The Cleveland Report:by Judge Elizabeth Butler-Sloss

Inquiry into child abuse in Cleveland 1987 (1988) Report of the inquiry into child abuse in Cleveland 1987 Cm 412 London: Her Majesty’s Stationery Office 0 10 104122 5This report, prepared by Judge Elizabeth Butler-Sloss after media publicity about a sudden increase in diagnoses of child sexual abuse at Middlesbrough General Hospital in early 1987, revealed both the tensions and the misunderstandings that can arise when child sexual abuse is diagnosed rather than disclosed. It received a lot of attention at the time not only for its revelations of the professional tensions that surrounded the increase in diagnoses but also because Judge Butler-Sloss attempted to set down some benchmarks for the diagnosis of child sexual abuse based on the best available expert opinion at the time.

Key points

  • There had been an increase in diagnoses of child sexual abuse following the arrival of Dr Marietta Higgs at Middlesbrough General Hospital in January 1987.
  • Some of these diagnoses had identified hitherto unsuspected abuse but most children had been returned to their families.
  • Generally the professionals had been inconsiderate to parents, failed to communicate and failed to undertake any wider assessment of the situation.
  • There was a long-standing unresolved tension between the police and social services over the investigation of child sexual abuse.
  • There were significant procedural failings in the handling of many of the cases as well as some dubious professional decisions.
  • The police were unable to follow up many inquiries, not just because of denial by the children but also because of failures by professionals to provide statements and other forms of corroboration.
  • The proper use of Place of Safety Orders at the outset was replaced by the use of Orders not supported by a wider assessment for the improper purposes of denying parental access and ‘disclosure work’.
  • This in turn led to huge increases in contested Interim Care Orders and then in wardship proceedings to relieve the burden on the juvenile courts.
  • Senior managers were not informed by middle managers of the growing crisis until quite late in the day.
  • Though social workers acted in good faith, they should have been more cautious in their interventions.
  • While other professionals failed to recognise police requirements, the police also failed to explain these to other professionals or to recognise their requirements.
  • Communication between senior managers in the police and social services was ineffective.
  • The police surgeon who led the opposition to the diagnoses should have taken more action to resolve the situation.
  • Dr Higgs denied responsibility for much of what happened, never gave pause for thought, was unable to understand other points of view, saw opposition as ‘denial,’ caused unnecessary stress to children and families and failed to take account of resource issues.
  • However, Dr Higgs and Dr Wyatt were not always wrong in their diagnoses.
  • Therapy should never be offered on the assumption that abuse has taken place.
  • Stuart Bell MP had overstated the case in relation to the diagnoses and the social services response but some of his complaints about the police being obstructed were justified.
  • Social services Court Liaison Officers should have sought legal advice.
  • Social workers failed to explain to parents how they could appeal against restrictions on access.
  • The use and behaviour of some Guardians ad Litem was improper .
  • Consent to examinations should be sought explicitly and an explanation given.
  • Do not assume that abuse has taken place and that lack of disclosure is a sign of denial.
  • The interviews done in Cleveland mostly failed the standards agreed by professionals working in the area of child sexual abuse.
  • Avoid trying to improve systems rather than skills because this can create the illusion that knowledge exists when it does not.
  • All those involved need to improve what they do and how they do it in the interests of the welfare of children.

Content

Elizabeth Butler-Sloss prefaces the report with four sections summarising the context and main events.

In the Background to the Inquiry, she explains that on 9 July 1987 the Secretary of State for Social Services ordered a statutory inquiry into “arrangements for dealing with suspected cases of Child Abuse in Cleveland from 1st January 1987”. She was assisted in this by David Hull, John Chant and Leonard Soper though she was responsible for the final report.

There were 74 days of hearings from 11 August 1987 to 29 January 1988 including eight days of private sessions for the parents; the children were represented by Andrew Kirkwood on behalf of the Treasury Solicitor.

In Child abuse: sexual abuse, she summarises current definitions of sexual abuse and notes that there are no reliable figures for its prevalence. She then summarises the sexual offences, noting that allegations of child sexual abuse tend to involve the more serious offences and that there is often pressure to keep the abuse secret and that children are often ‘double victims’. She notes that there is only anecdotal evidence about family abuse and that there was only one case of female sexual abuse in the inquiry but that mothers are not always protectors.

She states that it has lasting effects and illustrates this with Samantha’s story. She notes that there has been greater public recognition but also disbelief.

In Child abuse: physical abuse, she examines how physical abuse was dealt with in Cleveland and concludes that the handling of child abuse cases which did not involve sexual abuse was generally satisfactory.

In The story of the Cleveland ‘crisis’, she outlines the chronology of the rise in diagnoses following the arrival of Dr Marietta Higgs at Middlesbrough General Hospital on 1 January 1987. From a single diagnosis in February, there had been an increasing number of diagnoses leading to doubts among the police in April but followed by surges in May and June which had led to a breakdown in relationships between the police and social services, alarm in the courts at the number of contested cases where parents had been denied access to the their children, the setting up of a resource centre in the grounds of the hospital to hold the growing number of children being diagnosed as sexually abused and the intervention of the Regional Health Authority in an attempt to diffuse the situation.

Following a series of media interviews and the intervention of Stuart Bell, a local MP, the Minister of State had announced a statutory inquiry on 9 July 1987. Overall, there had been 125 diagnoses of child sexual abuse of which 78 had been made by Dr Higgs and 43 by Dr Wyatt; by the end of the inquiry 21 of the children diagnosed were in local authority care and 98 had gone home.

In Part One: People and events in Cleveland, she looks at the different actors in the situation.

In Chapter 1 The children in Cleveland, she outlines why she decided not to hear the children but to invite the Official Solicitor to represent the children; of the 165 children examined by Drs Higgs and Wyatt, 51 were over eight and 32 chose to speak to Andrew Kirkwood. She then gives examples of the children’s stories, from both those who had been abused and those who said no abuse had taken place.

In Chapter 2 Parents, she notes that there was a wide variety of families, including some known to the social services departments and some with known sex offenders living in the families. The parents of eleven families gave evidence; some were thankful that the abuse had been discovered but they complained about:

  • the brevity of the examinations,
  • the way other medical symptoms and medication were ignored,
  • the times when the examinations took place,
  • the difficulty in getting a second opinion,
  • failures to seek their consent.

They also complained about social workers making Place of Safety Orders, failing to communicate with them, refusing or restricting access to their children and not telling them about or allowing them to attend case conferences. Though there was praise from some parents, they had problems over legal advice and money and some parents were not happy with the ‘disclosure work’ and the ways in which it was undertaken.

Generally the professionals were inconsiderate, failed to communicate and failed to undertake any wider assessment of the situation.

The parents generally praised the South Tees Health Authority and only one parent complained about the police even though a number had been arrested and interrogated. A father and an uncle had committed suicide in prison and another had tried to kill himself while under suspicion.

In Chapter 3 Inter-agency bodies – Cleveland Area Review Committee and Joint Child Abuse Committee, she reviews the history of these bodies noting that there had been tensions between the police and social services over the investigation of child sexual abuse which, during the crisis, had led to the police failing to attend a crucial meeting. She identifies a problem of members seeking to protect their organisational interests and notes that none of the major agencies had responsibility for either of the Committees and their representatives had insufficient delegated authority.

In Chapter 4 Social Services Department, she notes that, at the time of the Beckford Report (1985), there had been a decision to give child care priority as a result of which various appointments had been made including that of Mrs Susan Richardson as Child Care Consultant. Before the arrival of Dr Higgs in January 1987, case conferences had been generally well attended; they were well recorded and there was good liaison over planning for individual cases. There were few cases of child sexual abuse, a general feeling that the guidelines were working well and a general view that seven-day Place of Safety Orders should be the norm. Though there were some variations in parental involvement in case conferences on physical abuse, no parents attended case conferences on child sexual abuse, though sometimes the chairman saw them afterwards.

Tensions had begun to arise between the police and social services after the case of a six-year-old girl initially recorded in February as having been abused but where it later appeared that this was highly unlikely and then a second case in March where the police took statements from Dr Higgs and from members of the family in circumstances which raised concerns for social services. Elizabeth Butler-Sloss comments that the management of this case was badly handled by both police and social services from the outset and “it did not get better” (p. 59).

Problems increased in April when two children who had been diagnosed by Dr Higgs as sexually abused elsewhere and then placed with foster parents in Cleveland were again diagnosed by her as having been sexually abused, leading to a whole series of inquiries and second opinions. However, Elizabeth Butler-Sloss points out that, at the special planning meeting on 3 May, there was no testing of the evidence; the focus was on wardship and it was suggested that the children’s existing Guardians ad Litem be appointed as Guardians ad Litem in this case even though they were present at the meeting. The meeting also decided to call in all the children who had been at the foster home in the past year for examination rather than asking their social workers to look out for signs of abuse. She notes that the children who were being looked after by the foster parents as childminders were seen by their GPs who could find no signs of abuse.

Over May Bank Holiday weekend 23 children were admitted to Middlesbrough General Hospital but the police were by now reluctant to accept the diagnoses while the social workers were unwilling to accept second opinion examinations by the police surgeons. At this time senior managers were largely uninvolved but two more waves of admissions in late May and mid-June created a crisis for fostering services.

Meanwhile, the police were unable to follow up many cases because the children denied the abuse and they had no other information to go on.

Initially the Emergency Duty Team had only taken out Place of Safety Orders if parents were unwilling to leave the children in the hospital and then only for seven days but they began to come under pressure from the consultants to proceed without a proper examination of the circumstances and were eventually instructed in effect to do what the consultants wanted without regard to the wider situation. Thus the parents’ complaints about the Emergency Duty Team were valid.

By this time the number of Place of Safety Orders had led to numerous contested Interim Care Orders and a third wave compounded the frustration of staff at the conflict between police and social workers. Though there was an emphasis on disclosure work, few people were trained to do it and they had to recruit independent social workers to do it.

In mid-June the Director of Social Services approached the local health authority, who involved the Regional Health Authority, and set up a child abuse group within his management team to monitor and co-ordinate their response. At the end of June, the children’s resource centre was opened in the grounds of Middlesbrough General Hospital to accommodate the children because of the problems they were creating on the wards.

By this time there was media interest, the parents’ concerns had been taken up by Rev Michael Wright and Stuart Bell MP had visited Middlesbrough General Hospital and spoken to parents and to the Director of Social Services. Overall, the Director had dealt with the situation appropriately but he should have acted more quickly to understand the situation, to bring people together to resolve problems and to seek outside advice on the situation. Mrs Richardson was a social worker with little management experience who, when appointed in July 1986, had written a cogent account of the department’s limitations but had ignored her own assessment in seeking to manage what was going on in 1987. Though she claimed to be “child centred”, she lacked “the management skills, or the foresight to control or contain the problems” (p. 83).

Overall, the parents’ criticisms of social workers were justified; any removal from home should be carefully considered and, though they had acted in good faith, they should have been more cautious in their interventions.

In Chapter 5 NSPCC, she summarises the work of the NSPCC in Cleveland – who were not involved in the situation!

In Chapter 6 Police, she outlines the structure of the police force in Cleveland and notes that, though the police claimed the previous arrangements had been sound, these had been framed for traditional cases, not for those involving younger children.

After the publication of Child abuse – working together (Department of Health and Security, 1986), the police had accepted the principle of a joint approach though no actual guidelines had been produced, those produced by the Area Review Committee having been produced without consultation with police officers at operational level; police officers were also unaware of Home Office Circular No 179/1976 which required disputed decisions to be referred to the Chief Officer.

Police distrust arose out of a case diagnosed in February when the child implicated her grandfather but a subsequent diagnosis in March when she had no access to her grandfather and a further diagnosis in June when she was in foster care convinced the police that their instincts had been right all along. Hitherto, they had only dealt with allegations from the victim directly or indirectly and they resisted investigating third party allegations for which there was no further supporting evidence.

Social workers could not understand this unwillingness but the police did not seek to understand social workers’ concerns.

They had problems getting statements from Dr Higgs, and the police photographers were upset about being asked to take photos where there was no evidence of injury particularly as this was obviously causing distress to the children.

However, though the lines of disagreement were set out in a meeting between social workers and police officers on 28 May, social workers were not told exactly what the problems were for the police nor were their Divisional Commanders told of the disagreements. Meanwhile, communication between senior managers in the police and social services appears to have been ineffective.

The police refused to respond to media pressure until 29 June when their media statement demonstrated their lack of awareness of aspects of the situation, and the following day they refused to share a platform with the social services at the County Council press conference.

Overall, the police had genuine concerns but should have taken action to avoid the conflict; they had focused on managing the reaction rather than on understanding the problem and had failed to recognise the problems for social services.

In Chapter 7 Police surgeons, she describes the arrangements for police surgeons who were mostly involved with child sexual abuse rather than physical abuse before summarising Dr Irvine’s background, his disagreement with Dr Higgs and his reactions to the situation. He had been the key opponent to the diagnosis but he had done nothing to get himself, or the police, out of the situation and should have sought outside medical opinion.

In Chapter 8 Health services in Cleveland, she summarises the arrangements in Cleveland and the District Health Authority’s prior involvement in child sexual abuse cases.

The Northern Regional Health Authority had appointed Dr Higgs in June 1986 to take up a post in neonatology at Middlesbrough General Hospital on 1 January 1987. She had asked if should could extend her interests to child abuse and had been asked to provide a timetable to show she could cover the post properly but never did. In September 1986, prior to taking up her appointment, she presented a paper with Dr Wyatt arguing for increased paediatric provision.

In June, following a complaint to the Region, a Second Opinion Panel had been set up, though an evaluation of the clinical practice of Dr Higgs and Dr Wyatt had agreed there was no evidence of clinical incompetence, and they had been forbidden to undertake further examinations without parental permission or a court order.

The Northern Region had, among other things, set up a Regional Reference Group to provide second opinions and responded to the Minister of Health’s request for a report. Overall, its responses had been timely, innovative and effective and its evidence in the inquiry had been well prepared and helpful.

The South Tees District Health Authority had surveyed the need for child sexual abuse training by early in 1987. At the time the children’s wards at Middlesbrough General Hospital were full of children with chest infections; there were staff shortages and poor facilities for parents. The influx of child sexual abuse cases in the first week of May was sudden and unexpected and put pressure on the clinical photography department. The nurses were also unclear whether parents could visit or remove children and complained about lack of communication from the consultants as well as waking children up in the night to do examinations.

There were several meetings to try and resolve the issues but Dr Higgs failed to understand that the budget was finite and that the wards were not equipped to deal with lots of healthy children; she also failed to provide any guidance for the nurses.

The pressure was partly relieved when the Orthopaedic Teaching Centre was turned into the Children’s Resource Centre.

Overall, Elizabeth Butler-Sloss judges that the District Health Authority responded well to the crisis.

Dr Higgs qualified in 1974 at the University of Adelaide, moved to the UK in 1977 and worked at Newcastle Medical School from 1979 to 1986. In 1983 she had attended a two-day conference on child sexual abuse at Northumbria Police HQ and in June 1986 had attended a BASPCAN conference in Leeds where she had heard Dr Wynne speak. In July she had made a diagnosis of child sexual abuse but the symptoms had disappeared and reappeared later.

Following her appointment to Middlesbrough General Hospital, she had signed a letter with Dr Wyatt about the shortage of paediatric resources. She saw child sexual abuse as part of general paediatrics but in her first case did not diagnose lichus planus et atrophicus which can produce changes in skin similar to child sexual abuse. She became more confident in her diagnosis when children made disclosures of abuse even though she had seen the foster children, whom she diagnosed as having been abused, three times without diagnosing abuse. She admitted at least one family to hospital for whom there was no need.

She did not see the technique she used as controversial and her response to the crisis was to ask for better facilities; when challenged during the Inquiry, she did not appear to have changed any of her views.

Overall, she denied responsibility for much of what happened, never gave pause for thought, was unable to understand other points of view, saw opposition as ‘denial,’ caused unnecessary stress to children and families and failed to take account of resource issues.

Dr Wyatt qualified in 1973 and worked in paediatrics in Southampton, moving in August 1983 to South Tees where he took on an enormous workload. He had little previous experience of child sexual abuse and, although senior to Dr Higgs, deferred to her in matters of child sexual abuse. His first diagnosis was made in April in relation to a case of ‘failure to thrive’ and, as he increasingly accepted her view of the signs as definitive, he changed his own practice.

Overall, he did not regard the diagnosis as open to question, he was unhappy about second opinions, thought ‘disclosure work’ was important, had no appreciation of the wider controversy and failed to attend case conferences and sometimes to write up notes.

Both he and Dr Higgs told parents the diagnosis directly and were not always wrong.

Elizabeth Butler-Sloss notes that North Tees child psychiatry and psychology service had received a referral for family therapy which had been provided on the assumption that abuse had occurred. This was certainly wrong at the evaluation phase.

There had been no formal complaints from GPs but informally GPs were unhappy about the lack of communication between the consultants and GPs and the difficulties the situation had created for GPs who were asked to attend case conferences at short notice.

In Chapter 9 Reactions to the crisis, she describes how the Community Health Council had become involved in the situation in mid-May and then, after the influx of admissions in June, how Rev Michael Wright had formed the Cleveland Parents Support Group. MPs had been made aware of the situation, among them Stuart Bell. He had first heard about the situation on 19 June and then seen Dr Irvine on TV on 26 June. He later appeared on TV himself, put down a private notice question to the Minister on 28 June and delivered a file of cases to him on 7 July.

The Inquiry looked in detail at the arguments he had presented and concluded that he had overstated the case about the diagnoses and the social services response because there were instances of corroboration of abuse and the automatic use of Place of Safety Orders had only begun late in the day. There was no evidence for social services ’empire building’ though there was evidence that the police had been obstructed.

They note that the nurses, the Regional Health Authority and the Social Services Department had good grounds for criticising his conduct but he refused to withdraw most of the allegations subsequently considered to be false by the Inquiry.

The media had become involved in the story quite late and journalists had disrupted the work of the hospital, but mostly the press had been well-behaved during the Inquiry and from the end of the Inquiry up to publication of the report.

In Chapter 10 Legal processes in Cleveland, she begins with an explanation of terms followed by a survey of the use of Place of Safety Orders during the relevant period. All but one had been taken out without the parents being present and until June they had been for seven days but 28-day notices began to be sought because of pressure on the courts and the need for ‘disclosure work.’ Surprisingly, 174 had been granted by magistrates at home when the courts were open.

Copies of some Place of Safety Orders were not sent to the Clerk of Court which compounded the problems when social workers asked for an Interim Care Order for which the Clerk did not know that there was a Place of Safety Order.

The juvenile court normally sat three days a week but was sitting for 14-17 sessions a week until moving the cases to wardship proceedings took pressure off the juvenile courts and put it on the High Court and on the Clerk to attend the High Court.

The situation also put pressure on the social services Court Liaison Officers, none of whom had legal training and who for the most part did not seek legal advice when they should have.

Hitherto, wardship proceedings had been little used but were adopted in 1987 to cope with parents’ frustration; however, the use of section 12B of the Child Care Act 1980 to terminate parental access during an Interim Care Order was not explained to parents or that they could appeal.

There was also a shortage of Guardians ad Litem (GALs) in Cleveland with delays of two to three months in appointing GALs, which was compounded in High Court cases when the GAL had to apply for legal aid which could take three months to come through. Many GALs were unhappy about the way Cleveland managed the GAL panel and the expectation that GALs would support social workers. However, some attended case conferences and planning meetings which meant they were not independent; some even saw themselves as having a role in ‘disclosure work’ which was entirely inappropriate.

In Part Two: Response to child sexual abuse (expert evidence), Elizabeth Butler-Sloss tries to establish a baseline against which one can judge practice in child abuse cases.

In Chapter 11 Medical examination and assessment, she points out that there are sometimes no physical signs of sexual abuse and there is no agreement on terms before describing the various diagnostic techniques, noting that the technique used by Drs Higgs and Wyatt is not conclusive on its own and needs further examination.

She notes the view that consent is assumed to be implied in many situations but recommends that it should be sought explicitly because parents do not always understand the purpose of an investigation. She summarises the issues surrounding examinations, consultation with a more senior colleague, second opinions, informing parents and recording and the presentations by Drs Hobbs and Wynne and by Dr Roberts, who disagreed with Drs Hobbs and Wynne. She concludes that Dr Roberts’s concern over the Hobbs/Wynne technique may have led her to cease to be independent in support of the parents.

In Chapter 12 Listening to the child, she poses the question: What should an adult do when a child speaks of abuse? and quotes from Child abuse – working together (Department of Health and Security, 1986):

A child’s statement that he or she is being abused should be accepted as true until proved otherwise. Children seldom lie about sexual abuse.

but points out that not every detail of a child’s story should be take literally.

She highlights the confusion over the purpose of interviews before describing various techniques and the problems caused by recording interpretations; people need to record both innocent and sinister interpretations. She also highlights the problem when people assume there is something to disclose and that lack of disclosure is ‘denial’ and the inherent difficulty in any attempt to help a child to tell because the child may speak of genuine abuse, may refuse to speak of genuine abuse or may have no abuse to speak of.

She sets out first the disagreements by professionals over facilitation work and then the areas of agreement:

  • Do not call an interview ‘disclosure’ because you assume abuse has happened.
  • Use only trained interviewers.
  • Approach the interview with an open mind and use open ended questions.
  • Have no more than two interviews, taken at the pace of the child in a sympathetic environment.
  • Accept the possibility you may have nothing to show at the end of it.
  • Record carefully.
  • Recognise the problems created by facilitation techniques in court proceedings and only allow them to be used by specially trained interviewers.

She accepts the arguments that parents should not be present and that ‘therapy’ should not be used for disclosure. The interviews done in Cleveland mostly failed these tests.

Reviewing the potential and dangers of video recording, she argues that they are generally helpful. She notes that anatomically correct dolls were generally not available and there were not people with sufficient training in their use.

She reviews the issues of consent and confidentiality, pointing out that disclosure of abuse cannot remain confidential and parents need to be told this; she also expresses concern that some children were told that the videos would remain confidential.

In Chapter 13 Social work practice, she reviews the evidence provided by Brian Roycroft (ADSS), David Jones (BASW) and Norman Dunning (BASPCAN). They agree that the needs of a child can best be met in co-operation with the parents and that removal from home should only take place with proper plans; responding on an emergency basis is rarely required and unlikely to be helpful. They agree on the need for planning and co-ordination, a family assessment, partnership with parents, avoiding a presumption of abuse and a proper assessment of the child’s needs.

There were, however, divergent views on involving parents in case conferences, but case conferences needed to review conflicting medical evidence and avoid the need for second opinion examinations if possible

All agreed that the current law was inadequate but she warns against focusing improvements on systems rather than on skills which can create the illusion that knowledge exists when it does not and she stresses the need for better training.

In Chapter 14 Approaches to the management of child sexual abuse in different areas of the country, she describes the approaches of nine different local authorities from across the country to the management of child sexual abuse.

In Chapter 15 Training, she concludes that training is inadequate.

In Chapter 16 The courts, she summarises the law and points out that a medical examination related to the general health of a child is implicit in the powers to remove children from home but no other types of examination.

She also points out that there are no powers under a Place of Safety Order to curtail access and that using Place of Safety Orders to facilitate ‘disclosure work’ is improper. She welcomes the proposal for an Emergency Protection Order set out in The law on child care and family services (Department of Health and Security, 1987).

She summarises juvenile court proceedings and wardship proceedings before comparing them and offering some suggestions for reform and concludes with a comparison with the Scottish system.

In Part Three: Conclusion and recommendations she sets out her overall conclusions and recommendations.

She concludes that there was a :

  1. lack of proper understanding of each others’ functions ,
  2. lack of communication,
  3. difference of view at middle management level which was not recognised at senior management level.

She adds specific recommendations regarding the conduct of Dr Higgs, Mrs Richardson and Dr Irvine and says there were failures at middle and senior management to take appropriate action, failures to seek legal advice and unacceptable professional disagreements that obscured the needs of children.

She recommends that:

  1. people recognise and describe the extent of child sexual abuse and generate more accurate data;
  2. people focus on the welfare of children, explain things to them, do not make unrealistic promises, listen to their views and wishes, avoid repeated medical examinations and repeated interviews and make sure those caring for the children know the situation;
  3. parents be treated with courtesy, informed about and given decisions in writing, told of their rights, offered support and given written explanations of any orders;
  4. social services should take out Place of Safety Orders for the minimum period, agree access where possible, inform and invite parents to attend case conferences (except in exceptional circumstances), provide a family assessment to the care conference, invite a lawyer to be present in complex cases, seek to resolve conflicts of opinion or at least identify the bases for the differences, put in place monitoring systems, supervision and support, including for Emergency Duty Teams, and pay attention to their relationships with the police;
  5. the police improve their communication and inter-agency work and recognise that the need to protect a child goes beyond the needs of a court appearance;
  6. the medical profession agree their vocabulary, investigate the signs and symptoms relevant to child sexual abuse, take full medical histories and make appropriate investigations for forensic purposes, keep accurate medical records, seek the informed consent of parents and identify areas of dispute;
  7. the Clerk of the Court keep records of Place of Safety Orders, which should be granted in court in court hours, and that parents should be given an explanation of the Ord

She also makes recommendations about inter-agency cooperation including a framework for handling allegations, about training and about Guardians ad Litem, the media, press and public.

In Part Four: Appendices she provides lists of those who provided evidence and a selection of the written material submitted to the Inquiry including figures provided by Dr Wynne and Dr Hobbs.

Discussion

One of the most striking differences between this report and the Hughes Report (Committee of Inquiry into Children’s Homes and Hostels, 1986), published only two years earlier, is the number of myths and misconceptions in the report, a combination of the rising ‘moral panic’ about child sexual abuse and the level of ignorance about it at the time. Thus, while one could give the Hughes Report to a student today confident that they could largely apply what they had learned from it today, one could not do the same with the Cleveland Report. That is not to say that there is not a lot to be learned from the Cleveland Report but that what can be learned has to be sieved carefully from what is misleading.

For example, we now know that, if you chose a random sample of 121 children, the number diagnosed as sexually abused by Drs Higgs and Wyatt, you could expect that around 20 would have been abused (Cawson et al., 2000) and, at the end of the Inquiry, 21 children were still in care. In other words the diagnostic success rate of Drs Higgs and Wyatt was no different from chance. However, neither they nor anyone else at the time could have known that.

There is perhaps less excuse for the assertion that child sexual abuse has lasting effects. Though there was no specific evidence on this subject at the time, the evidence on all other forms of abuse had been collected by Clarke and Clarke (1976) over a decade earlier. This showed that there are no lasting effects as long as the child is placed in a benign environment for long enough after the event – a conclusion that subsequent research into sexual abuse has largely supported.

We also know now that the data provided by Drs Hobbs and Wynne were highly skewed, exaggerating the incidence of paternal abuse by a factor of more than ten (Cawson et al., 2000) and probably misleading social workers and others for a decade.

However, the overwhelming message of this report is the lack of professionalism that engulfed so many people, including those, such as the Emergency Duty Team, who tried to put up some resistance to it. The crisis would not have developed in the way it did without Dr Higgs, Mrs Richardson and Dr Irvine, each of whom behaved unprofessionally in different ways, but it was able to develop because there were underlying tensions between the police and the social services department which had not been addressed and because middle managers tried to contain the situation rather than seeking to understand it, seeking advice from senior managers or seeking outside expert advice – unlike Mr Donaldson of South Tees District Health Authority who did, and as a result of which he was able to gain outside support from the Regional Health Authority to resolve the situation.

Consequently, what should have been a positive experience for a number of abused children as they were released from an abusing relationship turned into a very unhappy and distressing experience for many other parents and children who had to cope not only with a wrong diagnosis but also with a range of poor practices on the part of the professionals involved. In the end the professionals ‘shot themselves in the foot,’ ‘snatching defeat from the jaws of victory’ by failing to maintain the most basic standards of professional behaviour as they panicked about what they had found rather than sitting down and thinking through each situation before they rushed into action.

References

Cawson, P, Wattam, C, Brooker, S and Kelly, G (2000) Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect London: National Society for the Prevention of Cruelty to Children

Clarke, A M and Clarke, A D B (Eds.) (1976) Early experience: myth and evidence London: Open Books See also Children Webmag May 2010.

Committee of Inquiry into Children’s Homes and Hostels (1986) Report of the Committee of Inquiry into Children’s Homes and Hostels (Chairman: His Honour Judge William H Hughes) Belfast: Her Majesty’s Stationery Office See also Children Webmag June 2011.

Department of Health and Social Security (1986) Child abuse — working together: a draft guide to arrangements for interagency co-operation for the protection of children London: Department of Health and Social Security

Department of Health and Social Security (1987) The law on child care and family services Cm 62 London: Her Majesty’s Stationery Office

Panel of inquiry into the circumstances surrounding the death of Jasmine Beckford (1985) A child in trust: the report of the panel of inquiry into the circumstances surrounding the death of Jasmine Beckford Wembley: London Borough of Brent

2 thoughts on “The Cleveland Report:by Judge Elizabeth Butler-Sloss

  1. 2011 and some of these children still suffer nightmares at being removed from loving homes without being told anything.

    Some have lost contact with siblings. So much destruction of human lives.

    RAD was still being used a few years ago and in the one case I know of – the screams of the baby still haunt me. How is pain child protection?

    I have researched to find that after various conferences social workers, nurses, doctors etc begin to see the type of abuse everywhere they go.

    Same applies to lectures of witch finding. it is incredible and fascinating to observe the way these professionals are conditioned to see abuse, witches everywhere.

  2. The social services haven’t got a clue how to look after kids,
    I was in care for 18 years and in more than 10 homes,
    I don’t call that care, I call it abuse.

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