ANALYSIS:Independent review into tragedy highlights key failings across the community services, writes Susan McKay.
THE MOST distressing fact to emerge from the shocking independent review into the deaths of the McElhill family in a house fire in Omagh last November is that 13-year-old Caroline McElhill did her valiant best to save her family from her father.
Lorraine McGovern (29), Caroline, Seán (7), Bellina (4), Clodagh (2) and James (seven months) and Lorraine's partner - the children's father, Arthur McElhill (36) - died in a fire which he appears to have started after spreading petrol through their small terrace house to ensure an inferno.
The last thing Caroline did on this earth, as the flames engulfed the family home, was to phone the emergency services. She got through to the operator but it was too late. She was just seconds from death. When her charred body was recovered from the ruins she was clutching a mobile phone and a string of rosary beads.
By the time Caroline made that call, there was nothing that could be done. But just under a month before the tragedy, she had made a call which, had it been responded to properly, could have made all the difference.
In October 2007, the distressed and frightened child rang the police to beg them to go to her house because a violent row had erupted between her parents. She had phoned home from her friend's house and heard the commotion.
PSNI officers went to the house immediately. Lorraine met them and said the row was over and Arthur and the children had gone to bed. The police should have insisted on seeing the other members of the family, and, crucially, should also have gone to talk to Caroline. They did neither. It was 11 days before they reported the incident to social services.
The social service response was to put the referral on a low priority waiting list. This was despite the fact that the previous month, September 2007, social workers had removed a 13-year-old friend of Caroline from the McElhill home. They did so because Arthur McElhill was a twice-convicted rapist who was known by social services to be a "high risk to teenage girls".
No risk assessment was carried out in respect of the visiting girl, who was already, for reasons unrelated to the McElhill family, on the child protection register. Social services had previously given permission for her to stay at the McElhill home - without carrying out any checks. Nor, after the girl's removal, was any risk assessment carried out on Caroline or her siblings.
The police had been called out to deal with an incident at the McElhill home. By chance - yes, by chance - the PSNI's local designated risk manager overheard a communication about the call-out and informed the officers about McElhill's history. The police informed social services, but no action was taken until the following day, when the designated risk manager rang and advised the immediate removal of the visiting child.
The reason given for the failure to assess the risks posed to Caroline and her little sisters and brothers was that their mother had been designated their protector. In my view, this showed an unforgivable lack of understanding of the dynamics of families dominated by an abusive and violent man.
Lorraine had already failed to attend meetings with a health professional who was meant to monitor her role as protector. She objected to her partner's past offences being raised in relation to the visiting children. She told social workers that Caroline had overreacted to the row she'd overheard.
She was, in short, a typical victim of long-term domestic violence. Arthur McElhill was also a drinker and suffered from depression. Burdened also by poverty and the demands of a large family of young children, Lorraine, it seems, had been defeated. She was not in a position to protect herself or her children. She was protecting the abuser.
Lorraine was just 15 when she became pregnant to Arthur McElhill in 1993. He was 22 and awaiting sentence for a brutal indecent assault on a 17-year-old girl, who would later say that she had feared for her life. McElhill got a suspended sentence. In 1996, he indecently assaulted another 17-year-old girl.
He was sentenced to three years in jail and placed on the sex offenders register. After his release, he was classed as at high risk of reoffending. Soon afterwards, he moved in with Lorraine and the family grew.
In 2001, the social services file on the family was closed. When it was reopened, in 2007, without the inclusion of vital information, it was placed on a waiting list for allocation to a social worker, along with more than 200 others in the western health trust area. Cases involving sex offenders and domestic violence are not routinely given priority.
The review, like so many before it, is littered with references to failures in the system. Reports were not presented. Minutes were not written up. Key professionals did not attend meetings. There was no liaison between agencies. Protocols and guidelines were not enacted or not followed. Health visitors and school teachers were not informed that there was any cause for concern.
Lack of resources emerges, predictably, as a fundamental problem. The social work team leader was on a job-share, the other half of which had not been filled. Young and inexperienced social workers were left to make crucial decisions with neither support nor key information. Union representatives speak about a crisis, with overstretched frontline workers already unable to cope.
This is tough, demanding and complex work. Further swingeing cuts to social service budgets are pending.
During the Troubles, the level of domestic and sexual violence in the North was masked by the political violence. That is no longer the case and it is now starkly apparent that in the North, as in the Republic, male violence against women and children is disturbingly prevalent. At 13, Caroline McElhill did her best. That is so much more than can be said for the authorities.