Reforms introduced as a result of the Sally Clark case could lead to a halving in the number of cases of unexplained infant deaths and a positive legacy emerging from tragedy, says a feature in this week's BMJ.
Sally Clark was arrested in 1998 for the murder of her two infant sons. She was imprisoned but won her appeal in 2003. She died in March this year. The consequences of the case, says Jonathan Gornall, have been devastating for her family and far reaching for the medical and other professions involved.
Protocols introduced as a direct result of the case will be obligatory by April 2008 - the statutory process allowing this to happen has been astoundingly fast says the writer. Peter Fleming, a professor of infant health in Bristol, who implemented a structured system in Avon which will form the template of what will become nationwide protocol, says:
"(this) reflects huge concern within the professions that professionals and families were being let down by the system because nobody knew quite what was required of them."
The reforms establish a standard routine for a collaborative multi-agency response to every sudden unexpected infant death, detailing what is expected from ambulance crews, A&E staff, child protection co-ordinators, coroners, GPs, midwives, pediatricians, pathologists, police and social workers.
Two key changes are that police should visit the home with a pediatrician and a pediatric pathologist should always carry out the examination.
Professor Fleming believes the protocol will ensure more robust and reliable investigations and it could lead to a substantial reduction in the number of deaths from sudden infant death syndrome. When he and his colleagues introduced structured arrangements in Avon in 1984 the benefits soon became apparent - every one of the major risk factors for cot death was first identified there in the 1980s, he says.
The reforms mean new local boards will have to collate information on all deaths in their regions, which will feed into a national enquiry and that can draw nationally applicable conclusions.
However, the article does raise concerns about whether there will be adequate staffing to carry out these new protocols. Child protection has become something of a "poisoned chalice" for pediatricians and pathologists, says the writer, as they are increasingly the target of complaints. Yet, says Professor Fleming:
"Now at least we will be (protecting children) within a recognized and accepted framework, so in theory we can be criticized only if we have failed to do what we should have done, rather than merely for being there."