Professionals Against Child Abuse

Article republished with permission from onmedica.com

Author: Dr Heather Payne, consultant paediatrician

Child Protection work is demanding, sensitive and often difficult, and generates much anxiety for all concerned – children, parents, and all professionals including Paediatricians.

If, like me, you deal with child protection matters on a daily basis, you probably, like me, spend a fair bit of time reflecting on how the process works, and whether it does what it says on the tin. It’s not protecting children to remove them from non-abusive parents. Neither is it protecting them to leave them with abusive ones. There are many things we know we don’t know, like the EXACT significance of fingertip bruising, or of a simple skull fracture attributed to a fall.

The truth is that some of these injuries will be accidental, but some will be NAI, and it can be extremely difficult to get it right in every case. Err in one direction, and a baby goes home to further risk of abuse and may come back dead. Err in the other direction, and enormous distress is caused by unnecessary hospitalisation of the child or removal to foster care.

Until recently, I had confidence that the Child Protection process, (based on many years of ‘Working Together’ [1] with Social Services, Police and other colleagues highly skilled in this field) would protect both me and the children it was put in place to serve. The deal, reinforced by the Laming Report [2], is this: when you see a child who MAY have suffered NAI, but you are not sure, then use the Child Protection procedures to involve other eyes and ears, share information and come to a collective decision about the risk to the child. I felt that there was safety in numbers (decisions taken with professional colleagues), and that this appropriate use of the ‘medical model’ would mean I could express concerns and get answers to tough questions like ‘Is it safe for this bruised child to be in this household tonight or should we remove to a safer place?’

But my illusion of safe practice has been shattered by two recent GMC decisions [3] about professional practice relating to the Paediatrician Dr David Southall. In direct opposition to the Laming recommendations, the GMC have adjudged that David Southall was wrong to share his concerns about a high profile child abuse case when he did not have the full information. But this is precisely what we are obliged to do under all Child Protection procedures, which use words to the effect that ‘if you have concerns that a child MAY be suffering abuse you MUST refer’. This reflects the reality, often called the ‘jigsaw of child protection’ that no individual has all the pieces, but requires the help of others to get the full picture.

When there is concern about abuse, it is vital to assess the risk to the child of remaining at home. This is especially the case when a child has died and there is therefore a risk to any other children of the household. High stakes and high pressure assessments are the name of this game. However hard I try to maintain professional calm, and however carefully I choose my words, it’s not unusual for stressed parents to construe my precise but neutral questions about how the child came by their injury as ‘an accusation that they have battered their child’. I had always thought that the presence of a social work colleague would protect me from this becoming a substantiated complaint, but the GMC have now discounted the stories of David Southall and a senior Social Worker who took contemporaneous notes, and believed a parent’s accusation that David Southall accused her of murder. He has been struck off and the protection I thought I had which allowed me to do this difficult work as well and conscientiously as I can, without the worry of losing my job, is no longer there.

Nobody wants to get it wrong in Child Protection. Children’s lives and happiness are at stake in the short term. But in the longer term, the average Paediatrician is already walking away [4] from work in areas where they feel they are a sitting duck for those who would ‘shoot the messenger’. Courts delays in child care cases due to the lack of Paediatricians willing to provide Expert Witness reports are already directly affecting the lives of children and their families.

The rock of Child Protection work and the hard place of these GMC decisions [5] has led to this situation. The rock will not go away, so the hard place needs to examine itself and see whether its decisions are justified and really serve children, or whether the GMC has fallen into the first trap of child protection that we warn trainees about – always listen to what the child is telling you rather than just the parent.

References

1 HM Government 2006 Working Together to Safeguard Children http://www.everychildmatters.gov.uk/resources-and-practice/IG00060

2 Lord Laming 2003 The Victoria Climbie Inquiry http://www.victoria-climbie-inquiry.org.uk/finreport/finreport.htm

3 Chadwick DL, Krous HF, Runyan DK. Meadow, Southall, and the General Medical Council of the United Kingdom. Pediatrics 2006;117:2247-2251

4 Haines L, Turton J. Complaints in Child Protection. Arch.Dis.Child. 2008;93:4-6.

5 Williams, C. United Kingdom General Medical Council Fails Child Protection. Pediatrics 2007;119:800-802

Article from The Sentinel

Writer: Baronness Golding

It was I as the former MP for Newcastle under Lyme, who first asked for an investigation on the use of CNEP as a treatment for desperately ill babies with serious breathing problems. I did this following evidence shown to me by Mr and Mrs Henshall which was, for the main part, not directly related to the North Staffordshire Hospital. Since then, I have followed closely media reports of the various actions being taken against paediatricians, especially Dr Southall. I have often looked in disbelief at the virulent attacks on Dr Southall and have had many unquiet moments about the way I first dealt with Mr and Mrs Henshall’s concerns and whether I could have dealt with them in another way. This latest action by the General Medical Council in banning Dr Southall from working leaves all doctors at risk. When the third person in the room at the time spoke against the latest accusation, her independent evidence was not accepted by the GMC investigators. Where does that leave doctors’ protection against malicious patients?

Mike Wolfe’s recent column in The Sentinel on the evidence before the General Medical Council was ill informed and unbalanced, and follows the usual low standard of reporting on the case against Dr Southall.

I disagree totally with my colleague Paul Farrelly MP’s assertion that the GMC got its judgments absolutely right in banning Dr Southall from working. I have to say to him that listening to hospital gossip is not the best way to judge anyone. All doctors have their critics, some more vocal than others.

Have Dr Southall’s critics ever seen babies struggling for each breath? Have they ever looked into the face of a policewoman as she brings yet another small, unkempt and dead baby into the accident unit? Have they ever seen a mother half smother a baby and then cry out for help that the child has stopped breathing? Have they ever seen the strain on the faces of dedicated people as they struggle to bring sanity to the lives of children who have been serially abused? Have they ever listened to the words of denial of adults for the broken limbs or sickness of their children who have been serially abused? Have they ever looked into the eyes of children whose fear is locked inside them? These things I have seen. Dr Southall and other paediatricians will have seen such things many, many times. They will ask, as I have often done - who speaks for the child?

My contribution was to spend year after year as an MP, fighting to get the law changed to let children’s voices be heard in the courts. My battle was won - Dr Southall and others like him can never and should never stop being the voice of the child.

When I first met Dr Southall I was impressed by his commitment to help and protect children. Nothing that has happened since has led me to think I was wrong. Only a person who believed in what he was doing could survive the abuse he and other paediatricians have put up with for so long. I ask the question, why? These doctors hae, over the years, worked in a spotlight where their every moved was liable to be questioned. In whose interest? At what cost? The medical world should never stand still. Adults’ voices can always be heard, but who should speak for the child?

Mr Farrelly has said that “sorry” and “apologise” appear not to be in Dr Southall’s personal dictionary. I hope they are, because I wish to apologise to him and say how sorry I am if my initial concern has given fuel o what can only be described as a witch hunt, aided and abetted by some professional people who surely should know better.

Baroness Golding