What official information has been provided about the Suspected Inflicted Head Injury Service (SIHIS)?

The Department for Education has issued the following document – download here

What is the Suspected Inflicted Head Injury Service (SIHIS)?

The SIHIS will create a referral system for the assessment of a child with a suspected abusive head injury. At each pilot ‘hub’ there will be clinicians from all key disciplines involved in the assessment of the head injury (paediatricians, neuro-radiologists, haematologists and other disciplines). At the end of the assessment process a single report will be produced. This report will be used as part of the court proceedings process.

What age children will be referred to the Suspected Inflicted Head Injury Service (SIHIS)?

The pilot will cover children aged between 0 to 8 years old.

Where is the Suspected Inflicted Head Injury Service (SIHIS) currently running?

There are three pilot schemes now up and running under the Manchester University NHS Foundation Trust, Birmingham Children’s Hospital and Sheffield Children’s NHS Foundation Trust. Therefore court proceedings arising under these NHS Trusts will be referred to the SIHIS.

How long are the current Suspected Inflicted Head Injury Service (SIHIS) pilots running for?

The pilots will end on 31 March 2025.

Why are senior family lawyers raising concerns about the implementation of the Suspected Inflicted Head Injury Service (SIHIS)?

To date there has been no consultation by the Department of Education with any legal or medical professional bodies prior to the implementation of the pilots. This is a crucial missed step given it is these very professionals that will be able to provide a fair and balanced view on proposals.

Consultation would have also ensured that concerns do not arise around the breach of a parent or child’s Article 6 Rights (Right to a Fair Trial) and Article 8 Rights (Right to Family Life). These concerns will no doubt have to now be remedied as and when they arise through the Court’s appeal process.

What are the particular concerns raised by senior family lawyers about the premise of the Suspected Inflicted Head Injury Service (SIHIS)?

A family case involving a head injury which is believed to be non-accidental are some of the most serious and complex cases heard in the family justice system. The SIHIS therefore raises a number of very serious concerns, summarised as follows:

1. Clinical opinions can differ from opinions expressed by court appointment experts.
2. Differences of opinion between experts and /or treating clinicians often only come to light during the cross-examination process at Court.
3. Science and medical opinion behind intracranial bleeding remains a highly debated area amongst medical professionals.
4. Experts instructed can take a different approach to reaching the opinions expressed in their reports, basing opinions on a mixture of theory, clinical experience and research papers.
5. Court appointed experts have the benefit of reading all the Court papers and all medical records. The treating medical clinicians and therefore any clinician part of the SIHIS will not. The papers available in the court process are highly relevant and may identify the need for other medical experts to be instructed (e.g. a Geneticist) or even a relevant differential diagnosis that was not apparent to the treating medical clinician. Anyone accused of causing a non-accidental injury will have to produce a statement for the Court. The statement allows the person accused to set out a chronology of events that have arisen, possible explanations, any relevant diagnosed and undiagnosed medical history. This can be a lengthy document produced with the assistance of a skilled family lawyer who is able to eke out the details, making the information as clear as possible for any expert and other professionals to read. These documents are a result of a number of appointments with the client, and it often takes tens of hours to produce. This process cannot be replicated in any way shape or form under the DfE proposals. A lack of detail will result in unsafe opinions being expressed, leading to reliance placed on these reports by the Court.
6. The experts instructed in family proceedings are independent. The parties in a court case will also have an opportunity to voice any concerns about the instruction of a particular expert (and where necessary the Court will determine any disagreement). The parties will also have a joint input into the detail of instructions provided to the expert.
7. Often a case against someone accused of causing a non-accidental injury seems on paper to be heavily against them. It is only during the cross-examination process by specialist and skilled lawyers, do the gaps appear resulting in the Court naming no findings.
8. There is a very real risk of a miscarriage of justice where the Court has to make a decision a child cannot return to the care of their parent(s). Depending on the child’s age that could ultimately result in the child being adopted outside of the family.

“The ALC are aware of concerns expressed by practitioners on social media and elsewhere as to a new pilot scheme, which is we understand a DfE funded pilot, to create a multi-disciplinary clinical hub to examine and report on cases of suspected inflicted head injuries and which has been reported to be operational in  Manchester University Hospitals NHS Foundation Trust, Sheffield Children’s NHS Foundation Trust, Birmingham Women and Children’s NHS Foundation Trust.

There is no publicly available information about the scheme.

We, together with the other practitioner bodies, have made the President aware of our concern  as to the lack of publicly available information. As soon as we have information to share, we shall let our membership know. We wish to see the detail of the scheme in order that we may consider the implications of it and whether and what further steps are needed on behalf of our members”

Family Law Bar Association (FLBA)

Suspected Inflicted Head Injury Service Pilot

Yesterday afternoon we were sent the attached document by the Department for Education (please click HERE). This is the first written document we have been provided with that we have been permitted to share with our members. It explains the rationale for the Pilot. It introduces the concept of “expert clinicians” to produce “a single comprehensive report”. It says both that “the report will not replace the current court report (sic)…” but also “this aims to reduce the need for additional multiple Court instructed experts by distilling down, on an individual case basis, the complex issues pertinent to each child where additional expertise is required”. The purpose of this is to “allow for more timely decision-making and a reduction in unnecessary delays”. The intention is for the pilot to act as “proof of concept, to establish the value of such a system”.

No member of the FLBA was part of the group which developed this Pilot and we were not consulted upon it. As far as we are aware the same applies to the other practitioner groups, the ALC, Resolution and the Law Society. We are concerned about the concept of State appointed “expert clinicians” replacing single joint experts in these cases and “distilling down… the complex issues.” or being the arbiters of (or the basis for any decision upon) what “additional expertise is required”. In our experience the complex issues in a case emerge once the single joint experts have reported and not beforehand.

Some weeks ago we put together a group of barristers from within and outside the FLBA National Committee to assist with compiling our response to this. I am very grateful to everyone who is part of that group. We have compiled a list of questions which we have sent to the DfE and to the Family Justice Council Experts Sub Committee. These centre on issues such as consultation (with medical associations as well as practitioner groups), the method of appointment of the “expert clinicians” and how and by whom the Pilot is to be evaluated. You will see that the document is silent on these issues.”

Law Society

Awaiting a Response

Resolution

Awaiting a Response

Expert Witness Institute

“From the way this is described, I would question whether the report that is created by the multi-disciplinary team would be complaint with both the duties of an Expert Witness and the Family Procedure Rules and Practice Directions. Reports are supposed to be the independent product of the Expert Witness. In addition, cases such as Pinkus v Directline that experts should not be discussing their opinion with others. I would therefore question whether any report created by a  multi-disciplinary team could be accepted as expert evidence.”