27 Nov, 08 | by BMJ
As if “Baby P” wasn’t bad enough, now we hear about 2 women and 19 pregnancies resulting in 7 surviving children. The nearest we have to a name for this case is “the British Fritzl.” This somehow sums up the dehumanisation of abuse – these victims are without even the dignity of a public name; rape is about power as much as sex.
We will now enter a media orgy of blaming professionals. I look at these cases and wonder whether I have missed one a bit like this, but not for want of trying.
There are times when we are, with the current state of knowledge, powerless to do anything. Our suspicions remain just that, and we are not able to find enough evidence to prove them to even the balance of probabilities, which would be enough for a child care legal case (not a criminal prosecution of a suspected perpetrator, which requires proof “beyond reasonable doubt”). We are left wondering, sometimes for years.
We know that the serious case review on Baby P identified times in the months (and 60 contacts with professionals) leading up to his death when things could have been different. This was a child well known to child protection services. Whether or not we call them “errors” is not the most important thing, as it distracts us from practical progress in these situations. We need open discussion about what went wrong but not professional victimisation.
We should focus on what could have been done differently. Each professional group should identify how they might have modified their practice to fill the gaps. This never really happens in a part 8 or serious case review- these are usually external to the people really involved. Yes the professionals are questioned by the reviewers- but it’s not really a constructive process in many cases, and frequently results in anodyne conclusions that the death was not preventable and that what is needed is more adherence to procedure, better interagency training and communication. These have been the simplistic (and entirely predictable) conclusions of almost all the part 8 or Serious Case reviews in the UK over the past few decades. They don’t seem to move us forward.
When bad things happen to children like this, we need a complex and effective response to a complex and difficult problem. People (including me) justifiably want to know the answers to questions like “how on earth did they miss those rib fractures?” and “what were social services doing ignoring bruises in a child on the register?” or “how did nobody notice that 2 young pregnant women had no boyfriend?”
Those of us who work in child protection know that you can get caught out very easily by taking things at face value. The answer to the above question about rib fractures is that if you don’t have X ray eyes and nobody has communicated any urgency to you about the child, you might well accept the parents story that the child is “under the weather” and not examine them thoroughly on that occasion. Without the full information we should not jump to the superficial, facile explanation.
What we do need is the direct answer to the judgement question, and some analysis of why a decision was a good or a bad judgement, This is much more complex and layered, takes more time and knowledge, but is ultimately the only way to create answers to help things improve. At the moment we just rake over the bones. Baby P and these nameless children deserve more.
Heather Payne, 26 November
Heather Payne is a consultant paediatrician in Caerphilly with a special interest in fostering, adoption and child protection. She is also an associate dean for educational support and disability in the Wales postgraduate deanery.