Memorandum submitted by Dr Eileen Munro
SUMMARY
The Children Act 2004 provides the legal framework
for setting up a database on all children in England and Wales
on which professionals will log their contact with a child and
enter a "flag of concern" if they have any concerns
about a child's health or development. The laudable aims are to
improve the assessment of need and facilitate the provision of
effective help at an early stage. However, this proposed database
and the associated procedures for professionals on sharing information
are based on a misguided interpretation of the problems in children's
services. On balance, the database is likely to do more harm than
good because it will absorb substantial money and professional
time, while distracting attention away from the more fundamental
problems of improving the skills of the workforce.
1. Extending "child protection"
services to all aspects of children's health and development without
a substantial increase in funding will reduce the level of protection
given to children who are the victims of abuse and neglect.
2. Failures in communication in cases of
child abuse or neglect are due to shortcomings in professionals'
skills, knowledge, and resources, not to legal or technical obstacles
to sharing information.
3. The proposed policy includes the power
to breach confidentiality about low level concerns and concerns
unrelated to abusive parenting and this will be detrimental to
relationships with families.
4. The database is a method of screening
for low level concerns but does not meet the necessary criteria
to justify its introduction.
1. Extending "child protection"
services to all aspects of children's health and development without
a substantial increase in funding will reduce the level of protection
given to children who are the victims of abuse and neglect
The Government has extended the concept of child
protection to mean protecting children from any risk to their
development and safety. I wholeheartedly support the aim of helping
all children to fulfil their potential but the proposed changes
to children's services amount to a massive extension to professionals'
remit. There is no commensurate increase in resources planned
and so this must have a harmful impact on services to children
who are being abused or neglected. Indeed, Margaret Hodge, the
Minister for Children, has expressly stated that she wishes to
see a shift in emphasis towards early intervention and prevention.
This logically implies a shift away from the current emphasis
on protecting children at risk of significant harm from abuse
or neglect.
I am also concerned that extending the concepts
of "child protection" and "children at risk"
to all aspects of children's welfare obscures the unique issues
in investigating concerns about abuse and neglect. As many critics
have pointed out, the current preoccupation with issues of child
abuse is having a detrimental impact on the assessment of a child's
general well-being. However, the solution is not to merge abuse
with all other problems. A child "in need of protection from
abuse" is not the same as a child in need of any other service.
Most parents are loving and more concerned about their child's
welfare than any professional. Therefore, when working with them,
professionals show respect and treat them as valuable experts
on their child. However, when a suspicion of abuse is triggered,
for whatever reason, professionals need to take a different mindset
in interpreting the information they have and they need to take
a more critical, confrontational, challenging attitude in talking
to the parents. To improve the assessment of need as well as the
assessment of risk of significant harm from abuse, we need to
ensure that professionals have the skills to do both types of
assessment and have the resources to respond to identified needs.
At present, professionals only alert others
without the family's consent when they have a concern about abuse
or neglect. Extending the practice to include flags of concern
about any aspect of a child's health or development will lead
to a vast increase in the amount of data being shared. There is
a real danger that concerns about significant harm will be overlooked
in this mountain of data.
2. Failures in communication in cases of child
abuse or neglect are due to shortcomings in professionals' skills,
knowledge, and resources, not to legal or technical obstacles
to sharing information
The proposed policy grossly overestimates the
part played by the technical and legal aspects of information
sharing in the complex problems of improving assessment of need
and provision of effective help to children.
In relation to protecting children from abuse
or neglect, the importance of good communication between professionals
and the need to share information without consent has been recognised
since the 1970s. As a result, an excellent, well-established set
of guidelines has been developed for working together. When this
system fails, as it did in the case of Victoria Climbie, the common
causes are:
(a) The professional with significant information
did not recognise it as a sign of possible abuse or neglect and,
so, saw no need to share it.
(b) The professional with information thought
it was a cause for concern but of such a low level that it would
be dismissed by other agencies whose resource constraints led
to high thresholds for action.
(c) The professional tried to share the information
but the other professional failed to give it the same meaning.
This is particularly common when dealing with interpretations
of family life and when the new information conflicts with the
professional's existing assessment of the family.
Improving communication can best be achieved
by improving professionals' knowledge and skills in relation to
identifying abuse and neglect, eg a recurrent criticism in child
abuse inquiries is that no-one talked to the alleged victim but
doing so requires considerable expertise and was not done in the
case of Victoria Climbié because the relevant worker felt
inadequately trained to interview her.
3. The proposed policy includes the power
to breach confidentiality about low level concerns and concerns
unrelated to abusive parenting and this will be detrimental to
relationships with families
The Children Act 2004 allows for information
to be shared without the consent of the parents or children. The
Minister for Children has said that she does not want professionals
to have any discretion in logging their contact with a child or
a flag of concern on the database. Her examples have all involved
professionals then discussing their concerns without reference
to the family.
The arguments for confidentiality are both legal
and therapeutic.
Legally, a right to privacy is enshrined in
human rights legislation and the Data Protection Act. At present,
professionals only breach confidentiality if they consider there
is a risk of harm to a child. Removing confidentiality in cases
where there are non-abusive parents and minor concerns about a
child is going to be vulnerable to legal challenge.
Therapeutically, it is well established that
people are inhibited in revealing their problems if they think
the information will be shared without their consent. There is
already evidence that mothers are concealing postnatal depression
from health visitors because they are afraid of what will be done
with the information. If it becomes generally known that any contact
with a professional may be shared with other professionals in
your life, the impact on people's willingness to seek help will
be substantial.
Research with children shows that they care
strongly about who has access to information about them.
4. The database is a method of screening for
low level concerns but does not meet the necessary criteria to
justify its introduction
In medicine, there are three core criteria to
consider when deciding whether to introduce a screening measure
and none of them are met in relation to the proposed database.
(a) There should be an acceptable level of
false positives and false negatives, ie of children inaccurately
categorised.
All research evidence on the development of problems
shows that our predictive ability is very limited. A beguiling
picture of predictability is given by looking at adults with serious
problems and seeing how many of them had shown lower level problems
in the past. However, to establish the accuracy of predictions,
we need to know the base rates for those low level problems, ie
how many children displayed them. We then find that most of them
did not go on to develop serious problems.
In relation to the proposed database, we are
not in a position to even begin to estimate accuracy because so
many of the key concepts have yet to be defined, eg what is a
"cause for concern", what level of agreement is there
between professionals in judging whether some factor is a cause
for concern?
(b) The problem can be usefully treated.
The proposed database and information sharing
system is apparently intended to deal with ALL problems in children's
health and development. Therefore, there can be no single answer
to whether problems are soluble. However, the overwhelming lesson
from evaluative research of a range of social, psychological,
and psychiatric services is that they have, at best, only modest
success so we should be equally modest in our claims to be able
to change family functioning for the better.
Moreover, there is no persuasive case for claiming
that breaching confidentiality will improve assessment and response
to need. There is ample evidence that families are ASKING for
help and being turned away.
(c) The test itself does not carry any unwarrantable
risks.
The risks of this information sharing
system are manifold:
1. It will be expensive and absorb money
and time that could be better spent on developing the skills and
knowledge of the workforce.
2. It will have an adverse impact on
relationships between families and professionals when the former
learn the extent to which their privacy is being invaded.
3. The security of the information cannot
be guaranteed. Information will inevitably need to be available
to a vast number of professionals and there will be some among
them who use it maliciously.
4. Merging children at risk of significant
harm from abuse or neglect with all other children's problems
obscures the special difficulties of identifying them and the
specialist skills and knowledge needed to investigate a concern
about abuse.
5. Introducing such a mechanised system
to services that are understaffed may lead to some workers entering
a flag of concern on the database INSTEAD OF doing something about
it themselves.
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