NO one was there for Sadie Milson when it mattered. The attentions of her mother, Fiona, were diverted at the crucial moments when Sadie discovered her lethal medicine.

Social services did not put her on the At Risk Register, despite Fiona's battle with heroin.

The Primary Care Trust failed to send a drugs-trained health visitor to ensure Sadie was not endangered by her mother's addiction, despite Fiona taking her daughter to the doctors several times.

Fiona says she was "left to fend for herself". That isolation resulted in tragedy. Sadie took her mother's methadone and it killed her. She was only 19 months old.

Her mother accepts that the ultimate responsibility to keep Sadie safe was hers - although the absent biological father should be searching his conscience, too.

Fiona has more than paid the price for her neglect. As well as losing her daughter, she has been convicted of manslaughter and may yet see her unborn child taken away from her.

The report into this terrible case states categorically that none of the agencies concerned "could have predicted or prevented the death of Sadie". But it also makes clear that more can be done to safeguard the children of drug-using parents.

With drugs so prevalent, it is surprising that Primary Care Trusts do not yet have clear protocols in place for working with pregnant women and parents who are addicts.

If the report's eminently practical recommendations are adopted, future children like Sadie will stand a much better chance.

Updated: 10:34 Tuesday, November 15, 2005