Reflections on retirement 5. Child protection: the good, the bad, and the ugly

Child Protection

It is strange how one’s life journey doesn’t always take you on expected paths…

As a junior doctor and trainee paediatrician in the early 1990s, there were two career avenues I decided I really did not want to pursue: child protection and research. So I often wonder how it is, 28 years later, that I end up retiring from a career as an academic paediatrician specialising in child protection.

I suspect it was my time in Cambodia that set the compass leading me down this route. And perhaps, even more so, returning to this country – having seen the huge needs of children and families in such an impoverished and war-torn country – and wondering where the most vulnerable children and families in our country were, and what I could possibly do to make a difference.

I may puzzle over it, but I certainly don’t regret the career choices I have made. It has been an incredibly rewarding. Looking back, there is so much I can celebrate and feel positive about.

But it has also been a hard journey and it is perhaps only recently, with the prospect of retirement looming, that I have come to appreciate just how much of a toll it has taken. There are times when I feel tired and I look forward to no longer having to take responsibility for decision making and giving advice on individual cases – knowing that my advice can have such profound impacts on the lives of individual children and their families.

The good

As I look back, though, there is so much I can appreciate. Like the little girl who took me by the hand and proudly showed me round her new primary school after I’d seen her for a follow up medical after the one that led to her being taken out of the awful home situation in which she was living. Or the stressed out mum who learned to praise the good she saw in her child…

I first saw this little boy as a toddler brought to my clinic with constipation and soiling. From the moment they entered the clinic room, his mother poured out a torrent of abuse, calling him a ‘little shithead’ and ‘the child from hell’. Over the following months, with appropriate treatment, his constipation gradually improved. Each time they came to clinic, I made a point of telling the little boy something positive about himself. I also, over time, started asking the mother what she liked about him. One of the last times I saw him, they both came in beaming and his mother (now calling him ‘my little angel’) prompted him to show me his latest star chart – a gold star on every day.

Or another family where a bit of joint agency detective work led to a positive outcome for everyone…

As a newly appointed consultant I was asked to see a baby girl with rib fractures discovered on a ‘routine’ chest x-ray. There were no other injuries, the girl looked healthy and thriving and both parents seemed to be devoted to her. And yet, she had serious and unexplained injuries. Further investigations, including a home visit, revealed that the family lived in a poorly maintained first floor flat. In order to reach their home, the father, who had a disabling muscle condition which left him unsteady on his feet, would climb a narrow, unlit stairway, holding his daughter under one arm, while he held onto the bannister with the other. It became apparent that at times he had stumbled and, in doing so, gripped his daughter tightly round the chest – the likely explanation for the fractures. With a multi-agency child protection plan, rehousing to somewhere more suitable, and some parent training and support, the family were able to stay together and protect their daughter from further harm.

The bad

Sadly, not all the cases had such good outcomes, or such readily apparent solutions. I am sure there have been times when I have missed cases of abuse, given unhelpful advice, or simply been unable to reach any clear conclusions. I know that there have been times when decisions I’ve made have resulted in children being left in abusive environments. Equally, there have been times when my advice has ended up with children being unnecessarily removed from families. That is the hard road we walk balancing child protection and family support, where far too often, we just don’t know what route to take.

And there have been other cases where the best solution has been apparent, but we just haven’t had the resources to see it through…

I was asked to assess the baby of a couple with learning difficulties. The baby had suffered sunburn after the mother had applied after-sun lotion, not realising that it wasn’t actually sun-block. The baby had signs of neglect with poor growth and developmental delay. Both parents clearly loved their child, wanted the best for him, and would never knowingly harm him. A psychologist had assessed the parents’ capacity to take on board instructions and to be able to parent their child safely. The advice of myself, the psychologist, and the social worker was that, given enough support, these parents could look after their child. However, the levels of support that would be needed to ensure the child’s safety and wellbeing, were well beyond the resources available in the local authority, and the child was placed in care.

And the ugly

One of the most disturbing cases I have dealt with in my career was as a young registrar, early in my training. I was called to the emergency department to see a 2 year old who had been brought in with some minor injuries. From the moment I walked into the cubicle, the young girl, sitting on the examination couch, watched me with an intent, watchful expression. Throughout my examination she didn’t react at all – neither smiling nor crying – while her father sat stony-faced on the other side of the cubicle. I concluded that her injuries were accidental in nature and didn’t need any treatment, and I sent her home with her father. What really upset me though – and has haunted me ever since – were five words written in biro on her arm: ‘I am a little bitch’.

I have often wondered what happened to that little girl. What kind of a home did I send her back to? What kind of person did she grow up to be? Did anyone else pick up on the emotional abuse she was experiencing and act where I had failed to act?

Child protection does have its ugly side. Fortunately they are rare, but there are parents and others who deliberately and maliciously harm their children – physically, emotionally, and sexually. In the course of my career, I have had to deal with that. It isn’t easy seeing the pain that some children have to live with. Nor is it easy seeing the pain of parents who have their children taken away from them; of families torn apart by abuse, domestic violence, addictions. Or seeing adults carrying the pain of abuse they have suffered – from parents or partners, and sometimes just not knowing how to deal with that pain, or the stresses of life that can be so overwhelming that children end up getting caught in the middle and hurt themselves.

It isn’t easy. But it is important.

Which brings me back to the good, and one of the greatest privileges I have found through working in this field: the people. The very real and ordinary families who have shared with me some of their struggles, hopes and dreams; the amazing children, so many of whom show incredible resilience, joy and love, even in the face of such devastating adversity; and the professionals – social workers, police officers, nurses, teachers, doctors and others – all dedicated and committed to helping others, passionate about making this world a better place for children.

March 4, 2018

Low Carbon and Loving It

For many years now I have struggled with the reality that, in spite of all my rhetoric of justice, compassion and humility, my affluent western lifestyle is inherently unjust, damaging and unsustainable. In the face of the inconvenient truths of climate change and global inequalities, the tiny steps we as a family have taken to live simply and sustainably appear miniscule.

So I have been both challenged and encouraged by Mark and Tom Delaney’s inspiring book, Low Carbon and Loving It. The Delaney’s are a remarkable family whose totally radical lifestyle has sat with me like an uncomfortable stone in my shoe: a stone that nevertheless challenges me to keep walking and try just a little bit harder. Mark and Cathy have spent most of the past two decades living in tiny one-roomed homes in Indian slums, bringing up their two boys, Tom and Oscar, in conditions which I know I could never cope with. In doing so, they have successfully managed to reduce their carbon production from the Australian average of 23 tonnes CO_2eq to much closer to the Indian average of 2.3 tonnes.

Mark and Tom’s book describes something of their journey in achieving this. They set out, in a very readable manner, the science of climate change and why we need to take is so seriously. And they provide lots of practical suggestions of how we, in the affluent west, can take steps to reduce our unsustainable carbon footprints and contribute to a more just and sustainable world.

Few, if any, would ever have the courage to follow in their footsteps (I know I couldn’t), but all of us can do something. And, as Mark and Tom point out, it is imperative that we do, if our children and grandchildren, and – more significantly – the billions of people across the world who have no choice in their lifestyles, are to have a future to look forward to.

As Lois and I have moved to Allesley and set up Breathing Space, Low Carbon and Loving It has inspired us to do bit more to make our home, our retreat centre, and our lifestyles just a little more sustainable. Our hope is that others, too, will come alongside us in doing so.

Low Carbon and Loving It is available in both paper and kindle editions on Amazon:

https://www.amazon.co.uk/Low-Carbon-Loving-Adventures-sustainable-Australia/dp/0648247708

February 6, 2018

#EndFGM

Women’s Rights

Today is the 100^th anniversary of women being granted the vote in the UK. In the past 100 years great strides have been made in women’s rights. And yet the reality is that both in the UK and across the world, women continue to experience inequality, discrimination, disenfranchisement and abuse. This is particularly prominent in the practice of Female Genital Mutilation (FGM) – a cruel and abusive practice that leaves millions of girls and women scarred for life, both physically and emotionally.

The UN estimates that globally at least 200 million girls and women have undergone FGM, with rates as high as 97-98 percent in Guinea and Somalia. Most of those subjected to FGM are infants and young girls, who cannot possibly understand the awful trauma they are subjected to.

#EndFGM

The Sustainable Development Goals have called for an end to the practice by 2030. Tuesday 6^th February is International Day of Zero Tolerance for Female Genital Mutilation.

http://www.un.org/en/events/femalegenitalmutilationday/

We, in BASPCAN, are doing what we can to support national and international efforts to end FGM.

One of the keynote speakers at the BASPCAN international child protection congress, Elaine Storkey, has long campaigned for an end to FGM, addresses it in her book, Scars Across Humanity, and will be speaking on the topic as part of her closing keynote speech.

“Power, ideology and children at risk. How can we work together across cultural and faith divides to bring change?”

Children, especially girls, are at risk in cultures across the globe. In India, campaigners suggest that the population has lost 50 million girls over the last few decades, through infanticide and foeticide. Because of a marked preference for sons, the ratio of girls to boys in the population is also decreasing, rather than increasing, with affluence. In other countries, girls are subject to brutal female genital mutilation which leaves them with health problems for the rest of their lives. In the UK, 140,000 women currently live with its aftermath, and 10,000 girls this year may be in danger of being cut. Early enforced marriage, ‘honour’ attacks and trafficking for sexual exploitation all add to the list of atrocities which spell danger for young female populations.

This keynote suggests that behind these practices is not simply ‘culture’ but power, money, organized crime and lack of legal protection. Safeguarding is a global issue which needs to cross many boundaries. Progress is made when organisations and campaigners can work together, despite often deep-seated differences to address attitudes and develop strategies for change. We will explore how.

The issues faced in providing services locally for women and girls who may have undergone or be at risk of FGM are also the topic of a symposium by Dr Deborah Hodes and colleagues from University College London Hospitals.

Look out also for an interactive poster from Rasul Alis on ‘Why haven’t there been any prosecutions for FGM?’

The full congress programme, further information and registration details are available on our congress website:

https://www.baspcan.org.uk/congress-2018/

October 8, 2017

The health costs of energy inefficient housing: once again, it is the poorest who pay the highest price

The process of moving house has enlightened me about the Energy Performance Certificate (EPC): a measurement of the energy efficiency of a building, and a legal requirement for all properties being sold or rented (yet another advantage of our EU membership, apparently).

Energy Performance Certificates

The EPC gives a grade, from A to G, on how efficient the building is, how much it costs to heat and light, and what its carbon dioxide emissions are likely to be. It also gives suggestions on how the energy efficiency could be improved.

Our current home has an EPC grade of D (about average for the UK), uses about 36,000 kWh of energy for heating each year, and produces about 9.1 tonnes of CO2. The house we are buying is somewhat worse, being in band E. It uses about 23,000 kWh (being a smaller property), but produces about 11 tonnes of CO2.

However, for an investment of around £20,000 we could improve that to band C, cut our CO2 emissions by a third, live more comfortably in a warmer home, and cut our energy costs substantially.

We can afford to do that.

Energy Vulnerability

Not so those on low incomes or state benefits, who suffer a triple whammy. People living in either private rented or public housing are more likely to be living in energy-inefficient properties; they are more likely to experience energy vulnerability and be unable to pay their electricity or heating bills; and they have no control over improving the energy efficiency of their homes, while the private landlords have no incentive to fork out the capital to do so, and the austerity-driven local councils are unlikely to prioritise this over other more pressing demands.
Frustratingly, though, this isn’t just about feeling good about doing our bit to help tackle climate change, nor even about feeling a bit more warm and comfortable during the winter months. Living with energy vulnerability has a direct impact on our health. Last week I attended a seminar exploring the health costs of energy inefficient housing in the UK and France. The authors pointed out that people living in homes in bands F and G have an overall higher mortality, as well as substantial risks of ill-health, not to mention the impact on lost days at work, and for children, poorer educational outcomes.

Conversely, a relatively small investment now in improving the energy efficiency of our public and private rented housing could have huge impacts on the NHS budget, not to mention the very real impact on the lives of those who can’t afford to stay warm.

End Fuel Poverty

According to the End Fuel Poverty Coalition, 2.35 million households in England are living in fuel poverty. Surely it doesn’t need to be that way?

September 18, 2017

The Garib Rath Express to Lucknow

We shared a dish of rajma and rice from one of the platform vendors as we stood waiting on platform nine for the Garib Rath Express. Who knows how many others we shared the platform with: young men and women on their mobile phones; colourful groups of women with their babies; old men blissfully sleeping; porters pushing their way through with luggage on their heads, their shoulders, their arms… While on the tracks beneath us Mynah birds, rats and rubbish collectors scavenged among the detritus of earlier trains.

This was my first encounter of the legendary Indian railways, so I guess it was only fitting that our train should be an hour late, all adding to the vibrant, colourful, noisy experience. As it pulled in, we realised that carriage J2 was at the opposite end of the platform from that previously signified. So, we joined the melee of J2 passengers as it surged towards the opposite tide of G5, and finally, amidst much shouting, pushing and shoving, and all-round consternation, we found ourselves squeezed into our seats with the train slowly pulling out of the station, while the huge crowd continued to press onto the over-flowing unreserved carriages. Somehow, there seemed to be just as many people on the humid, seething platform as when the train had pulled in quarter of an hour previously.

We, meanwhile, settled down for the seven-hour journey to Lucknow, relieved to be on the train, and grateful for our reserved seats and for the very welcome aircon in the carriage.

The Garib Rath Express crawled at a snail’s pace through the centre of Delhi, over the Yamuna river, and on out through the sprawling suburbs, taking over an hour to travel what seemed like no more than a couple of kilometres. At this rate, we wondered how we would ever get to Lucknow, 500km away. But we did. Slowly, as we left the great conurbation behind, we gathered speed, and made our way across the great, spreading plains of Uttar Pradesh. Through Moradabad, Bareilly and Shahabad, the train kept going. On past spreading fields of sugar cane, skirting new towns, their high-rise apartments towering above the inevitable rubbish dumps, each sprouting its own, depressing shanty town where rubbish pickers eked out a living from the filth and stench. So much ugliness and shame sitting side by side with so much colour and beauty.

While we had waited on the platform in Delhi, a holy man had wandered by, dishing out blessings in exchange for a few rupees. But what does blessing mean in the face of so much degradation? What would fullness of life look like for a family struggling to pull together enough for their next meal?

Is it just about survival? Striving to lower the horrendous child mortality rates that tear these families apart? Or basic sanitation and hygiene? A guaranteed meal?

Surely it must be more than just a relentless drive for a better standard of living, buying into the meaningless consumerism of our own indulgent lifestyles?

The questions sat with us, unresolved, as we finally pulled into Lucknow station, 3 hours late, but fortified along the way by cups of sweet chai, even sweeter kofee, and snacks of puri and samosas bought from the cheerful vendors who pushed their way through the crowded carriages at each stopping point.

April 17, 2017

West Midlands: No-one left behind

I am proud to live in the West Midlands. It is a great part of the country, with a rich history and a dynamic sense of diversity and inclusion. And it is an area that seems to offer hope and promise. And it is in that context that the mayoral election coming up on the 4^th May seems to be an incredible opportunity for a new direction – one in which we see some real development that benefits everyone and in which no-one is left behind.

That is the promise being offered by James Burn, the Green Party candidate for the West Midlands mayor.

In his manifesto, James Burn outlines his vision for a better West Midlands:

This manifesto is my vision for a better West Midlands. A West Midlands we can create together. A happier, healthier and more sustainable West Midlands where no-one is left behind.

This is a bold and ambitious manifesto, but one which seems to get to the heart of what is needed to make the West Midlands a better, healthier and more sustainable region. James sets out his vision for what is needed in terms of greater transparency, accountability and inclusion in the governance of the region; for a growing economy; more accessible transport and housing; a healthier environment; steps to boosting equality and diversity; tackling crime; and working for greater wellbeing and public health.

And, although ambitious, I see this as a credible and achievable manifesto, and one which James seems to have the credentials and commitment to see through.

James is currently an elected councillor for Chelmsley Wood in Solihull. He is Leader of the Opposition on Solihull Council (one of the 7 constituent members of the WMCA).

James has lived in the West Midlands for more than 15 years and has worked across much of the region in the private, public and voluntary sectors including as a senior policy advisor within local government. He is a qualified social worker and currently runs his own small business.

So I will be voting for James Burn in the forthcoming Mayoral election.

I encourage all my West Midlands friends to read his manifesto and to take this opportunity to bring about a positive change for our region.

James Burn’s Mayoral Manifesto

You can read James Burn’s manifesto by clicking here, or on his website: www.jamesburn.org

Here are some highlights:

Democracy

Ensuring that the West Midlands Combined Authority is transparent and accountable and truly representative of the people of the West Midlands;
Taking a lead in only taking the average salary for the West Midlands and being transparent in his own expenses;
Engaging more directly with the communities he is representing

The economy

Championing inclusive growth and supporting small enterprises, co-operatives and local businesses in the region;
Supporting more apprenticeships and skills training;
Pressing for the living wage throughout the West Midlands, reporting on the gap between the highest and lowest paid workers in the authority, and lobbying for a trial of universal basic income in the region

Transport

Bringing public transport back into public ownership;
Improving local bus, metro and rail links and ensuring they are more accessible to all, including students, the elderly, the disabled, and parents with young children;
Developing a long-term plan to increase walking and cycling and making them safer and more accessible to all

Housing

Making the provision of more housing, including more affordable housing, a top priority;
Improving standards for private landlords;
Helping homeless people get back on their feet and stay there by the provision of more housing options, linking together homeless services, and ensuring the provision of good information to those in need

Environment and Energy

Working towards a clean and affordable, low-carbon energy system;
Setting up a municipally owned West Midlands Energy Company to provide clean and affordable energy to the West Midlands;
Protecting wildlife and green spaces and making them more accessible to all

Equality and Diversity

Challenging discrimination and inequality throughout the West Midlands;
Promoting open working and collaboration between faith groups, BAME communities and women’s groups and the police, schools, voluntary groups and others;
Ensuring more women, members of BAME communities and people from socio-economically disadvantaged groups are able to start up their own businesses;

Crime and Community

Commission community and voluntary organisations to investigate ways in which the police can improve their relationships with local communities;
Targeting sexual violence and abuse of both adults and children through police training, reporting of violence and abuse, and public education;
Focusing more resources on tackling the causes of crime including evidence-based drugs policies, restorative justice, and support to reduce reoffending

Wellbeing and Public Health

Institute well-being measures for the success of the combined authority broken down across geographical areas and socio-economic groups;
Tackling income inequalities;
Promoting programmes to improve mental health and wellbeing

April 14, 2017April 14, 2017

Psalm 22: Why have you forsaken me?

Psalm 22: Good Friday 2017

A psalm of lament for all those who walk in darkness,

who cry out to a God who seems to have abandoned them.

My God, my God, why have you forsaken me?

Why are you so far from helping me?

O my God, I howl in the daytime but you do not hear me.

I groan in the watches of the night, but I find no rest.

My God, my God, why have you forsaken us?

We are the hidden ones, the lonely ones, those who suffer in silence.

We are the elderly widow, sitting alone in a care home with no-one to visit;

The homeless man, huddling against the cold in a urine-tainted alley;

The confused teenager, scarred by abuse and the blade in her own hand;

The grief-stricken parents, crying out for the baby so cruelly snatched from them.

My God, my God, why have you forsaken us?

Yet still you are the holy God whom Israel long has worshipped.

Our ancestors hoped in you, and you rescued them.

They trusted in you, and you delivered them.

They called upon you: you were faithful to your covenant.

They put their trust in you and were not disappointed.

But as for me, I crawl the earth like a worm,

despised by others, an outcast of the people.

All those who see me laugh me to scorn:

they make mouths at me, shaking their heads and saying,

‘He threw himself on God for deliverance:

let God rescue him then, if God so delights in him.’

My God, my God, why have you forsaken me?

Why are you so far from helping me?

O my God, I howl in the daytime but you do not hear me.

I groan in the watches of the night, but I find no rest.

My God, my God, why have you forsaken us?

We are the innocent ones, the powerless ones, those who cry out in silence.

We are crushed and broken, cast aside; trampled on by those with power.

We are the children gasping for breath with Sarin-tight lungs;

We are the ordinary civilians in Aleppo and Homs;

The helpless pawns in the global struttings of might.

We are the unsuspecting citizens of Westminster and Stockholm;

We are PC Palmer and Jo Cox, giving our lives in the cause of what is right.

My God, my God, why have you forsaken us?

Yet still you are the holy God whom Israel long has worshipped.

Do not desert me, for trouble is hard at hand,

and there is no one to help me.

Wild beasts close in on me, narrow-eyed, greedy and sleek.

They open their mouths and snarl at me,

like a ravening and roaring lion.

My God, my God, why have you forsaken me?

Why are you so far from helping me?

O my God, I howl in the daytime but you do not hear me.

I groan in the watches of the night, but I find no rest.

My God, my God, why have you forsaken us?

We are the persecuted ones, the voiceless ones, those who persevere in silence.

We are the Coptic Christians, torn apart by extremist bombs;

We are Nigerian school girls abducted by Boko Haram;

We are the children, the women, whose basic rights are stolen;

The lesbians and gays condemned by church and state;

The minority groups, the poor, and all who are pushed to the margins.

My God, my God, why have you forsaken us?

Yet still you are the holy God whom Israel long has worshipped.

Why are you so silent, God, why so far from helping me?

My strength drains away like water, my bones are out of joint.

My hands and my feet are withered, you lay me down in the dust of death.

The huntsmen are all about me:

a circle of the wicked hem me in on every side.

They have pierced my hands and my feet –

I can count all my bones –

they stand staring and gloating over me.

They divide my garments among them.

They cast lots for my clothes.

My God, my God, why have you forsaken me?

Why are you so far from helping me?

O my God, I howl in the daytime but you do not hear me.

I groan in the watches of the night, but I find no rest.

My God, my God, why have you forsaken us?

We are the hungry ones, the thirsty, who groan with pangs of silence.

We are the mothers and babies in South Sudan, crying out for a breastfull of milk;

We are the victims of greed in a world of plenty;

The marginalised poor in the slums of Manila and the Favelas of Mexico;

The exploited, the trafficked, those held in bonded labour;

We are the disempowered immigrant standing in line at a foodbank,

While the rich grow richer and turn the other way.

My God, my God, why have you forsaken us?

Yet still you are the holy God whom Israel long has worshipped.

Be not far from me, O God:

you are my helper, hasten to my aid.

Deliver me from the sword,

my life from the falling of the axe.

My God, my God, why have you forsaken me?

Why are you so far from helping me?

O my God, I howl in the daytime but you do not hear me.

I groan in the watches of the night, but I find no rest.

My God, my God, why have you forsaken us?

We are your people, your ordinary people.

We sit in silence with all our fears and doubts.

We feel like broken candles in a world of growing darkness,

silent voices in a world of violence and greed.

Injustice and oppression shatter the lives of so many and our prayers seem so futile.

We cry out to you, O God, and yet you are silent.

My God, my God, why have you forsaken us?

Silent God, we bring the cries of our battered hearts, and the cries of those burdened by illness and bowed down by the weight of oppression. We bring them so that we may not be silent. Hear us in the name of Jesus, forsaken on the cross.

* The quotations from the Psalm (in italics) are taken from Jim Cotter, Psalms for a Pilgrim People. Morehouse Publishing, 1998

April 3, 2017

The London Evening Standard, the Metropolitan Police, and Executive Pay

A leading article

This evening, the London Evening Standard ran a page 2 article on the new Metropolitan Police Commissioner, Cressida Dick, who has chosen voluntarily to take a £40,000 pay cut compared to her predecessor.

An editorial comment praised this move, and encouraged those on top end salaries to ‘follow Ms Dick’s fine example.’

With policing budgets under pressure, this is a welcome indication that Ms Dick is in touch with reality. In many sectors the gap between executive and average pay is rising for no good reason.

Putting their money where their mouth is?

Given that the London Evening Standard’s incoming editor, George Osborne reportedly already earns in excess of £1.5 million per year (Politics and greed: seeking integrity and justice, 27th March 2017), I wonder whether he will follow his columnist’s advice and Ms Dick’s fine example?