It is now some decades since the growing awareness of the different types of child abuse fundamentally changed the work of consultant paediatricians and of social workers. The idea grew that the protection of the child should take precedence over all other considerations, but this idea presupposes a well functioning system in which authority figures such as consultant paediatricians make few major mistakes.
The 1987 inquiry into the Cleveland sex abuse scandal, when dozens of children were taken from their families, showed that opinion regarding physical signs could be deeply divided, and the inquiry and subsequent episodes emphasised the damage that could be caused to families through ill considered opinion or action. In January 2003 Lord Laming, in the inquiry into the Victoria Climbié case, made numerous recommendations. These concerned health care and actions by professionals, but in the summary of the inquiry that the Royal College of Paediatrics and Child Health produced for paediatricians I saw no mention of safeguards for parents.
I saw no mention of safeguards for parents
From the legal point of view it is notable that the health authority or NHS trust has no duty of care to the parents while their child is in its care. This leaves the parents with little opportunity for redress. To the lay person the proposal that the child may in due course bring a retrospective action, but only for damage that the child may have suffered through negligence, does not seem to be of immediate relevance.
Retirement and having become a grandfather seem to have changed my focus. I find it difficult to accept that the only steps usually open to parents are to make a complaint to the very organisation concerned (until the organisation eventually agrees to allow an independent inquiry) or to try to obtain a judicial review (which is beyond the means of many parents). The only alternatives—appeal to the health ombudsman or complaint to the General Medical Council—are somewhat remote. Parents have to answer serious charges by a number of authority figures unaided, unrepresented, and in a potentially frightening environment. Even if an accused parent or carer were to have good answers to mistaken or unsupported charges by senior figures, there would still be a likelihood that the social services would retain a degree of suspicion or uncertainty. At the least this suspicion might result in placement of the child on the at-risk register, possibly with restriction of visiting or other orders. Does this matter?
A case involving a family I know well emphasises the power that paediatricians have, compared with that of social services and parents, irrespective of the merits of the parents' version of events. In this case the nursing staff may well have found the care of the child quite challenging: the child was still on a ventilator three years after a catastrophic neonatal illness but was making developmental progress and needed increasing mobilisation. The increased activity resulted in repeated temporary disconnections from the ventilator, each of which had to be reported and investigated.
For whatever reason, the paediatrician had formed the view that the original illness—for which no cause had been found—may have been caused by the parents and had set investigations in train. The repeated disconnections were now regarded as attempts by the mother to harm her son, despite the fact that the nursing and medical notes showed that on eight of 10 disconnections over a period of two months she was not present. Child protection proceedings were triggered on the last occasion.
Social services had to act on the paediatrician's account of the suspicions. Further observation, police investigation, and a forensic psychiatrist's report found no evidence of actual or intended child abuse, but not before the family had suffered severe stress, in fact just short of tragedy. The parents' account was later vindicated by the withdrawal of a nurse's accusatory report, as having been “mistaken.”
The Royal College of Paediatrics and Child Health recently expressed its concern that paediatricians are coming under stress from accusations linked to child protection. This suggests to me that all may not be well in a wider field, but it could be that not all the faults rest with the public. Such proceedings are inevitably stressful, and professional training and retraining would appear to be the best way forward, as Lord Laming and others have recommended.
It would also be helpful if accused parents due to face powerful professionals in a potentially intimidating environment had the right to submit the relevant papers to an independent professional and that an alternative view of the situation, if so held, could be presented. There are few other circumstances where an accused person risks (for them) such a serious outcome without representation.
I do not believe that such a measure would shield parents who abuse their children, as the parents' representative would need to be an experienced and independent professional in good standing, and it would help the maintenance of best practice in child protection work. Professionals who chair child protection conferences might welcome the opportunity to have additional opinions available when they have to make a decision in the face of uncertainty.