Progess in child protection since the Cleveland child abuse scandal

The 1987 Cleveland child abuse scandal saw 121 children removed from their families. Natalie Valios finds out what has changed for professionals when they take on abuse cases today.

Many will remember 1987 as the year the great storm hit the south of England. In Cleveland, it will go down in history as the year that child protection professionals were battered by a storm of quite another nature.

Over the course of a few months, two paediatricians diagnosed sexual abuse in 121 children from 57 families in the area. Most of the children were removed from their homes under place of safety orders. This unprecedented situation came at a time when professionals were waking up to the existence of child sexual abuse. One factor in this was the launch of ChildLine in 1986. High profile inquiries into the deaths of Jasmine Beckford and Tyra Henry in their family homes combined to form a climate where social workers were wary of leaving children in potentially abusive situations.

Norfolk paediatrician Rosalyn Proops was working in Edinburgh and then East Anglia during the Cleveland months. “It was a time when UK paediatricians were hearing about concerns of sexually abused children from the USA. We were realising that a number of children we were seeing may well have been sexually abused.”

When the Cleveland story broke, Proops’ boss said he supposed that a child he had seen years ago who had gonorrhoea “probably didn’t catch it from the toilet seat”.

“For paediatricians, Cleveland was a defining moment in realising that the unthinkable did happen to children,” Proops says.

In June 1986 Sue Richardson was appointed to the new post of child abuse consultant by Cleveland social services department. Faced with the paediatricians’ diagnoses, she thought the only way forward was to remove the affected children from their families.

The 1988 inquiry into child abuse in Cleveland, chaired by Baroness Butler-Sloss, blamed the crisis on lack of proper understanding by agencies of each others’ functions lack of communication between agencies and a difference of opinion by middle managers which weren’t recognised by senior staff and then affected those on the ground.

Twenty years on, Richardson says she is still waiting for the real lessons from Cleveland to be learned. “The majority of children can’t speak about the abuse and they need adults to diagnose it. The ones who couldn’t tell anyone what had happened were our controversial cases. Nobody has yet addressed how those children can be protected.”

Many in the field argue that it is still no easier to get child sexual abuse out in the open today than it was then. Tink Palmer, director of Stop it Now! UK and Ireland, a public education campaign to prevent child sexual abuse and a project of child protection charity the Lucy Faithfull Foundation, says: “There have been new laws and procedures, practice and policies and that’s all very good, but they’re applicable to the children we know about. But research shows us that we are dealing with about 10 per cent.

“Eighty per cent of children are sexually abused by someone known to them. This means they aren’t going to be able to report what is happening easily.”

Palmer says that we as a society have failed to get to grips with the embedded issues of child sexual abuse in our communities and how we get that into the open. “Since the 1997 publication of Sir William Utting’s report People Like Us there has been no or little progress in bringing abusers to justice and securing convictions or providing adequate help and treatment for abused children,” she complains.

Lord Laming, whose name has become synonymous with child protection since heading the Victoria Climbie Inquiry, agrees “the position is rather patchy” when it comes to diagnosis of, and response to, cases of child abuse.

“In many places there is much better interagency, multi-professional working and there’s more sensitivity to listening to children and taking their concerns seriously,” Laming says. “My concern is that this isn’t assured everywhere and there are still times where children feel they aren’t heard and too much attention is focused on the adults in their lives and not them.”

For Laming, who was social services director at Hertfordshire in 1987, the biggest thing that has happened since Cleveland is the passing of the Children Act 1989, which he regards as an ambitious piece of legislation that includes, but goes beyond, child protection.

“The saddest thing is that we are still some way off from implementing it so that children can benefit from the different ways of providing assistance to them and their families,” he says.

Laming is now pinning his hopes on the new local safeguarding boards, bought in to replace Area Child Protection Committees under the Children Act 2004. “I hope they will usher in a new era of effective interagency working,” he says.

For professionals, raising the issue of child abuse remains as difficult as it was 20 years ago. Earlier this month, 50 UK paediatricians accused the General Medical Council of deterring doctors from raising child protection concerns through its treatment of paediatricians David Southall and Sir Roy Meadow.

Proops, who is also the child protection officer for the Royal College of Paediatrics and Child Health, says: “There are few times when a doctor can say with any degree of confidence that a child has been abused. Most of the things we find when we examine children can have occurred through a number of different ways. It’s about probabilities.”

However, while everything during Cleveland hinged on the medical diagnosis – in particular anal dilatation – now looking at the anus is just part of the clinical examination of a child and is not as significant as it used to be, says Proops. And multi-agency working, supervision and peer review ensure that doctors are properly supported and not left to work alone on difficult cases.

“If we are concerned, we will want to find out more and talk to health visitors, social workers, GPs and that’s how you build up a jigsaw of finding out what has happened so you can decide whether they have been abused,” Proops says. “All forms of child protection must be managed in a multi-agency way.”

Proops thinks there have also been important changes in the intervening years when it comes to identifying abuse. “Paediatricians have more experience of examining children so we know that minor abnormalities are just that and not something to be worried about. They are not as definitive as we thought they were 20 years ago, for example the size of a hymen opening in a pre-pubertal child.”

There is also more research, and in November the RCPCH is due to publish evidence- based guidance on the physical signs of child sexual abuse.

The majority of the Cleveland children were eventually returned home with all proceedings dismissed. Nowadays the approach to child abuse allegations is more measured, with the onus being on removing the perpetrator from the home rather than the child.

Viv Hogg, team manager for one of two access and assessment teams at Gateshead learning and children’s services, started working in child protection 12 years ago. Then the emphasis was on preventing danger rather than building safety, often resulting in removing children from their parents. “Now we look at how we can ensure the child is safe within the setting they live in,” she explains.

Despite this, Richardson believes that the legacy of Cleveland is “fear of controversy, and fear of getting it wrong”. As one who was caught up in the eye of this storm, it is hard not to take her concerns seriously.

The Lessons
Improvements in diagnosing and responding to child abuse since 1987:

• Greater interagency working, supported by new Local Safeguarding Children’s Boards
• Clinical examinations backed up with multi-agency working, supervision and peer review
• More experience and research around the physical signs of child sexual abuse versus natural minor physical abnormalities
• Greater focus on ensuring the child is safe within the setting they live in, including removing the perpetrator from the home rather than the child

Further information
Working Together guidance, 1999 and 2006 

Achieving Best Evidence in Criminal Proceedings: guidance for vulnerable or intimidated witnesses, including children, 2002

Signs of Safety: A Solution and Safety Oriented Approach to Child Protection Casework 

The Resolutions approach was developed in Bristol in 1992 to work with families who were in denial or in dispute with authorities

Contact the author
 Natalie Valios

This article appeared in the 26 April issue under the headline “Twenty years of progress?”

This weeks other feature article:

Commissioning and children’s centres. How Hertfordshire broke the mould