Snapshot

In 2023, Public Hearing 33 of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability considered a case study of two children living with disability. They were referred to as Kaleb and Jonathon. 

In response to recommendations from the public hearing, the Ombudsman has been investigating some of the public sector agencies that had interactions with Kaleb and Jonathon. 

Queensland Health staff had concerns about Kaleb and Jonathon’s safety and wellbeing from birth. The boys were diagnosed with disabilities, including significant global developmental delay (delay in reaching milestones in several areas) and intellectual disability. In those early years, Queensland Health staff made several child protection reports to the Department of Families, Seniors, Disability Services and Child Safety (Child Safety). 

Kaleb and Jonathon had a range of paediatric and specialist health appointments with Queensland Health services between 2000 and 2020. At times, they did not attend these appointments. Health staff followed up on their non-attendance on some, but not all, of these occasions. In this investigation, we also found there were occasions when Queensland Health did not make bookings for specialist appointments for Jonathon when required.

After their father’s death in 2020, Kaleb and Jonathon were admitted to hospital and treated for severe malnutrition.

What we investigated

This investigation examined whether the current practices and procedures of Queensland Health would prevent other children with disability from experiencing the nature and extent of the harm Kaleb and Jonathon suffered. We found that it has developed some practices and procedures to help staff identify and respond to child abuse and neglect, but we also identified opportunities for improvement. 

What needs to be improved

Queensland Health needs to provide staff with clear and consistent information about how to identify and respond to child protection concerns. In particular, staff need clearer guidance on: 

  • concepts like cumulative harm, parent behaviour and neglect of medical care
  • resources to use to inform decision-making, such as Child Safety’s Child Protection Guide
  • the importance of consulting with expert staff within hospital and health services’ child protection units.

Queensland Health also needs to ensure that:

  • staff can recognise that in some circumstances, missed medical appointments may be a sign of potential neglect
  • hospital and health services have effective information management systems that support service delivery, including for responding to child protection concerns.

Recommendations

Recommendation 1
Queensland Health amends its current practices and procedures to include more detailed and consistent information about the concept of a parent being able and willing to protect their child from harm.
Recommendation 2
Queensland Health amends its current practices and procedures to include more detailed information about cumulative harm.
Recommendation 3
Queensland Health reviews its current practices and procedures and considers whether to mandate that health staff use Child Safety’s Child Protection Guide when they are assessing child protection concerns.
Recommendation 4
Queensland Health amends its current practices and procedures so that when staff identify a child protection concern, they consult with their child protection unit if they have queries and it is practical to do so. This should be promoted as best practice.
Recommendation 5

Queensland Health amends its current practices and procedures so they all consistently prompt staff to:

  • review a child’s health records when responding to a child protection concern 
  • consider any previous presentations at hospitals or health services, and any previous child protection concerns 
  • discuss their immediate concerns with colleagues who have had contact with the child and their family.
Recommendation 6

Queensland Health amends its current Specialist Outpatient Services Implementation Standard to:

  • include information about child protection considerations (for example, neglect of medical care)
  • link to Queensland Health’s child protection practices and procedures and Child Safety’s Child Protection Guide.

Queensland Health should also ensure hospital and health services align their practices and procedures with these updates.

Recommendation 7
Queensland Health amends its current Specialist Outpatient Services Implementation Standard to include more detailed guidance about what is required in clinical audits, including considering whether the patient lives with disability and has a child protection history.
Recommendation 8

Queensland Health audits, at regular intervals, a sample of outpatient appointments that children fail to attend, and where the children have been subsequently discharged from the outpatient service, across each hospital and health service, to assess:

  • whether clinical audits have occurred as required 
  • the quality of the clinical audits if they have been conducted
  • whether the hospital and health service can improve its clinical audit process.
Recommendation 9
Queensland Health reviews its current practices and procedures so they clearly and consistently communicate its expectations about how staff respond to suspicions of harm.
Recommendation 10

Queensland Health amends its current practices and procedures to include information about:

  • what staff should do if they have child protection concerns that do not meet the threshold for reporting to Child Safety or the Queensland Police Service
  • how and where staff should record these concerns.
Recommendation 11
Queensland Health amends its current practices and procedures so it audits, at regular intervals, a sample of child protection reports made by health staff to Child Safety.
Recommendation 12
Queensland Health amends its current practices and procedures to include information about the obligation of Queensland Health staff to consider human rights when responding to child protection concerns.
Recommendation 13
Queensland Health assists hospital and health services to implement more contemporary information management systems to address the issues identified in this report.