No
Consensus over mysterious report
Jonathan Gornall, freelance journalist
Government
guidelines designed to safeguard children whose illness is fabricated
or induced could be undermined if a group of cross-party MPs currently
paying close attention to a document of unclear origin succeed in their
bid to persuade the children's minister to dilute the rules. Jonathan
Gornall reports.
Hospital
Doctor 18th MAY 2006 FEATURE on Page 16,17,20 and 21.
Hospital
Doctor - Thursday 18th May 2006
Weighing
in at 104 pages littered with what at first glance appear to be credible
footnotes and references, a report currently doing the rounds in Whitehall
and Parliament purports to be a heavyweight and damning indictment of
the DoH's 2002 guidelines, Safeguarding Children in Whom Illness is
Fabricated or Induced. It also, by implication, challenges the related
report on fabricated and induced illness (FII) issued simultaneously
by the Royal College of Paediatrics and Child Health for the clinical
guidance of its members.
Misdirection of Social Policy - essentially an attack on Munchausen
Syndrome by Proxy (MSBP), as FII used to be called - certainly has friends
in high places. A cross-party group of MPs are pressing for a meeting
with Beverley Hughes, the children's minister, to discuss its controversial
claims that not only are parents being falsely accused of MSBP in their
thousands but that this 'hypothetical medical condition' probably doesn't
even exist.
The theme
was taken up by the Sunday Times on 23 April under the headline 'MPs
say hunt for abusers may be out of control'. The paper said: 'Innocent
parents are being falsely accused of abusing their children and threatened
with having them taken into care, according to a report backed by MPs.'
The report,said
the paper, had been drawn up by 'Consensus, a group of parents and professionals'.
Yet when Hospital Doctor tried to contact Consensus, no one - including
the MPs apparently happy to rely on its anonymously authored accusations
- appeared to know who or what it was.
On 18 March,
retired hospital consultant Dr Richard Taylor the independent MP for
Wyre Forest and one of the cross-party group, wrote to Julie Jones,
president of the Association of Directors of Social Services (ADSS),
quoting the Consensus report at length. (see panel).
He said that
'given the ADSS's support for the FII Guidelines - the basis of which
is brought into question by these findings he was inviting the association
to 'marshal its rebuttals, point by point, against the various itemised
misgivings' in the report. But when Hospital Doctor spoke to Mr Taylor,
he claimed to have no idea who had authored the report: 'We are not
claiming ownership of it or anything like that. And I couldn't tell
you who produced it.'
Did he not
wonder who the authors were, given that he was prepared to accept the
report and submit it to a minister? 'I need to know about its reliability
and veracity, certainly, yes.'
Mr Taylor
wasn't the only member of the cross-party group whose knowledge of Consensus
appeared hazy. Lynne Featherstone, Lib Dem member for Hornsey and Wood
Green, said she had neither contact with, nor knowledge of, the identity
of the organisers, while Damian Green MP for Ashford and Tory frontbench
spokesman for immigration, was unable to find 'the relevant piece of
paper'. But he said: 'We all had individual constituent cases who appear
on the surface to have been very badly treated by the existing guidelines,
so almost with or without the Consensus report, which happened to act
as a catalyst, we got together. I want the minister to get somebody
independent to take a careful look at these guidelines.'
The only
member of the House of Lords in the group is Earl Howe, shadow spokesman
for health, who in 2003 declared MSBP was a 'theory without science....one
of the most pernicious and ill-founded theories to have gained currency
in childcare and social services over the past ten to 15 years'.
Not
clear
He, too, was
'not at all clear who Consensus are myself, but a document that they
prepared has reached me. The group have considered that in some depth
and want to present it to the minister.'
The Milton
Keynes address at the top of the document is that of David Mortimer,
a campaigner involved with several groups concerned with the rights
of fathers, including UK Fathers, Mankind and Families Need Fathers.
He is also a member of the Equal Parenting Council and a group called
Family Law Reform. Mr Mortimer also claimed to have no idea who was
behind Consensus, and said he had been telephoned anonymously and asked
whether he would be prepared to hand-deliver the report to named politicians
and Whitehall officials.
He had agreed
to distribute the document because Consensus appeared to share some
common concerns with his group, UK Fathers- not least the same 'enemy'
in the named civil servant whom both sides claim has derailed reforms
for which they had been campaigning.
Serious accusations
against this civil servant, who was responsible for setting up the working
party to establish the FII guidelines, are repeated in the Consensus
document, even though a departmental investigation by David Normington
permanent secretary at the Department for Education and Skill (DfES),
has cleared him of all wrongdoing.
The working
party was set up after a recommendation by Prof Rod Griffiths in his
2000 report, Review of the Research Framework in North Staffordshire
Hospital NHS Trust. The remit of the Griffiths inquiry had been broadened
to embrace MSBP to satisfy pressure groups determined to discredit the
child-protection work of paediatrician Prof David Southall.
One of the
Griffiths recommendations in 2000 was that 'in order to assist in the
correct identification of children who have either had illnesses induced
or fabricated by their carer', the DoH should convene a multidisciplinary
panel to produce guidelines that would 'aid professionals in their identification
of this type of abuse and would suggest good practice in multidisciplinary
and multi-agency management of such cases'.
Bitterly
disappointed
The campaigners appear to have misunderstood this as a promised review
of the very existence of MSBP and were bitterly disappointed with the
guidelines published by the DoH in 2002. The Consensus document misleadingly
maintains that the 'intended and acknowledged reason for the working
party' was 'an inquiry into the correct diagnosis of MSBP' and 'a challenge
to Dr Southall's questionable approach'. But Prof Griffiths told Hospital
Doctor he was happy with the FII guidelines and had no doubt MSBP/FII
existed. 'I certainly came to the conclusion that the syndrome if that's
what it is exists, because there are papers describing that kind of
collection of symptoms and behaviours and so forth from an awful lot
of different countries and over quite a period of time. 'He said it
was not true the DoH guidelines has, as Consensus says, 'launched the
mistake they were intended to prevent' by twisting 'the commendable
impulse behind the Griffiths report'.
Consensus
says the working party had been loaded with 'known adherents of Dr Southall
and the MSBP hypothesis' and had focused on 'the construction of national
screening for MSBP - on the unexamined assumption that Dr Southall's
intuitions and the MSBP/FII hypotheses were correct'. Not so, according
to Prof Griffiths. 'I sat in on the early meetings of the group that
the department put together and it was a pretty wide-ranging group,
'he said. 'If I could have thought of anybody else who ought to be there,
I would have said so. I don't think they set out to frustrate our recommendations,
I think they did their best with it.' Prof Douthall, whose work in child
protection has long marked him out as a target for campaigners on behalf
of women accused of abuse, was shown a copy of the Consensus report
by Hospital Doctor.
'This is
a thoroughly deceitful and mischievous document that makes utterly misleading
use of statistics and a handful of unsubstantiated and entirely one-sided
so called case histories for the clear and sole purpose of sabotaging
the work of child protection agencies in this country' he said. 'It
is nothing more than a continuation of the now well-documented campaign
against doctors and other professionals who work in this difficult and
thankless field and I hope the minister will treat it with the contempt
it deserves.
'It is disgraceful
that MPs have allowed themselves to be recruited to this campaign and
are apparently happy to peddle the report's allegations without having
any idea of the identity of its authors or their motives.' Although
there are no signatories to the full Consensus report, all 14 case studies
in it were provided by Lisa Blakemore-Brown, a psychologist and long-term
opponent of MSBP who, in her own words, gave evidence to the Griffiths
inquiry of 'alleged malpractice by Prof David Southall...and in relation
to the erroneous thinking and methodology of Munchausen's Syndrome by
Proxy'.
Often
mistaken
Ms Blakemore-Brown, author of the book Reweaving the Asperger's Tapestry,
believes the symptoms of such conditions as Asperger's Syndrome, autism
and attention deficit disorder are often mistaken by doctors and social
workers for signs of abuse. Since 1996, she has written letters to various
ministers, health secretaries and even the Prime Minister highlighting
her concerns about the possible misdiagnosis of MSBP. She could not
say who the authors of the Consensus report were, but suggested they
had chosen anonymity for fear of persecution: 'If you want a story,
we've got a fascist government that will leap on anybody who owns up
to saying anything against what it sets out as policy.' Whoever the
authors were, the Consensus report is riddled with inaccuracies and
misrepresentations. According to Consensus, as one Sunday paper reported,
'up to 12,000 children a year are being taken into care for MSBP-related
reasons', but this figure is entirely speculative. Consensus, highlighting
the 'high regional variations for the incidence of child abuse', neglects
to point out that these figures apply to all categories of child protection
and not solely to cases of MSBP. The report suggests, with no justification,
that 'a probable explanation' for the disparity is that 'in certain
areas of Britain, the MSBP hypothesis is disregarded - whereas in others,
it is taken as gospel and applied with zeal'.
Also, Consensus
misleadingly suggests that the total number of children in care is rising,
and that this supposed rise may have been precipitated by a progressive
redefinition of normality as a criterion of child abuse. However, although
the document points out that the number of children in care rose from
49,500 in 1994 to 61,100 in 2004, a less selective reading of the trend
shows that the number has been steadily declining since 1976, when 96,000
children were in care. In 2005, there were 60,900 in care and the total
number of referrals to social services 552,000, down from 572,000 the
previous year.
Case
studies
Some of the
case studies were sent by the MPs to the ADSS. 'They asked whether we
had any significant reservations and the guidance, 'said Andrew Webb,
co-chairman of the association's children and family policy committee
'and whether there were any factual errors in the document. I confirmed
that ADSS fully supported the guidance but refused to comment on the
second on the basis that all I had was a bundle of anecdotes about poor
practice and no first-hand evidence.'
In a second
letter last month, Mr Taylor set out bullet points from the Consensus
report for rebuttal or otherwise by the ADSS. 'I will respond, 'said
Mr Webb, 'but having now read the document, while it sets out to alert
minister to alleged mismanagement of internal processes in the DoH and
the DfES, it doesn't appear to add any light to the debate about children
whose parents fabricate symptoms or induce illness in them. That type
of abuse is well documented and needs to be investigated.'
From a social
services perspective, said Mr Webb, 'the document basically condemns
itself when it states "the actual job of social services is to
deal with dangerous and unpleasant people" and goes on to say "Initial
assessments are implements of familial destruction" - two quotes
that really point out how little it understands about the nature of
social services. The Consensus document makes no reference to the needs
of children.'
Quite
worrying
Mr Webb added:
'It's really quite worrying that a group of MPs should consider this
document seriously as it completely misrepresents the whole role and
function of social care for children.' Nevertheless, the MPs, armed
with their anonymous Consensus report, are believed also to be seeking
a meeting with the Royal College of Paediatrics and Child Health (RCPCH)
to discuss the college's companion document to the DoH guidelines on
FII.
The RCPCH
said its guidelines had drawn on the expertise of paediatricians and
those in many other disciplines. 'The working group included a number
of parents and independent lay members. These documents provide guidance
for agencies and professionals at a local level in these difficult and
sensitive cases,'
The MPs and
the anonymous campaigners of Consensus are likely to find the college's
position on the subject no less robust than it was when its FII guidelines
were issued in 2002. 'Protecting children from harm is a priority for
paediatricians, 'wrote the working party in its report. 'We wish to
move some of the focus from the carers, and make the welfare of the
child the absolute priority. There is unequivocal evidence that carers
can and do cause harm to children through fabricated and induced illness.'
SUMMARY:
THE CONSENSUS REPORT
'Extract
from Dr Richard Taylor MP's letter to the president of the Association
of Directors of Social Services using information from the Consensus
report to highlight his concerns about the 202 DoH guidelines and referring
her to specific pages of the report. He asked the association to 'marshal
its rebuttals point by point'.
99
pages fully-sourced and referenced published 19 September 2005‘
Assessing Ordinary Parents as Abusers, Assessing Ordinary Children as
Victims’
Potential
Problem Areas with the official 2002 Guidelines on MSbP / FII:
‘Safeguarding
Children in whom Illness is Induced or Fabricated’
A.
THE FII GUIDELINES: Flawed Intellectual Architecture?
p16: The
2001 departmental Working Group (‘WG’) adopted a mistaken
remit
p17: The
WG’s stated aim was to devise “correct” methods of
“identifying” FII cases
p18: The
WG went off on a tangent, setting up machinery to process supposed FII
cases
p21: The
WG’s membership lacked expertise/qualifications to evaluate the
FII hypothesis
p22: The
WG did not consider medical evidence sceptical of the FII hypothesis
p25: “A
defective WG, working to the wrong brief, produced the wrong guidelines”
p26: “Sick
children were reclassified as abused children”. The 2001 draft
Guidelines:
- lowered
the standard requirement for significant harm (p29)
- listed
many ordinary behaviours as telltales of abusive FII parents (p31)
- listed
many ordinary behaviours as telltales of abused FII children (p33)
- directed
referrals to Social Services on a ‘possibility’ FII ‘might’
be involved (p5)
- gave
no / almost no consideration to medical explanations other than FII
(p35)
p37: The
Department’s own statistics concede that there is no significant
FII problem
p41: The
2001 departmental public consultation on the draft guidelines was misdirected
p42: The
widespread reservations about the draft guidelines were not taken into
account
p45: In 2002,
the flawed guidelines went to tens of thousands of non-medical practitioners
p47: During
this wide dissemination, the flawed guidelines were further ‘dumbed
down’
p49: Official
training in the guidelines has added elements of anti-medical extremism
p64: The
promised review of the FII hypothesis (post-Cannings) was circumvented
B.
THE FII GUIDELINES: Possible Effects?
p50: There
are some 570,000 referrals to Social Services (all causes) each year
- 2003 quoted
p51: There
are some 264,000 Social Services ‘Initial Assessments’ (all
causes) each year
p52: A number
of these interventions (x000s?) could be for misplaced FII concerns*
p55: Marked
regional variations could suggest that some counties might be over-zealous
p51: Each
needless initial assessment can seriously damage a family*
p51: Some
90-95% of Social Service interventions seem to be misplaced:
- 95% of
referrals do not lead to placement on the At Risk register p51
- 90% of
Initial Assessments do not lead to placement on the At Risk register
p51
p52: Some
children may be on the At Risk register for invalid FII concerns*
p53: Some
children may have been removed from their parents for invalid FII concerns*
p56: Some
children may be adopted for FII (despite a tacit official admission
of no FII)*
p15: Areas
of primary need-and-risk may be skimped in the quest for nebulous FII-cases
*Statistical
information / research on the likely scale of any problem may be a priority
Summary
prepared by the Cross-Party Parliamentary FII Group. For evidence, see
the full text as per page citations
Attachment
to the letter March 2006 from Dr Taylor (Chair) to Julie Jones Minister
(ADSS Chair)
