Has child protection become a form of madness? Yes

Dear Sir,

I feel obliged to respond to the rather silly debate presented in
your last issue of the BMJ as regards safeguarding children. Devoid of
facts, the debate from both quarters was ill informed and in my view
completely missed the fundamental point of multi agency safeguarding.
Crucially, that there is a huge and largely unknown population of children
nationwide who are extremely vulnerable and who exist below the scrutiny
of responsible agencies. Their only lifeline is the alertness of those
professionals with whom the come into contact and the efficacy of local
processes.

Taking my own relatively small county of Dorset as an example; we
have a child population of around 80,000. Every month, some 300 referrals
of children considered to be at risk of serious harm are made to
Children's Services. Following assessments, at any one time, approximately
300 children are subject to ongoing child protection plans. Something like
3000 children every year have been the subject of referrals but did not
reach a threshold for intervention. This does not make them any the less
vulnerable and these children added to an even larger group of children
and families considered to be "in need" make up a local population,
potentially in excess of 8000, of children at some risk. These children
and of course, a further group of vulnerable children whose carers have
deliberately kept them out of view of safeguarding professionals, will
attend universal services such as children's centres and schools and will
sooner or later, present in health settings, including GP Practices.

The upshot is that, a Dorset GP could be seeing several really
vulnerable children every week and if the practitioner's level of
awareness and the Practice's processes for record keeping and information
sharing are not up to the task, the GP may be routinely missing signs of
abuse or excluding opportunities for exchanging information with another
professional. If this scenario looks familiar, its because it appears in a
lot of Serious Case Reviews and was certainly a feature in the Victoria
Climbie and Peter Connelly Inquiries.

Actually, the level of engagement of Dorset GPs with multi agency
safeguarding arrangements has never been higher. There is an impressively
large attendance at training events and information sharing by GPs is
usually appropriate and effective. Every Practice has a named GP lead and
all their staffs receive annual training at level 2 or higher. Sadly I am
personally aware that this is far from the case across the country.

Ultimately, much of the bureaucracy could be eliminated. Lines of
communication could be considerably shorter and the inherent propensity
for human error reduced. Achieving this would require a root and branch
merge of health and social care functions and many professionals tasked
with the responsibility of making the current arrangements work, would
argue that this merge is long overdue. Until then, we have to make the
best of what we have.

I suspect that the tabloid - like banner that you chose for this
article "The Madness of Child Protection" implied your own acknowledgement
that the arguments presented in it were less the result of analysis and
insight and more a populist meander supporting the perceptions of a
witless minority that safeguarding is bureaucracy gone mad.