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Ms Mildred Gordon (Bow and Poplar) : Does my hon. Friend agree that it is not only a question of physical damage, the fire bombing of houses, the fear felt by children on the way to school, attacks in the street which, if nothing is done about them, will eventually lead to someone being killed, or the fact that woman are afraid to go out at night and that whole parts of the east end which used to be lively are now dead after 9 pm ?
We must also consider the emotional damage that race hate inflicts on young children. A little boy of five with a bandage around his knee told me that he was bitten by a dog because dogs do not like black people. That is terribly sad, because children's self-image and their confidence is being destroyed by race hate. Is it not time that the Government--some of whose members have sent out racist signals on a number of occasions--sent out an anti-racist signal by doing something about the law ?
Mr. Gerrard : I agree absolutely. Sometimes it is easy to look at the extremes of violence and say that we must deal with the murders and arson, and ignore what may be regarded as the more trivial offences of abuse and graffiti. We may ignore the cumulative effect of such behaviour.
From time to time, we have all been insulted, but most of us do not have to deal with insults, abuse or personally directed graffiti every day. My hon. Friend the Member for Bow and Poplar (Ms Gordon) has drawn attention to the serious psychological damage that that causes. That damage reveals the need for subsection (2) of the new clause, which makes certain acts racial harassment offences. At the moment, victims of harassment do not trust the authorities--including the police, councils, voluntary organisations or schools--to take action. The feeling is that no one will help. Although many local authorities have improved their anti-racist policies and the police have improved their methods of dealing with racial crime, people's perception is still that no one will help them. For that reason, it is vital that the law should be changed. That would send out a message about public policy and make it easier to deal with the perpetrators of racial harassment.
There is no reason for complacency or for saying that we can wait and that there is time for study. It is time for action. I do not hold out much hope after what the Minister said earlier, but I should have thought that we might have a positive response tonight because people in our constituencies cannot continue to wait.
Debate adjourned.-- [Mr. Arbuthnot]
Debate to be resumed this day.
Motion made, and Question proposed,
That Mr. James Cran, Mr. Charles Hendry, Mr. Andrew Hunter, Sir James Kilfedder, Mr. Eddie McGrady, Mr. Ken Maginnis, Mr. Jim Marshall, Mr. Peter Robinson, Mr. Clive Soley, Mr. Richard Spring, Mr. John D. Taylor, Mr. David Wilshire and Mr. Mark Wolfson be members of the Northern Ireland Affairs Committee. -- [Sir Fergus Montgomery, on behalf of the Committee of Selection.]
Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Arbuthnot.]
Mr. David Martin (Portsmouth, South) : My luck in the ballot has enabled me to raise a matter of grave concern to individual constituents in Portsmouth which also has national relevance. The issue of child protection and child abuse is deeply emotive. Having children myself, and with active family involvement for many years supporting the fine work of the National Society for the Prevention of Cruelty to Children, I am well aware how easy it is to be misunderstood or misrepresented if one even questions, let alone criticises, fashionable theories and practice based mainly, these days, on the Children Act 1989 and the guidelines produced by the relevant Government departments since.
In the past 20 years, in the paramount interests of the child's welfare, we have given draconian powers to the state to interfere in everyone's home and family, principally through the agents of doctors, police, social workers, probation officers and employees of the NSPCC. We have given powers which require careful training, maturity, sound judgment, restraint and, above all, considerable common sense on the part of all those people to whom they are entrusted on our behalf.
If not so exercised, those powers can do immense damage and grave injustice to innocent parents and other adults, including teachers, who have the misfortune to have the finger merely of suspicion pointed at them, and who find themselves effectively having to prove their innocence of assumed guilt rather than the other way around. The facts of the case affecting my constituents, the Dunne family, are chilling. Mr. and Mrs. Dunne are responsible, decent people, happily married, with unblemished characters and no history of child abuse. They live in their own home in Southsea, in good financial circumstances, and have close family living nearby. They have two sons--Andrew, aged three and a half, and Stephen, aged six months. On 25 February, at 6.15 pm, Mrs. Dunne was bathing the then five-month-old Stephen when she felt a swelling on the right side of his head. She was very worried. There was no sign of bruising, and the swelling felt like fluid. Her husband returned home at 6.45 pm, and they immediately decided to go to the paediatric unit at St. Mary's hospital for casualty attention. They arrived at 7 o' clock and were registered at half-past 7. Stephen had not been seen by 10 pm. He was tired--they were sitting in a corridor--so Mrs. Dunne returned home with the child, the nurse suggesting a visit to their doctor the next morning.
They rang at half-past 8 the next morning, and saw Dr. Robinson at 9.45 am. She referred them immediately to St. Mary's again, writing a letter and telephoning to warn of arrival. By 11 am Stephen had not been examined. Mrs. Dunne suggested coming back when they were less busy, and the nurse said that she would telephone. They were telephoned at 3.45 pm and Stephen was at last seen at 4 pm, almost 24 hours after the injury had been noticed.
He had shown absolutely no signs of distress, vomiting, nausea or of being off his food, as one might expect with a significant head injury. Two doctors in succession examined him and asked whether he had had a fall or a knock. Mrs. Dunne simply did not know what had caused
Column 770it, and said so. It was a pure isolated home accident, the type that any experienced parents, even of a superhuman type, regrettably find themselves unable to explain. At 6 o'clock, he was given two head X-rays and admitted overnight. Mrs. Dunne stayed on the ward with him, but had little sleep as Stephen was woken every hour. The next morning, Mrs. Dunne's sister came to visit with Mr. Dunne. Others were on the ward. At about 10.30 am, Dr. Martin Hardman, a consultant paediatrician, arrived. Unlike the two doctors the previous day, his manner was unfriendly and intimidating. He examined Stephen all over, making it clear that he was looking for signs of injury. He found nothing whatever. He asked repeatedly how the swelling occurred. To the Dunnes' disbelief and horror, he then said offensively, "It's obvious, isn't it ?", plainly implying that they had inflicted the injury themselves.
The Dunnes became even more upset. Finally, Dr. Hardman suggested that they go into a private room. With breathtaking ignorance of all that had gone before, he then accused them of not seeking immediate medical attention. He claimed that Stephen had a fractured skull and that "someone must have done it". He said that Stephen must have several more X-rays and stay in hospital, not for medical reasons but to keep him in a safe place.
Mr. Dunne insisted that they return home, and they did so, with Dr. Hardman warning him that it would not look good to social services. The next day, Stephen had eight X-rays of his body. Naturally, no injuries were revealed. His head was further X-rayed. The Dunnes returned home.
That evening, the nightmare worsened, when two police officers and a social worker arrived. They wanted Mr. Dunne to go to the police station for an interview, but he objected strongly and telephoned his parents, who arrived shortly afterwards. Eventually, Mr. and Mrs. Dunne were interviewed in separate rooms at home. One can imagine the emotional turmoil.
The following day, Mrs. Dunne experienced traumatic depression. She felt that she could not be alone with her children, as she was terrified that they may have an accident. She rang the social worker, who came to try to put her mind at rest. On 8 March, a child protection conference was held. Incredibly, it was decided to place Stephen on the child protection register, and to review the case after a month.
The Dunnes are in the grip of the system. There is no apparent escape from it, or from the record. They have appealed to the hospital and to Hampshire social services, the result of which, without my raising the matter as soon as possible in the House, is likely to be explanations and apologies from the hospital for the delays before Stephen was finally seen, but no retreat or effective action with respect to their treatment at the hands of Dr. Hardman. The social services will, understandably, probably reiterate that it is their duty to investigate such matters, and that they merely played it according to the law and the guidelines, once Dr. Hardman had alerted them.
There should be a rigorous independent case conference about the following. First, why did the hospital take from 7 pm on Friday 25 February until 4 pm on Saturday 26 February before examining a five-month-old baby, despite an injury later described as a fractured skull--of which, incidentally, the parents would like proof--and given that it is common knowledge that the first 24 hours are the most critical in such cases?
Column 771Secondly, why was Dr. Hardman plainly ill informed about such details ? Flouting all guidelines, he turned to the parents in a public place and, without demonstrating an open mind, made a profoundly shocking allegation.
Thirdly, what inquiries had Dr. Hardman made of Mr. and Mrs. Dunne's GP about family history and the likelihood of child abuse in respect of their children before activating all the panoply of the child abuse system ?
Fourthly, what official independent procedure can investigate Dr. Hardman's diagnosis and actions--apart from my raising what is admittedly one side of the matter in the House as a matter of urgency--and appropriate action consequential on that ?
Fifthly, why could not Hampshire social services, in such a case and with such a family, at least try to arrange a low-key, preliminary visit by an experienced social worker, instead of the immediate and traumatic arrival of a social worker accompanied by two police officers whose duty was to take statements and, apparently, take the father off to the police station ?
Finally, will my hon. Friend the Minister consider further general considerations that arise from this case ?
The NSPCC recently set up an inquiry into why, when there has rightly been such concentration in recent years on laws and procedures to investigate child abuse, the incidence of such deaths does not diminish. There must be more concentration on prevention. If parents are treated thus, as the Dunnes were, despite their family history and record, when they jointly attend casualty with their child, should not the obvious lesson to every other parent--a lesson potentially most harmful to children--be that, if they go to casualty with an injured child, they will be dubbed a suspected child abuser, with all that that entails ?
I shudder to think what would have been activated if the unexplained and unexpected cot death of my wife's and my second child, at the age of five months in 1980, had received this sort of investigative attention--not to mention the broken arm of our four-year-old boy some years ago as a result of a home accident. We are all extremely vulnerable as parents, especially those of us who believe in the right of parents to smack young children as part of sensible discipline.
Of course the investigators can--and no doubt do--always argue that they have a duty to act. Of course it can be explained that child protection conferences are not tribunals to decide whether abuse has taken place ; that the placing of a child on the protection register does not imply that the parents are guilty of abusing their child. Tell that to Mr. and Mrs. Dunne, or to their family, or to others who get to hear it ; tell it to the marines.
According to paragraph 6.39 of the authoritative guidelines in "Working Together", for a child to be placed on the register either there must be an identifiable incident and professional judgment that further incidents are likely, or significant harm is expected on the basis of professional judgment of findings of the investigation, or on research evidence.
These are the criteria on which the conclusion in Stephen's case was based. Perhaps my hon. Friend can ask to see the evidence that could have led to that conclusion--particularly the essential finding that further incidents are likely or to be expected. That finding is deeply
Column 772offensive to responsible parents, incorporating as it must complete rejection of the idea of an isolated, one -off home accident. It may also be relevant to ask how older brother Andrew, three and a half years old, has safely reached such an age without being protected from his parents by a paediatrician, the social services and the police.
While doing all we can to root out the evils of genuine incidents of child abuse which turn our stomachs, let us keep a sense of proportion, and, above all, common sense. Only a tiny minority of parents are child abusers, under any reasonable definition of the term. Mr. and Mrs. Dunne have certainly never been in that category, and everything should now be done to see that their faith in the justness of the system is restored, including the immediate removal of Stephen from the child protection register.
I ask my hon. Friend to do what he can to put things right, not only for the sake of this family but for others who may experience similar treatment, which so distorts and misdirects where the real effort is required : in the constant and necessary battle against the horrors of child abuse.
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis) : My hon. Friend the Member for Portsmouth, South (Mr. Martinhas had the good fortune in the ballot which has enabled him to raise this constituency case. He has set it in the context of his personal and family experience. I fully understand my hon. Friend's concerns for his constituents, especially in the light of his account of the unfortunate and worrying chain of events preceding the child protection investigation.
My hon. Friend asked some important questions about the handling of the case and the possible redress available to the Dunnes--questions similar to the inquiries that I requested be made when I heard of his concerns.
I propose to consider first the problems that Mr. and Mrs. Dunne encountered at St. Mary's hospital, since they seem to be at the core of the case, before I move on to the child protection issue that my hon. Friend has raised.
I understand that there may be some disagreement between Stephen's parents and the hospital about the precise sequence of events, starting with their attendance at ward C2 on 25 February. The hospital's account is that they presented themselves at the medical admissions ward at 7.35 pm on Friday 25 February because Stephen had a lump on the right side of his head.
When a nurse booked them in, she is said to have explained to them that they would have a long wait because the paediatric unit was extremely busy at the time. The consultant paediatrician was on the ward between 9 pm and midnight, treating a sick baby. There is a hospital document which states that, at 10 pm, the parents did "not wish to wait longer to see doctor"
and they then took Stephen home.
The following day, they saw their GP, who referred Stephen as an in-patient back to St. Mary's hospital. They then presented themselves again at the hospital, and Stephen was admitted at about 4.30 pm.
However, while there may be some dispute about the sequence of events, what is not in dispute is that Stephen was not seen by a doctor on the evening of 25 February. This raises very serious issues about the reception of patients on ward C2 at St. Mary's hospital. The local arrangement at St. Mary's hospital in Portsmouth is for children who need urgent attention to be directed straight
Column 773to a children's ward. That should not mean that the standards of care are lower. We would still expect suitably experienced staff to be available to assess all children immediately they arrive. Once a child's condition has been assessed, the child may have to wait for treatment--if other children have greater clinical needs. But we have made it clear in our guidance entitled "Welfare of Children and Young People in Hospital" that every hospital should have effective procedures to prioritise waiting children, and ensure they are seen promptly.
Hospital staff cannot prevent parents from taking their children home if that is what the parents have decided. But no child should under any circumstances be sent home or formally discharged by hospital staff unless the child has first been given an opportunity to be seen by a doctor.
Mr. and Mrs. Dunne understandably, and rightly, made use of their entitlement under the patients charter to complain through the hospital complaints procedures about the service they had received. Current procedures provide for a full investigation into complaints and for a prompt written response to be made. I have seen the response of the chief executive, which acknowledges the failure of the hospital staff to respond promptly and correctly in the first instance, and offers apologies for that failure.
The matter was also discussed at a meeting of the hospital clinical standards board on 24 March, and the chief executive has now written to Mr. and Mrs. Dunne to inform them that the board shared his concern over the admitted failures of 25 February. I understand that the board chairman and medical director of the trust are to hold urgent discussions to determine and agree the steps to be taken to ensure that such a distressing incident is not repeated.
If Mr. and Mrs. Dunne are dissatisfied with the process of the handling of their complaint, they may complain to the health service ombudsman. However, he is unable to investigate that part of the case which is about clinical judgment, as it falls outside his jurisdiction.
If part of a complaint involves clinical judgment, the matter can be referred to the regional director of public health, for him or her to decide whether an independent professional review by two consultants not involved in the case should be carried out. None of these avenues, of course, precludes Mr. and Mrs. Dunn taking action through the courts if they so wish.
I will be asking the chief executive for an assurance that any necessary action has been taken in response to the issues that have been raised by the failures acknowledged by the chief executive and the board. I shall also be asking the chief executive to satisfy himself and me that all relevant staff at the hospital are fully trained in child protection procedures.
That brings me to the next aspect of this case and the further question raised by my hon. Friend--the child protection investigation.
The issue of alleged or suspected child abuse is one of extraordinary sensitivity. It trails with it a heavy cloud of suspicion. It can create mistrust and division among the closest of families, and it creates the paradox that, at the very time when parents and families most need support and reassurance, when a child whom they love is in pain, officialdom arrives with questions to be answered.
Often in such cases, of course, there are no easy answers. That is why I understand the anguished feelings
Column 774of Mr. and Mrs. Dunne. Like all families in such a situation, they must not be labelled guilty, but presumed innocent until and unless guilt is proven and, accordingly, treated with respect, sensitivity and courtesy. Anything else is intolerable, inhumane and in contravention of the basic principles of British justice. My hon. Friend referred to the Government's inter-agency guidance on child protection, "Working Together under the Children Act 1989". Set firmly within the context of that Act, it strikes the right balance between promoting decisive action where that is necessary to protect children from abuse, and reinforcing the need for all professionals to acknowledge the rights and responsibilities of parents and to approach each case with an open mind.
At an operational level, Government guidance should be promoted through the local inter-agency procedures drawn up under the auspices of the area child protection committee. Hampshire published revised child protection procedures in January 1993. I understand that Mr. and Mrs. Dunne have a particular concern about a reference in the procedures that states, at paragraph 3.3(iii) :
"Where health staff have information or concern regarding the welfare of a child they will notify the Social Services Department promptly. In child protection cases, the degree of confidentiality will be governed by the paramount need to protect the child". I further understand that Mr. and Mrs. Dunne met representatives of the social services department on 21 March to outline their particular concerns, and that they have been invited to take the matter up with Hampshire, once the present issue has been resolved, if they want to further the discussion about improvement in practice involving abuse procedures.
Following one issue that has arisen in this case, Hampshire social services will be consulting Victim Support about its role in helping families in child protection situations, to ascertain whether there are lessons to be learned on a broader scale.
As for the police involvement and action, my hon. Friend will understand that I cannot comment, but Mr. and Mrs. Dunne may want to make use of the normal channel for complaints concerning the police, which is the Police Complaints Authority.
My hon. Friend asked for the removal of Stephen's name from the child protection register. That is a local decision taken in accordance with guidance under the Children Act 1989, and one in which I cannot intervene. I know that, in line with our guidance, Stephen's parents, and another family member--Mrs. Dunne's sister--attended the whole of the initial conference called by Hampshire on 8 March to discuss Stephen's case. Before that conference, Mr. and Mrs. Dunne were given a leaflet of explanation about child protection conferences, together with a copy of the factual report of events.
Mr. and Mrs. Dunne have also been invited to attend the review conference planned for 5 April. I hope that they feel able to work in partnership with the social services and the other agencies involved in the case.
I understand my hon. Friend's concern--indeed, his scepticism--about the view stated in our guidance, that placement on the register does not imply any guilt. I re-emphasise the important point that the purpose of the child protection conference is simply to decide whether or not to place the child's name on the child protection
Column 775register. If the decision is made to do so, the conference will draw up a multi-agency, multi-disciplinary plan for the child's protection.
As our guidance makes clear, the conference is emphatically not a forum for a formal decision that a person has abused a child--that is for the courts. Likewise, placement of a child's name on the child protection register does not mean that the child has been abused. It is a record of children for whom there are unresolved concerns and for whom there is a co-operative protection plan of the kind that I described.
Parental involvement is central to the principles of the Children Act 1989. Before that legislation, we had seen media interviews with some of the parents involved in high-profile child abuse cases in which they had been denied information by authorities, were at best confused, and at worst saw the professionals involved as active enemies. We wanted parents to be involved at all stages of an investigation or intervention, to be informed about the basis for it, and to be consulted at all stages subsequently.
We have made considerable efforts to promote family involvement through the development of training materials financed by our child abuse training initiative, and through a practice guide on "The Challenge of Partnership", which is in preparation. Among materials funded through the training initiative was the development and production of a training package on "Family Participation in Child Protection".
We have also helped to finance a new edition of a joint Family Rights Group and National Society for the Prevention of Cruelty to Children publication, "Child Protection Procedures : What They Mean For Your Family". It has been translated into several languages and is very helpful to parents and family members, in particular in understanding the procedures surrounding child protection conferences and in avoiding jargon--a trap into which professionals too often fall, and one which can be a
Column 776real barrier to involvement at a time when all the individuals in the family may be feeling particularly isolated and vulnerable. We are funding a training video on parental perceptions of significant harm and child protection investigations, which is aimed to be accessible to both social services professionals and to parents. I conclude by agreeing wholeheartedly with my hon. Friend that we must keep a sense of proportion, while doing all that we can to root out incidents of child abuse. This is why "Working Together" aims to create the conditions in which agencies act swiftly and decisively when immediate protection of the child is the highest priority. We cannot afford to lose sight of the fact that, in the most extreme circumstances, we are preventing a threat to a child's life. We are all too well aware of cases in which social services, and other agencies, have been rightly criticised for inaction or inappropriate action. Recent well-publicised cases in Islington and Nottingham have demonstrated all too clearly that the child pays the penalty for the mistakes of the professionals. It is equally right that it is a fundamental principle of the Children Act 1989 that the safety of the child is the paramount consideration.
On the one hand, the debate is about the damage which can be felt by families who feel falsely accused of having abused their child. On the other hand, unexplained head injuries in a child of this age must always feature high on our list of priorities for consideration of investigation, to ensure that the child, whose welfare is of paramount importance, is not at risk of harm.
There are questions to be asked in this case. They are questions which I shall be asking of the hospital. Were the complaints and appeals procedures available to the family ? I hope that the coming conference will resolve the difficulties faced by the family, and that Stephen will go on to flourish in a happy and supportive family atmosphere. That is what local and national policy must be all about.
Question put and agreed to.
Adjourned accordingly at twenty-nine minutes to One o'clock.
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