Logan Mwangi: Hospital 'failed to report extent of injuries' in year before five-year-old’s death
Report by Hamish Auskerry
Warning: This article contains descriptions of child abuse
Doctors who saw and treated five-year-old Logan Mwangi for multiple injuries a year before his death did not report them to social services, a safeguarding review has found.
Logan was murdered in July 2021 by his mother, Angharad Williamson, stepfather, John Cole, and Cole's son, Craig Mulligan, after suffering extensive physical and emotional abuse at their hands.
His body was found dumped in the River Ogmore in Sarn, Bridgend. He had suffered 56 external cuts and bruises and "catastrophic" internal injuries, which were likened to those seen in a fall from a great height or a high-velocity car crash.
At the time, experts said the injuries could have only been caused by a "brutal and sustained assault" inflicted on Logan in the hours, or days, before his death.
Following a trial earlier this year, John Cole was sentenced to life imprisonment and ordered to serve a minimum of 29 years. Angharad Williamson was also sentenced to life imprisonment and was ordered to serve a minimum of 28 years, while Craig Mulligan was sentenced to 15 years.
A child practice review into the care he received from the police, his school, social services and hospital staff who treated him during his short life, identified multiple missed opportunities by healthcare professionals to report a catalogue of injuries inflicted on the five-year-old.
It said its findings may be "systemic" failures and not isolated instances of "poor practice".When Logan first attended A&E in August 2020, the review found "no evidence" that information about the extent of his injuries "was shared with agencies outside of the health board".
Several of these injuries "even in isolation" should have triggered a referral.
On 16 August 2020, Logan was taken to hospital with injuries his mother and stepfather claimed were sustained from a fall down the stairs. He had an injury to his arm, bruises on his right cheek and a fractured arm.
Staff raised concerns about "the delay" it took for Logan's mother to seek medical attention.
The police and social services agreed the threshold to launch child protection enquiries had not been met, based on "limited medical information". No one from the hospital was present at this discussion.
Police carried out a home visit on the same day after talking to social services.
Officers spoke to Williamson and Cole and reported that the explanations provided were "consistent" with a fall down the stairs.
However at the time, the true extent of Logan's injuries were not known to the police or social services and only came to light when investigations began for the safeguarding review following Logan's death.
On the day the five-year-old was taken to A&E, a paediatric consultant carried out a further assessment and thirty one images were taken of his injuries.
The injuries recorded were:
• 1cm blue mark above penis• Superficial erythema, a skin reaction that can be triggered by an infection, to ankle and two 2cm bruises• Two bruises to forehead• Bruising to the top of both ears, bruising behind one of the ears• Bruises to both cheeks• Carpet bruise to chin• Bruising to left arm and generalised bruising around fractured shoulder
The review found "no evidence that information about these injuries was shared with agencies outside of the health board".
The review goes on to state: "Several of the injuries, even in isolation, should have triggered a referral."
The lack of information sharing highlighted an issue about the culture at the Cwm Taf Morgannwg Health Board, where junior members of staff felt unable to challenge more senior colleagues.
Ultimately, this led to safeguarding concerns going unreported to other services, the review said.
Jan Pickles, who oversaw the review told a press conference, it was "a significant missed opportunity" that reports of Logan's injuries were not passed on.
She said as a result of this, no agency was "ever able to develop a full picture of what was happening".
Dr Dan Hurford, Medical Director at Cwm Taf University Health Board told a press conference on Thursday afternoon there are a "number of actions" already in place to improve safeguarding.
"We apologise to Logan's father, we apologise to his family to all of those who knew and loved him. We apologise about the failures in our systems that could have presented earlier opportunities to recognise abuse and protect Logan. We fully accept the recommendations."
Claire Marchant, the Director of Social Services at Bridgend Council also apologised for the failings during the press conference.
"The fact we were unable to protect Logan will always remain a source of great sadness", she said.
"The review has identified there were opportunities to share information... Mr Mwangi was not told his son was on the register, as a council we apologise unreservedly this was the case", she added.
Following the unanimous agreement by professionals to take Logan off the child protection register, as he was no longer deemed at risk of "significant harm", the decision was made not to inform Benjamin Mwangi. He had last seen his son in 2019 when Williamson andLogan travelled to his home in Essex but Cole forbid Williamson to see her the father of her child again.
"Speaking previously about his son, Mr Mwangi said: "Logan was the sweetest and most beautiful boy whose life has been tragically cut short. The world is a colder and darker place without this warm smile and the happy energy with which he lived his life. The hole that has been left in the hearts of all who knew him will never be filled."The review also found that despite interactions with different agencies, Logan's "voice was not heard" and the complex home environment and adult relationships "overshadowed professionals’ line of sight to him".
Logan's stepfather John Cole was reportedly a former member of the National Front and repeatedly racially abused Logan in front of other members of the family.
In another part of the report, it was found social services had not been sensitive enough to how Logan’s race impacted his life experience.
The report said, “Professionals did not fully explore the content of [Logan's] race and ethnicity on his lived experience."
It continues that “with the value of hindsight” both Cole and Craig Mulligan, Cole’s son, “held and expressed racist and discriminatory views” that “one would expect would have made life very hard” for Logan.
There were also concerns around Cole’s previous convictions which included assaulting a child, as well as domestic abuse, possession of an offensive weapon, theft and illegal drug possession.
There was found to be “a lack of curiosity” about the risks Cole posed.
Cole was described as manipulative, and able to “effectively” dupe “his partners and some professionals he came into contact with”.
The review also highlighted Cole, Williamson and Rebecca Trudgill, Craig Mulligan’s mother, were in a “polyamorous sexual relationship” they called “Banshee”.
The sexual relationship between the three adults meant Logan had “frequent close contact” with Cole, as well as Mulligan.
What else did the review find?
Due to the covid pandemic, the review stated there was an "absence" of one-to-one sessions undertaken with Logan with lockdown restrictions in place which led to "pressures upon child protection systems at that time, such as high levels of staff absences due to the Covid 19 pandemic."
There were gaps in risk assessments and specialist skills around interrogating and analysing evidence such as the family reporting different versions of events and family relationship histories.
Throughout the pandemic period, it said there were "clear and consistent efforts" made by Logan's school to keep in touch with him and his family.
It also said police responded to all requests for help, concerns from agencies involved and members of the public in a "sensitive and timely manner."
What does the report recommend?
The report has made 10 local recommendations and five national recommendations following Logan’s death.
These include urging Cwm Taf Morgannwg Health Board to commission an independent review into its practice and management of identifying and investigating non-accidental injuries in children.
Nationally, it suggests the Welsh Government should consider commissioning a review of approaches to undertaking Child Protection Conferences to help with identifying best practice, as well as the possibility of an annual National Awareness Campaign to raise public awareness on how to report safeguarding concerns.
How have politicians responded?
The Deputy Minister for Social Services, Julie Morgan said the government accepts the recommendations and "must learn lessons from this review".
“This is a tragic case and our thoughts are with everyone affected by Logan’s death, particularly his father.
"I have been deeply shocked by events leading up to Logan’s death. The pain and suffering he must have experienced is truly horrifying.
“I welcome the publication today of the Child Practice Review and thank all those who have been involved in conducting the review. We must learn the lessons from this review and we accept the recommendations relating to Welsh Government. I expect all agencies involved to take time to digest this and we will work with them to take forward the other national recommendations to ensure changes are made.
“I want to repeat how sorry I am to Logan’s father and reiterate my commitment to improve services to ensure vulnerable children are protected. I will make a further statement in the Senedd on Tuesday.”
The Welsh Conservatives said it is calling for a Wales-wide review of children's protection services and highlighted the issue of using agency workers in understaffed departments.
Shadow Social Services Minister Gareth Davies MS said, “The report also shows the Council being quick to blame Covid for some of its shortcomings, but it does suggest that the Labour Government’s guidance was not clear or responsive enough to allow social workers to properly safeguard vulnerable children during the pandemic.
“It is clear that in addition to Bridgend Council implementing the report’s recommendations, we need a Wales-wide review of children’s services which, sadly, Mark Drakeford continues to block despite Wales being the only UK nation not undertaking one and having the UK’s highest rate of looked-after children.”