Being more suspicious of abuse will not prevent deaths, says GP Michael Fitzpatrick

    The furore over the death of baby Peter in Haringey has led to doctors and social workers involved in child protection being urged to be more critical and invasive in their assessments. According to the Lancet our child protection system is “a disastrous mess”. Meanwhile, the British Medical Association has produced a 62-page child protection toolkit, exhorting doctors to “take immediate action when dealing with children at risk”.

    A powerful consensus has emerged from the various court judgements and inquiries and commentaries on the baby Peter affair. This echoes the conclusions that emerged from the earlier inquiries into the death of Victoria Climbié in Haringey – and indeed of similar scandals going back over 30 years. It is that inexperienced, poorly trained and inadequately supervised social workers and doctors were duped and bullied by manipulative abusers, and their actions were ineffectual in preventing gross neglect and serious, ultimately fatal, injury to these children.

    Yet, in a judgment described by the Lancet as incomprehensible – issued on the same day as the second official review of the baby Peter case – the High Court upheld the decision by the General Medical Council to strike off from the medical register the paediatrician and child protection expert David Southall. As the Lancet noted, children’s secretary Ed Balls, had insisted in response to the baby Peter case that all professionals involved in child protection should “act to put the child first and not be deceived by the parents” – yet Southall had been struck off for doing just that. Roy Meadow, the leading figure in promoting awareness and intervention in relation to child abuse in the UK, suffered a similar disgrace in 2005 (subsequently reversed by the High Court).

    One of the key themes popularised by Meadow and Southall and their colleagues was the need to “think dirty”, to suspect that when a child presented with obscure symptoms that these may be a manifestation of abuse. The recent BMA guidelines implicitly endorse this approach, one that has achieved a growing influence over the past 20 years in a society increasingly preoccupied with issues of risk and danger, not least in intimate relationships. Whereas the family was once regarded as a refuge for adults from the cares of the world and a safe haven for children, it has come to be regarded as a hidden realm in which abusive relationships thrive.

    Though Meadow and Southall suffered professional disgrace because of their involvement in court cases that ended up as miscarriages of justice, the misanthropic think dirty outlook that they promoted has endured, to re-emerge as the guiding principle of child protection policy after baby Peter. Though the ascendancy of this outlook from the 1980s onwards has provoked the occasional backlash, it did not prevent the deaths of Peter, Victoria Climbié or numerous other children.

    When it comes to recognising abuse, the difficulty for professionals in day-to-day contact with young children and their families is that the majority of parents and carers are deeply committed to the welfare of their children. It is neither possible nor desirable for doctors, nurses and social workers to adopt the default assumption that all parents are potential abusers. Nor is it legitimate to assume, as many recent commentators on Haringey have, that parents who live on low incomes are more likely to abuse their children. Professionals – and the public – must also acknowledge that no system can protect all children from abuse.

    Michael Fitzpatrick is a GP in Hackney. He lives in Haringey

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