquiries in relation to this case.

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