Coercing GPs into attending child protection case conferences will do nothing to improve safeguarding
In the wake of the Baby P scandal comes a constant chorus of demands that GPs should be forced to attend case conferences about children considered to be at risk.
We are also obliged to complete comprehensive reports at short notice, to arrange weekly formal meetings with health visitors and midwives and to undergo regular training in the skills and procedures of statutory child protection. These proposals will certainly contribute to the unsustainable burden of paperwork (and expectations) now being imposed on primary health care, but I doubt whether they will do anything to prevent parents and carers from abusing and occasionally even killing their children.
Though it is many years since I gave up on child protection conferences as a waste of time, I attended assiduously in my early days in general practice. I recall the business-like approach of the police, who were punctual and professional, by contrast with the casual inefficiency of the social workers, who were always late and ill-prepared.
I am not surprised to find that the police have now, in effect, taken control over these child protection conferences (not that this was much help to Baby P). I recall too the frustration that I and my colleagues felt over the refusal of social services authorities to take our concerns seriously and to provide support for families that were struggling with their children. These frustrations were compounded by the experience of trying to deter social workers from ill-judged interventions in families, the consequences of which we were sometimes left to manage over succeeding years.
I have undergone several bouts of compulsory training in child protection over the years. This has more in common with the “re-training” or “re-programming” of dissident intellectuals in Stalinist regimes than with any serious educational course. I have noticed that such training is often carried out by staff who have less practical experience – and sometimes less theoretical knowledge – about child health than the doctors and health visitors who are the targets of their indoctrination. The priority is not to pass on insights about risks to child health but to secure familiarity and compliance with the constantly changing jargon of this field. I have lived through times when children were “battered”, victims of “non-accidental injury” and then diverse forms of “abuse” and “neglect”; where once we were concerned with “protection”, now we do “safeguarding”, “welfare” has given way to “well-being”. One theme that has steadily gathered momentum over these years is the cynical preoccupation of professionals, not with protecting children, but with covering their own backs against the sort of public and professional retribution that attends cases such as that of Baby P.
As a direct consequence of the Baby P case, there has been a dramatic increase in peremptory demands for medical reports on children deemed to be at risk and demands that GPs attend case conferences. For practical purposes, playing the “safeguarding children” card now trumps any concerns about patient confidentiality, for all family and household contacts. There has also been a sharp increase in coercive interventions in families, including the removal of children. For doctors, the Hippocratic injunction “first do no harm” raises the question of whether sometimes we have a responsibility to protect children and families from authorities waving the flag of “child protection”.
Michael Fitzpatrick is a GP in Hackney and author of Defeating Autism: A Damaging Delusion, published by Routledge
This article is published in the 22 April 2010 edition of Community Care magazine under the headline Child Protection Training is as Much About Fluency in Jargon