Given the growing concern among paediatricians that the Children Act 1989 is failing severely abused and neglected children,1 the publication of this book is timely and welcome. It is one of a series of 20 publications, “Studies in Evaluating the Children Act 1989”, produced by the Thomas Coram Research Unit, Institution of Education, University of London. Drawing on both quantitative and qualitative research data, the book looks at three main areas: trends in the use of experts, the role of the legally appointed guardian, and the role of experts in care proceedings.

Not surprisingly, there has been an increase in the use of experts since 1989, with psychiatrists being most frequently called as experts (41% of cases), followed closely by paediatricians (35% of cases). The authors report that most cases involving expert evidence are neither controversial nor complex, and that cases involving contradictory evidence are few. Interestingly, when conflicts do arise between experts they tend to involve mental health specialists and centre on the proposed care plan rather than the necessity of a care order.

Guardians see themselves, as do the courts, as experts in the field of social work and child care matters. Most guardians see themselves as competent to assess attachment and bonding, undertake risk assessment, identify mental health issues, and identify expert clinicians. Overall, guardians are most likely to instruct child and adolescent psychiatrists. Most are not satisfied with locally based child and family mental health services and tend to instruct experts from a small “elite” with considerable experience of legal proceedings who work on a national basis. The authors note that these experts are unlikely to be able to offer any treatment to the children they are asked to see.

The final study reported in the book examines the views and experiences of child and adolescent psychiatrists. The findings are revealing and concerning. Child and adolescent psychiatrists working in this field do so outside of the National Health Service, and as such are not accountable. The psychiatrists interviewed freely admit that there is no consistent theoretical perspective underpinning their approach to child protection litigation—their approach is described as “eclectic”. Perhaps most disturbing of all, is the conclusion that without this unaccountable and eclectic elite, the system would collapse.

With regard to implications for future policy, the authors highlight the inherent tensions in the “welfare versus justice” approach to litigation and in the “forensic versus therapeutic” psychiatric approach, but are less clear as to the best way forward.

This book is well written and informative, but given the lack of paediatric input, cannot tell us where we should go from here. Speight and Wynne have given us a wake up call. This book suggests to me that it's time to smell the coffee.