Niall Dickson BBC Social Affairs Editor

Victoria Climbie's parents sent their daughter to the United Kingdom for a new life.

Instead the eight-year-old was starved and beaten until she could cry no more.

Her killers were her great aunt and her boyfriend.

But the inquiry team said eight-year-old Victoria could have been saved if police social workers and doctors had done their jobs properly.

The fact Lord Laming so often has to state the blindingly obvious is a testament to the gross failings

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There were failings at every stage in every organisation that had a responsibility to the girl.

The police, as one officer put it, "in the A to Z of investigations did not even get to B".

In the hospitals, established good medical practice "was not practiced".

Some of the social work was "a disgrace".

New structure

The greatest failing was among senior people who were accused of "incompetence" and "buck-passing".

In many ways, the recommendations of the Lord Laming inquiry are as revealing as the commentary.

Part of Lord Laming's answer is a new structure of accountability

The fact Lord Laming so often has to state the blindingly obvious is a testament to the gross failings of the child protection services.

For example the 44th recommendation was "staff working with children should be regularly supervised".

And the 52nd recommendation was no case should be allocated to a social worker unless he or she has received the necessary training and experience.

No one emerges with much credit in this report, least of all senior staff in all agencies, many of whom were found to be inept and incompetent and then passed the buck.

Lord Laming's answer in part is a new structure of accountability, not just for child protection but for all children and family services.

Improvements

At its apex, a cabinet committee and a national agency with new co-ordinating boards at local level.

It is far from clear ministers will follow this route precisely and many questions remain about the inquiry's proposed model, although radical reform of some kind now seems certain.

But of course if changing the structure was the entire solution, this problem would have been cracked long ago.

As the inquiry itself has recognised, there also needs to be major improvements in training, supervision and professional practice.

Only if those changes come about will this major investigation have proved worthwhile.