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Editorial

The Lancet, Volume 373, Issue 9678, Page 1819, 30 May 2009

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doi:10.1016/S0140-6736(09)61000-XCite or Link Using DOI

Urgent: a UK Commission on Child Protection

Original Text
The Lancet

Last week, three contradictory decisions made a mockery of child protection in the UK and Ireland by further adding to the confusion around how best to protect vulnerable children.

On May 20, Judge Sean Ryan released the final report of Ireland's commission into child abuse, which revealed that over the past few decades, more than 30 000 children were repeatedly raped, beaten, and molested by priests and nuns in Catholic church-run schools and orphanages. Now aged 50—70 years, none of the victims will have the justice that they deserve because none of their abusers will be prosecuted.

Then on May 22, the second review into the death of Baby Peter—who died in August, 2007, aged 17 months after repeated abuse—was released and stressed that his mother's continuous cover-up of his abuse was no excuse for the multiple agencies and individuals involved for failing to protect him. Indeed, after a media campaign, the General Medical Council (GMC) suspended the paediatrician who did not detect signs of repeated abuse immediately before his death. This second review states that professionals should use their judgment and instincts to pursue the investigation of potential child abuse, even in the knowledge that they may be mistaken.

Therefore, it is incomprehensible that on the same day as the second review was released and the UK Secretary of State for Children, Schools, and Families, Ed Balls, said that all professionals involved in child protection should act to put the child first and not be deceived by parents, the High Court upheld the GMC's decision to strike the paediatrician and child protection expert, Dr David Southall, off the medical register for doing just that. Mr Justice Blake threw out Southall's appeal against the GMC's decision, which was based on him allegedly accusing a mother of killing her son. Justice Blake confirmed the decision of a GMC panel and upheld the view that the mother was “an impressive, credible, and reliable witness in the central issues of the case”. In a press statement, the advocacy organisation, Professionals Against Child Abuse, said that this decision will be a further deterrent to paediatricians and other health professionals from getting involved in child protection work.

So, in light of all these conflicting messages, what are professionals committed to protecting children supposed to do? Child protection in the UK and Ireland is a disastrous mess and it is clear that no amount of reflex retribution, retraining, and tinkering around the edges will be enough to fix it.

One group of paediatricians and child protection workers believes that different types of child abuse need different ways of dealing with it. Premeditated child maltreatment by perpetrators who are deceptive, so this group argues, may need more and earlier involvement of specialist police units since the police cannot be intimidated by dangerous child abusers and can protect social workers and paediatricians.

A different view emerged from evidence reviewed in our child maltreatment Series. The Series authors argued that a change towards earlier police involvement may actually cause more harm to the large number of children who come from chaotic and incapable families with social instability. They advocated a comprehensive child and family welfare approach, where the emphasis is on addressing need, rather than a safety approach, which focuses on determining culpability. In their view, the welfare emphasis means that more maltreated children are likely to receive therapeutic and supportive services. And although they agreed that some types of child maltreatment do require criminal prosecution, the difficulty remains for paediatricians at the frontline to diagnose the different types of child abuse and refer to the appropriate services. Clearly there is no overall consensus among professionals on how to best serve the very people they try to protect—children.

Paediatricians need to speak up loudly and take the lead in a concerted effort to change the current, clearly inadequate system in the most appropriate way. The government should put the Children's Commissioner in charge to urgently set up a National Child Protection Commission that reviews all the evidence emerging from national and international data and devise evidence-based recommendations on how best to protect vulnerable children.

Society has the collective responsibility to do justice to the memories of 30 000 Irish victims, Baby Peter, Victoria Climbié, Ainlee Labonte, and all the other countless and nameless victims of damaging and life-threatening child abuse.

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Other Articles of Interest

Comment Supporting paediatricians who work in child maltreatment Carole Jenny. The Lancet 17 January 2009; Volume 373, Issue 9659: Page 195

Comment A dismal and dangerous verdict against Roy Meadow Richard Horton. The Lancet 23 July 2005; Volume 366, Issue 9482: Page 277

Comment When childhood dies Richard Turner,Richard Horton. The Lancet 3 January 2009; Volume 373, Issue 9657: Page 3

Series Recognising and responding to child maltreatment Ruth Gilbert,Alison Kemp,June Thoburn,Peter Sidebotham,Lorraine Radford,Danya Glaser,Harriet L MacMillan. The Lancet 10 January 2009; Volume 373, Issue 9658: Page 167

Obituary Vincent J Fontana Ivan Oransky. The Lancet 27 August 2005; Volume 366, Issue 9487: Page 710

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