Who should we blame for the death of Baby P?
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6643 (Published 05 November 2014) Cite this as: BMJ 2014;349:g6643
- Emma Parish, editorial registrar, The BMJ, London, UK
- eparish{at}bmj.com
Some cases of child abuse are so awful that they indelibly mark the public’s consciousness and force us to review our whole approach to safeguarding children.
Victoria Climbié and Peter Connelly were both from Haringey in north London. Both were killed by their families. Both had had contact with healthcare, the police, and social services on many occasions. Understandably, such cases call into question the role and competency of professionals charged with identifying vulnerable children and protecting them from abuse and violence.
Last week’s illuminating BBC documentary Baby P: The Untold Story showed how social services bore the brunt of public loathing after Peter Connelly’s death, overshadowing the roles of the police, health workers—and indeed the perpetrators (www.bbc.co.uk/programmes/b04n6sm0).
Sensational newspaper headlines—for example, the Sun’s “Blood on their hands” with its campaign calling for the sacking of all the social workers involved—fuelled the frenzied blame game that followed the announcement of Peter’s death.1 Misconceived comments by politicians didn’t help.
David Cameron, then leader of the opposition, remarked at prime minister’s questions in 2008, “This is a story about a 17 year old girl who had no idea how to bring up a child. It’s about a boyfriend who couldn’t read but could beat a child, and it’s about a social services department that gets £100m [€128m; $160m] a year and can’t look after children.”2
But Tracey Connelly was 26 when Peter was killed, and Edi Carmi, senior social worker, concluded in her local review of the case that all the professionals involved in his care had “made mistakes.”3
The BBC documentary went on to consider Sabah Al-Zayyat, a locum paediatrician who assessed Peter at St Ann’s Hospital, London, two days before his death. The hospital’s team of four consultants was two posts down, with another on long term sick leave. The team had previously raised concerns about clinical safety because of stretched resources to local management and Great Ormond Street Hospital, which was managing doctors at St Ann’s.
A report after Peter’s death found that Al-Zayyat had been appointed to a role beyond her competencies and into a department already flagging up difficulties. Complete medical records and appropriate nursing support were not available to her when she saw Peter.4 Al-Zayyat was vilified in the media as incompetent, and she received death threats.
The police had taken part in multidisciplinary team discussions about Peter when he was admitted to hospital with injuries suspected to be non-accidental in December 2006 and June 2007. Yet their handling of the case received relatively little media attention, the BBC documentary said.
Increasingly overwhelmed
How do we identify which families need support and which children need more protection to ensure their health and wellbeing? We rely on the professionals who they come into contact with, but they are increasingly overwhelmed.
In England in 2012, 600 000 children were referred to social care, and 400 000 of them were judged “in need” as defined by the Children Act 1989—that is, potentially requiring support from the local authority. More than 42 000 had a child protection plan in place, and 65 000 were being looked after by their local authority.5
Between 2007 and 2012 referrals to social services steadily increased by 11%; initial assessments rose by 48%; the number of children with protection plans by 29%; and the number of children looked after by local authorities by 12%.5
It is increasingly difficult to recruit and retain the staff who do this work. As of September 2013, 3610 of the UK’s full time equivalent children’s social worker posts (out of a total of 26 520) were vacant. Each social worker had an average of 17 “children in need” to care for, and some as many as 36.6 Are these numbers sustainable?
All paediatricians can tell you of a case of child abuse that was missed. Those who commit these crimes are often good at hiding the evidence, even from other family members and neighbours. Children should not be removed from their families lightly.
In his inquiry into Victoria Climbié’s death, Lord Laming stated that “the greatest failure rests with the managers and senior members of the authorities whose task it was to ensure that services for children, like Victoria, were properly financed, staffed, and able to deliver good quality support to children and families.
“In this day and age, it must be reasonable to expect the free exchange of information within the National Health Service.”7 Yet seven years after Victoria’s death in 2000, these lessons had still not been learnt.
Professionals need to have all the relevant information to be able to collaborate properly. We need ways of sharing information much quicker than the nine months it took to collate the information for the local review into Peter’s death.3
Child abuse increasingly concerns our communities. High profile investigations, such as that into the wide scale abuse in Rotherham,8 make its unseen ubiquity shockingly obvious.
Terrible crimes
Peter’s parents and Victoria’s aunt were responsible for terrible crimes. The BBC documentary showed that calls from the media to hold individual professionals accountable distracted from who was really to blame.
Ed Balls, then secretary of state for children, schools, and families, ordered an investigation “independent of politics” into Peter’s death to be done in just two weeks, which led to the dismissal of Sharon Shoesmith, Haringey’s head of children’s services. Four years on the courts ruled that her dismissal was unfair.
Professionals in healthcare, the police, social services, and education try to make the systems impenetrable to the missed opportunities for communication; search for the patterns that can be hard to spot; and ensure we have done all we can to protect children.
However, our greatest challenge is doing all this but knowing that the outcome may still be the same.
Notes
Cite this as: BMJ 2014;349:g6643
Footnotes
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I am a paediatric trainee, London Deanery (currently out of programme).
Provenance and peer review: Commissioned; externally peer reviewed.