:00:11. > :00:13.Good evening. The case of Neeve Laftery and
:00:13. > :00:16.Georgia Rowe is undoubtedly tragic. The two girls left the Good
:00:16. > :00:24.Shepherd care centre in Renfrewshire one night in October
:00:24. > :00:27.2009, and jumped from the Erskine Bridge in an apparent suicide pact.
:00:27. > :00:37.Yesterday, a Fatal Accident Inquiry found failings in the way both
:00:37. > :00:38.
:00:38. > :00:41.girls had been treated in care. And those failings were not unique to
:00:41. > :00:46.this case - lack of communication, poorly completed paperwork, and
:00:46. > :00:49.understaffing. In a moment, we'll be discussing whether the system
:00:49. > :00:59.works, but first Aileen Clarke has spoken to the families of both
:00:59. > :01:03.
:01:04. > :01:08.The Georgia Rowe and Neeve Laftery were two troubled, complex
:01:08. > :01:13.teenagers who, by a strange quirk of fate, were taken into care the
:01:13. > :01:15.same day. The following year, they died on the same day as they fell
:01:15. > :01:21.together from the Erskine Bridge. Why they decided to leave their
:01:21. > :01:25.care home that night and go to the bridge to take their lives, that it
:01:25. > :01:29.will never be known. But the lengthy fatal accident inquiry into
:01:29. > :01:35.this case heard a host of issues raised about the workings of a care
:01:35. > :01:44.assistant. I feel that Neeve Laftery was
:01:44. > :01:54.systematically fields by the care system from the start to the finish.
:01:54. > :02:04.-- she was systematically let down. They were just a roof over her head.
:02:04. > :02:06.
:02:06. > :02:12.There was nothing else. Nothing. I was seeking some into a venture in
:02:12. > :02:15.to look at Georgia -- I was seeking some intervention.
:02:15. > :02:20.I wanted to know why she was behaving in the way she was
:02:20. > :02:25.behaving. We needed to learn from this. I did not know what was wrong
:02:25. > :02:31.with her. She was very much loved and very
:02:31. > :02:40.much wanted. We all had great hopes for her. We could all see the real
:02:41. > :02:46.girl behind the difficult behaviour. We loved her unconditionally. We
:02:46. > :02:55.all had hoped that she would come through. We wanted her to get the
:02:55. > :03:03.help she needed so she could move on to be a happy girl. She never
:03:03. > :03:07.got the chance. The share of notes in her findings
:03:07. > :03:10.that the two girls refused to co- operate with counselling and says
:03:10. > :03:15.that it is not possible to conclude that a lack of psychological input
:03:15. > :03:19.was relevant to their deaths. It is nevertheless of concern, she says.
:03:19. > :03:23.Despite all the potential in good from our variety of psychologists,
:03:23. > :03:29.the inquiry heard of no structured and sustain therapy being
:03:29. > :03:32.undertaken by either girl. Meanwhile, the girls's families
:03:32. > :03:39.believes the system was taking little notice of concerns raised by
:03:39. > :03:47.those who knew the girl's best. I should have been listened to. She
:03:47. > :03:55.was my daughter. I knew her. I knew what she needed. I am a responsible
:03:55. > :04:01.parent who loved my daughter. I felt that I was not listen to. I
:04:01. > :04:04.was undermined. I was fobbed off. She is not ready, you haven't
:04:04. > :04:10.addressed any problems and you have swept everything under the carpet.
:04:10. > :04:17.That is what I said in front of the social workers, the people making
:04:17. > :04:22.the decisions... It was like banks, but no thanks. I never expected
:04:22. > :04:26.Jorja to ever be in that kind of environment. I expected some help
:04:26. > :04:32.and interventions to be good move forward. I never expected that we
:04:32. > :04:34.would be into the system that we Despite their concerns about the
:04:34. > :04:38.two girls being placed in the open unit of the Good Shepherd Centre in
:04:38. > :04:43.the books before they died, just how open it was on the night the
:04:43. > :04:47.girls left for the bridge came as a dreadful shock.
:04:47. > :04:51.They both leave. Nobody questions them. Nobody knows they're missing.
:04:51. > :04:58.Nobody knows they have gone. How do you think I feel when I have
:04:58. > :05:03.dropped my daughter off at 10 minutes past seven -- 7:10pm. We
:05:03. > :05:09.had a beautiful day. Less than 30 minutes later, she has left that
:05:09. > :05:17.unit. And nobody knows why. Nobody knows. They did but know until
:05:17. > :05:20.after they were dead. There was no security. -- they did not know.
:05:20. > :05:24.One of the sheriffs main findings was that the deaths of the two
:05:24. > :05:28.girls may have been avoided if there had been four staff on duty
:05:28. > :05:32.in the unit that night. There were only two, with only one on the
:05:32. > :05:36.premises at all times. She also noted a number of other relevant
:05:36. > :05:39.facts, including the failure of police and authorities to hold
:05:39. > :05:43.detailed and really accessible information relating to a child.
:05:43. > :05:48.The need to ensure that that is copied to the residential placement.
:05:48. > :05:51.The need for better communication and up-to-date information. And the
:05:51. > :05:57.need for a stand-alone risk assessment for every child in
:05:57. > :06:02.residential care with consideration of self-harm and suicide. This
:06:02. > :06:06.fatal accident determination is lengthy and detailed. The Share
:06:06. > :06:10.Focus there is something of value here for those working in this area
:06:10. > :06:13.right across Scotland. One of the stand-out pieces for me is where
:06:13. > :06:18.the sheriff talks about the veritable mountain of paperwork
:06:18. > :06:21.generated by the girl's social work departments and the Good Shepherd
:06:21. > :06:25.Centre. It became apparent during the course of the inquiry that
:06:25. > :06:28.there were many instances where there were failures among
:06:29. > :06:33.professionals to communicate information in a cogent,
:06:33. > :06:37.straightforward and commonsense way. She says, taken as a whole, some of
:06:37. > :06:41.these failures suggest a lack of professionalism and a tendency to
:06:41. > :06:45.view form-filling as an end in itself without considering such
:06:45. > :06:50.matters as the value or the relevancy or the accuracy of the
:06:50. > :06:54.information contained in all that paperwork. There are examples in
:06:55. > :06:58.here of decisions being made with no paper work at all, of vulnerable
:06:58. > :07:03.children being placed in units with no updated paper work with them,
:07:03. > :07:08.and then there was Neeve Laftery's suicide note, which was not read by
:07:08. > :07:13.some of those involved in her care. It was left in the file in a draw.
:07:13. > :07:17.How often in the past have we heard when a child has died, a child
:07:17. > :07:21.known to social services, that there was vital information known
:07:21. > :07:26.but it was not passed on to the people who needed to know that at
:07:26. > :07:29.the time they needed to know what. I'm joined now in the studio by
:07:30. > :07:32.Duncan Dunlop, Chief Executive of Who Cares? Scotland, the advocacy
:07:32. > :07:35.group for children in care, and Jennifer Davidson, Director of the
:07:35. > :07:37.Centre for Excellence for looked after children in Scotland, which
:07:38. > :07:47.provides training and research, and from Inverness by Sandy Riddell who
:07:47. > :07:52.represents the Association of Directors of Social Work.
:07:52. > :07:57.Jennifer, I just want to get some sense of how typical of this
:07:57. > :08:03.situation these two young women find themselves in... One of the
:08:03. > :08:07.things that struck me about both of them is that their own families
:08:07. > :08:12.were involved in having them could into care for temporary periods.
:08:12. > :08:18.This was not a situation where social workers were taking children
:08:18. > :08:22.away from their families. Part of the families were co-operating. Is
:08:22. > :08:27.that typical? First of all, or what is important
:08:27. > :08:33.to say is that we will all be moved by this story and that it is a
:08:33. > :08:40.really powerful story of the pain and the real tragedy of the loss of
:08:40. > :08:46.these families. In relation to the question about how relevant or her,
:08:46. > :08:53.and this may be, I think there is an important message here about
:08:53. > :08:58.understanding where there needs to be blame situated.
:08:58. > :09:01.Is this a common situation? Services are quite patchy. I don't
:09:01. > :09:06.think we can say confidently that this is, not uncommon. But it is
:09:06. > :09:10.quite apparent that there are aspects of this that are
:09:10. > :09:17.extraordinarily poor practice. I don't mean the details of the
:09:17. > :09:20.case. I am trying to get the sense of an image. Children are mainly
:09:20. > :09:23.taken into care because social workers decided is not safe to
:09:23. > :09:29.leave them with their parents or ever has taken care of them. That
:09:29. > :09:39.was not the situation with either of these teenagers. Is there
:09:39. > :09:49.situation, whether families a core It is less common than the
:09:49. > :09:50.
:09:50. > :10:00.situation you have described. other thing that struck me,
:10:00. > :10:06.listening to Niamh's mother and Georgia's aunt, they Apethorpe that
:10:06. > :10:10.the girls were going into a therapeutic process. Whether it be
:10:10. > :10:17.wrong to think that? I don't think they were wrong to expect that from
:10:17. > :10:23.a care assistant, and I think what we are seeing here is a complete
:10:23. > :10:27.failure of all of those systems who were responsible for the care of
:10:27. > :10:36.the two girls when their families give them over to the system to
:10:36. > :10:41.care for. This is an example of a catastrophic failure of the
:10:41. > :10:47.system's not working together and certainly not working in a way that
:10:47. > :10:53.we expect the care system to be working for children who are
:10:53. > :10:57.clearly emotionally distressed. you think the aunt and the mother
:10:57. > :11:01.have realistic expectations? Again, they seem to believe that what was
:11:01. > :11:08.happening was these children were going to be looked after in a way
:11:08. > :11:12.that would actually contribute to their development and they end up
:11:12. > :11:17.basically, not been left to their own devices, but in open units with
:11:17. > :11:24.other children, all of whom are severely troubled in one way or
:11:24. > :11:31.another. There are several things to come out of this and firstly, I
:11:31. > :11:36.hope this inquiry has brought some peas to everyone. But lessons need
:11:36. > :11:40.to be learned from this. If we go back to the issue why were they in
:11:40. > :11:44.care in the first place? You can look at the complex nature of that
:11:44. > :11:50.family situations where they come from. There was a breakdown in
:11:50. > :11:55.close relationships, maybe not with the two women betrayed in that film,
:11:55. > :12:01.but close relationships were not good for them. The impact of that
:12:01. > :12:06.can be very severe and have severe consequences. I understand that,
:12:06. > :12:11.but what I am tried to get that is there was clearly an expectation on
:12:11. > :12:15.the part of the parents that this would help them, but it looks from,
:12:15. > :12:21.and I'm not just referring to this particular case, I am asking on
:12:21. > :12:26.behalf of anyone who is in this situation, whether they perhaps
:12:26. > :12:36.have misunderstood? Perhaps residential care homes are not
:12:36. > :12:37.
:12:37. > :12:44.there to be therapeutic centres, but are more their in a way to keep
:12:44. > :12:54.young people say if. We consult and that is a pair with a lot of people
:12:54. > :13:00.
:13:00. > :13:07.who have lived in residential care, and we looked as a case last week,
:13:07. > :13:14.as PSCs are different. Homes have got better and there are less
:13:14. > :13:23.incidents of abuse, but relationships are the guiding tours
:13:23. > :13:28.that are needed. We take them into a care setting and it has to give
:13:28. > :13:34.them the talks to build relationships. They will only get
:13:34. > :13:38.there through having a continuity of care relationship with quality
:13:38. > :13:43.staff in those units. That is what is important. In terms of therapy,
:13:43. > :13:50.what they really want is an adult who is going to be there throughout
:13:50. > :13:56.their care journey. You heard there, particularly from Jennifer Davies
:13:56. > :14:00.and that this build a systemic failure. When you read this report,
:14:00. > :14:05.particular details like how many staff there were in the home on
:14:05. > :14:08.that particular night seemed about the least of their problems. The
:14:08. > :14:15.sheriff concludes that neither of these young women should have been
:14:15. > :14:20.in open units and the first place and the reason they were his beat
:14:20. > :14:28.usual, you know, people not communicated with each other.
:14:28. > :14:37.Social workers not knowing what was going on, etc. The problem is this
:14:37. > :14:40.happens every single time we have one of these cases are. The lesson
:14:40. > :14:46.is that everyone needs to work together, but nothing seems to
:14:46. > :14:51.change. One of the panel for messages from the mother and the
:14:51. > :14:55.art was very much along the lines of not just communicating with them
:14:55. > :15:00.or working in partnership, it is actually listening to them and
:15:00. > :15:04.listening to the young girls as well. This is an absolute tragedy
:15:04. > :15:11.and I would like to convey my condolences to the families.
:15:11. > :15:19.understand that, but one of the points the sheriff made his many of
:15:19. > :15:23.these homes, there is too much listening to the girls. There would
:15:23. > :15:28.be Aurelien -- there would be a rebellion, not necessarily these
:15:28. > :15:32.two girls, and then the staff say they cannot be bothered. This
:15:32. > :15:37.certainly highlights the challenges and the difficulties that staff
:15:37. > :15:42.based in dealing with a vulnerable, volatile adolescents, particularly
:15:42. > :15:47.in situations where they self-harm. But we have got two young women
:15:47. > :15:56.here, again, just going by what the show this has concluded, they both
:15:56. > :16:03.had self-harm, various degrees are trying to commit suicide and
:16:03. > :16:08.expressed their wish to die, yet they ended up in an open facility
:16:08. > :16:14.where they could lead at will where the sheriff concludes they should
:16:14. > :16:20.not have been. It was not just the care home, it was the network of
:16:20. > :16:23.social work departments and other agencies. Everyone says that needs
:16:23. > :16:32.to change, we are not working together, but every case that comes
:16:32. > :16:42.up, that is always the problem. think what this particular tragedy
:16:42. > :16:48.highlights is that risk-management criteria should be in place. There
:16:48. > :16:54.are issues about how social work and providers of care communicate
:16:54. > :17:01.with each other. One of the things that surprised me as an outsider,
:17:01. > :17:06.it seems to be extraordinary that someone who has attempted to commit
:17:06. > :17:13.suicide has no risk assessment done. These girls were not in the
:17:13. > :17:17.appropriate placement. We have to look at the resources that exist of
:17:17. > :17:23.these children who are so distressed. There are some emerging
:17:23. > :17:29.services that will be able to meet needs. My apologies, we have run
:17:29. > :17:39.out of time. Thank you for taking part. A quick look at tomorrow's's
:17:39. > :17:42.
:17:42. > :17:52.front pages. -- at tomorrow's front pages. That is all we have time for
:17:52. > :18:00.
:18:00. > :18:08.tonight. I will be back tomorrow. The rain returns tomorrow. Some
:18:08. > :18:16.torrential, thundery downpours expected. North of the brain band
:18:16. > :18:21.should be quite nice, particularly north-west England. Feeling cool
:18:21. > :18:27.under the band of rain. The southernmost counties, after a bit
:18:27. > :18:34.of rain in the morning, a dry day in store. A few sunny spells
:18:34. > :18:42.possible. Not especially warm. Brightening up to the south of
:18:42. > :18:47.Wales, but through mid-Wales, further rain in the afternoon. In
:18:47. > :18:51.Northern Ireland there will be some sunny spells about the day and the
:18:52. > :19:01.western areas of Scotland will have a fine day. Cloud gathering to the
:19:02. > :19:02.
:19:02. > :19:07.far north later run. -- later on. Northerly winds digging in. Friday