More training is key to helping GPs and police improve child protection

None of the agencies involved in Victoria Climbie’s case are spared
criticism in Lord Laming’s report into her death.

“Not one of the agencies empowered by parliament to protect
children in positions similar to Victoria’s – funded from the
public purse – emerge from this inquiry with much credit,” he says
in his report.

While the majority of recommendations relate to social care, Laming
also highlights the need for significant improvements for police
and health care professionals over the next two years.

Starting with the police, three main deficits emerge: resources,
training and priority given to child protection teams.

Both child protection teams (CPTs) involved in Victoria’s case,
Brent and Haringey, were based in poor accommodation with “cramped
conditions, poor heating systems and difficult access”.

“Police vehicles were scarce, computer equipment was outdated and
inadequate, and offices were poorly decorated and equipped,”
demonstrating the low priority the service was given, says the
report.

The lead officer on child protection for the Association of Chief
Police Officers, Terry Grange, says a review of CPTs across the
service would reveal that child protection is seen as a marginal
activity. “Funding and resources are always a struggle. If you are
on the margins, you are on the margins in that struggle.”

Although Laming found no direct link between Haringey CPT’s
standard of service offered to Victoria and the adequacy of
resources, he said it would be wrong to discount the “corrosive
effect that a long period of neglect and under-resourcing” can have
on the morale and effectiveness of such a team.

Two recommendations call for an effective child protection database
and IT management system as well as ensuring CPTs are not
“disadvantaged in terms of accommodation, equipment or
resources”.

Closely linked is the low status attributed to CPTs. Evidence given
to the inquiry described CPTs as “cardigan squads” and the
“Cinderella” of the force.

“Strong efforts must be made throughout the police force to raise
the profile and status of child protection work to a level that its
importance deserves, thereby encouraging high-calibre officers to
apply,” Laming says.

Any suggestion that child protection policing is of a lower status
should be eradicated with government taking the lead, the report
says. The neglect of CPTs, at least in London, “may be due to the
lack of prominence given to such policing by central
government”.

It calls for the Home Office to ensure that child protection
policing is included in the list of ministerial priorities for the
police and for chief constables to give child protection
investigations a high priority in their policing plans.

Yet the first national policing plan mentioned child protection
just once (news, page 6, 28 November). Grange said he could not
find the word “child” once in the draft plan, but the final
document says “appropriate priority” should be given to child
protection.

“But how do you define appropriate? The Home Office should be more
specific,” he says.

Other police recommendations focus on training. Despite the volume
of evidence given in the inquiry, “it remains unclear exactly what
training was available”.

Laming’s report recommends that the Home Office should implement a
national training curriculum for child protection officers and
specific child protection training should be added to the syllabus
for the strategic command course.

Grange contends that the Metropolitan Police has “responded
magnificently” to what happened. In June 2000, a new child
protection command unit, SO5, was established, instigated by the
Serious Crime Group and headed by commander Carole Howlett (now
deputy assistant commissioner). This centralised all London
CPTs.

This was the “turning point” and “whole working practices changed”,
according to detective inspector Michael McDonagh, who heads Camden
child protection unit. He adds that officers attending the inquiry
gave feedback on issues raised, so many of the recommendations have
been pre-empted.

About £230,000 has been spent on new accommodation for the
Camden team. There has been an increase in officers and McDonagh
says “morale is high”. A new child protection IT package called
Protect has been introduced and this will be superseded this year
by the pan-Met system, Merlin.

Training in child protection has also increased from non-existence
to the introduction this year of a four-week course.

“Since June 2000, there has been a huge commitment from the Home
Office, the Metropolitan Police Authority and Metropolitan Police
Service to put child protection in the forefront of everyone’s
mind,” McDonagh adds.

Some of the police recommendations are echoed for the health
service. Laming believes that “GPs are an extremely important
element of the child protection framework”.

Victoria was registered with two GPs, Dr Indravadan Patel in June
1999 and Dr Wasantha Gooneratne in November 1999, but these records
amount to two registration cards containing basic
information.

Laming calls for the Royal College of General Practitioners to
explore the feasibility of extending the process of new child
patient registration to include information such as living
conditions and school attendance.

Had Patel asked these questions in Victoria’s registration he would
have established Victoria was not attending school and was living
in a potentially unsuitable hostel, and would then have considered
Victoria to be a child in need of careful monitoring.

GPs also need to ensure that all members of their practice staff
are aware of who to contact in local health agencies, social
services and the police.

But chairperson of the British Medical Association’s community care
committee, Dr Andrew Dearden, said he would be disappointed if most
GPs did not know a contact at social services or could not find out
relatively quickly.

Dearden calls for electronic centralised records, “so even if the
staff are not consistent, the information is”. But this is unlikely
to be introduced for at least five years, he warns, and raises data
protection issues.

However, in his general recommendations, Laming urges the
government to issue guidance on the Data Protection Act 1998, the
Human Rights Act 1998 and common law rules on confidentiality and
their impact on information sharing between professionals when
there are welfare concerns about children. And he again raises
training. “I was surprised to hear that an experienced GP such as
Dr Patel had never received any training or guidance in child
protection matters, particularly in the recognition of possible
deliberate harm.”

He says all GPs should receive training in the recognition of
deliberate harm to children and in the multi-disciplinary aspects
of a child protection investigation. The Department of Health
should look at introducing training in these areas for all general
practice staff and other primary health care staff.

The Royal College “strongly supports” these recommendations. “We
believe that the concept that the needs of children are paramount
must be made explicit in the undergraduate and postgraduate
education and training of doctors and other health care
professionals.”

Dearden agrees, but warns if GPs have to train in one specific area
every three years as suggested, it would have a “knock-on effect”
on other medical areas. Also, GPs are not always best placed to
spot abuse, as abusers are more likely to take an injured child to
casualty where there are no records, he says.

“What is needed is more training, more time and more awareness,” he
says, adding that with more time with a patient, a GP is more
likely to detect other problems.

“Ideally, where there is sufficient staff and funding, I would like
the vast majority of the recommendations to be implemented. But in
a situation where there is not enough staff or funds, my fear is
only the minority will be implemented,” he warns.

– For more background information on the Victoria Climbie Report
see www.communitycare.co.uk/climbie