Proposed vote of no confidence in GMC rejected by RCPCH

BMJ 2008;336:791 (12 April), doi:10.1136/bmj.39545.627685.DB

News

Paediatricians debate a motion of no confidence in General Medical Council

Owen Dyer

London

UK paediatricians will debate a motion of no confidence in the General Medical Council’s handling of disciplinary cases involving child protection work, at their professional association’s forthcoming meeting.

The motion has been put forward by 32 members of the Royal College of Paediatrics and Child Health and will be tabled at the college’s annual spring meeting, to be held at York University from 14 April.

Many but not all of the motion’s signatories are members of Professionals Against Child Abuse, a group formed last year in response to high profile GMC cases against paediatricians.

The motion argues that paediatricians are more harshly treated than other specialties, citing cases in which other doctors escaped removal from the register after convictions for assaulting children and viewing child pornography.

The motion also accuses the GMC of giving too much weight to serial and vexatious complaints by campaigners and of failing to consider previous investigations that have exonerated paediatricians when starting proceedings against them. This constitutes double jeopardy, the paediatricians argue.

Paul Davis, a consultant paediatrician in Cardiff and one of the signatories, said the fear of being struck off was a "powerful deterrent" in discouraging professionals from giving expert testimony and from making child protection referrals.

"I can’t give you statistics that prove this has led to children’s deaths," he said, "but I do know that the numbers on the child protection register have declined sharply, with no evidence of a decline in child abuse. This is not an abstract issue for those of us who work in child protection."

Without identifying them by name, the motion expresses "grave concerns" about GMC cases involving two well known paediatricians, Roy Meadow and David Southall.

Professor Meadow was struck off by the GMC in July 2005 over his role as an expert witness in the murder trial of Sally Clark, whose conviction for killing two of her children was later overturned. He contested his erasure and was reinstated after hearings in the High Court and the Court of Appeal (BMJ 2006;333:933; doi: 10.1136/bmj.333.7575.933-a).

The GMC suspended Dr Southall from child protection work for three years in 2004 for making allegations to police against Sally Clark’s husband after watching a television documentary on the case. Dr Southall was struck off in December 2007 after a GMC panel ruled that he had acted "without justification" in accusing a mother of murdering her child (BMJ 2007;335:1174; doi: 10.1136/bmj.39420.690845.DB).

Dr Davis said, "The GMC has never apologised to Roy Meadow, even though its ruling was overturned. There’s something wrong when an organisation that’s supposed to pronounce on others’ wrongdoing can’t acknowledge its own mistakes."

Patricia Hamilton, president of the Royal College of Paediatrics and Child Health (RCPCH), who criticised the GMC for striking off Dr Southall, said that motions passed at the meeting are "not automatically RCPCH policy" (BMJ 2007;335:1174; doi: 10.1136/bmj.39420.690845.DB).

"Nevertheless," she added, "we are of course aware that the difficulties of working in child protection are a concern for many of our members, and we are working with the GMC and other organisations to resolve these issues."

A spokesperson for the GMC said, "It is extremely rare for a paediatrician to appear before a panel in connection with child protection work. Since 2004 panels have considered more than 600 cases. Only two could reasonably be said to have been about paediatricians involved in child protection work.

"Our critics are trying to create the impression that the GMC is intent on unfairly persecuting paediatricians involved in child protection work. Nothing could be further from the truth, and by painting a misleading picture our critics risk creating or adding to the very problem they say they wish to resolve."




BMJ

PACA

When the Safeguarding Children boards were set up a whole new set of policies were bought into play. If a child is deemed at risk now, the approach is to call a multi disciplinary meeting at the school (now the lead in child protection) and what happens fom there on in is that the parents/carers are offered a support and care package, if they take this up they do not place the child/ren onto the at risk register a far more holistic approach is taken. This accounts for the drop in children being placed on the child protection register.

Furthermore the vast majority of children placed onto the at risk register are put on it for neglect, which includes not taking a child to the GP or to a hospital - so Dr Davis's claims are moot - they wouldn't see these children in the first place. The referrals come from teachers.

The second and equally as important point is how the Child Homicide Index is collated. The homicides recorded are based on somebody being charged or accused of murdering a child. In the context of a child being killed by a parent or carer, the index is not accurate enough to draw any conclusions about death rates, this is because the figures only relate to somebody being charged or accused with that offence, if the parent is cleared the figures do not reflect that and neither does it reflect with any accuracy how many child homicides occur in any given year. For example Angela was originally charged with killing her three children in March 2000, those three deaths will have been recorded for homicides for that year, not for the years the babies died - so you see the statistics are so innacurate as to not give anyone a clear indicator as to the true rates of child homicides. I am waiting to hear back from the Home Office statistician to see if the figures were ammended regarding all the cases in which the parents were acquitted of killing a child. Bottom line is this, child homicides have not changed, according to the statistics, since the 1970's. PACA's claims are potentially very misleading. In real terms if more SIDS and SBS cases have been indentified as homicides in the last 20 years then it would mean that in real terms child homicide figures have dropped.

The current situation regarding paediatricians claims that children are dying or being unprotected as a direct result of the GMC disciplining child protection doctors who have seriously erred in their judgement is without foundation and the rhetoric is baseless.

Oh what a coincidence that Southall et al fail to mention that Southall has a hearing at the RCJ on the 22nd of April - couldn't be a little lobbying going on here could it - uhhhm, I know, the RCJ sent the case of the Henshalls back to the GMC, PACA twist the truth (surprise surprise) and blame the GMC and the high court judges are going to totally approve of this sort of behaviour ...... There again, do any doctors working in CP actually understand the law, my experience is that they don't have a clue.

'Climate of fear' for paediatricians

As the GMC convenes over a child's death, doctors are experiencing a growing
sense of persecution

Gaby Hinsliff, political editor

The Observer, Sunday April 13 2008

This article appeared in the Observer on Sunday April 13 2008 on p17 of the
News section.


Paediatricians fear that they are facing a backlash because of their work
with children, the medical regulator has been warned, as the controversial
doctor struck off the register for wrongly accusing a mother of killing her
son faces a new hearing over experiments on premature babies.

A spate of cases which have been heard by the General Medical Council have
raised fears that doctors working closely with children will find it hard to
carry out child protection work. The new case being heard into the work of
Professor David Southall centres on the death of Stacey Henshall, who was
taking part in trials of a procedure designed to help infants who were
having difficulty breathing. Her sister Sofie was also left brain-damaged.
Their parents maintain that they did not give proper consent to the
children's involvement.

A decision on reopening the case against Southall and two colleagues, to be
announced by the GMC this week, risks inflaming a bitter clash between the
regulator and paediatricians who argue they are being unfairly persecuted
and that high-profile cases are frightening off doctors.

Professionals Against Child Abuse (Paca), a campaigning alliance of mainly
paediatricians, has tabled a motion of no confidence in the GMC to be
debated this week, citing the previous Southall hearings.

The GMC's chief executive, Finlay Scott, however, blamed paediatricians
themselves for whipping up unnecessary fears. A study by the GMC found that
those specialising in children's medicine were actually the least likely of
five groups to face disciplinary investigations. 'Paediatricians involved in
child protection do not attract disproportionate numbers of complaints and,
what is more, the GMC has demonstrated that it is capable of handling these
complaints in a sensible way,' he said.

Scott said the new complaints against Southall, Dr Martin Samuels and Dr
Andrew Spencer was not evidence of a vendetta. The GMC has twice rejected a complaint from Stacey's parents, Carl and Debbie Henshall, and reopened the
files only after losing a judicial review sought by the couple. 'We defended
our decision but the court said we were wrong,' Scott said. 'I don't think
this is an example that exactly supports the hypothesis.'

Southall, an internationally renowned expert, was banned from practising in
December, after the GMC ruled he had inappropriately accused Mandy Morris of
drugging and hanging her 10-year old son - although he denies this.

He had been previously banned from child protection work after telephoning
police to suggest that the husband of Sally Clark - the solicitor wrongly
jailed for murdering her children - had killed the babies. Southall did not
know the medical history and had only seen Stephen Clark on TV.

The current case dates back to 1991, when the three doctors were overseeing
research into a new technique for helping premature babies breathe, known as
continuous negative extrathoracic pressure, or CNEP, at the University
Hospital of North Staffordshire.

The CNEP tanks worked by lowering the air pressure around a baby's chest, a
less invasive procedure than traditional ventilation via the windpipe.
However, the trial found slightly higher rates of death or brain damage
among 122 older babies placed in the tanks, compared to those who were given
ventilation.

The technique was stopped at the hospital in 1999. The doctors have argued
the death rate variations were not statistically significant and that the
babies involved were already desperately ill.

An inquiry by the Department of Health, published in 2000, concluded that
while the trials complied with rules in force at the time, these were not
sufficient safeguards for the parents and children involved.

A spokesman for the University Hospital of North Staffordshire declined to
comment on the Henshall case.

The Paca no-confidence motion cites details of the cases of Southall and Sir
Roy Meadows, the expert witness in Sally Clark's trial who wrongly suggested
that the odds of two cot deaths in the same family were 73 million to one.
The true figure is around 200 to one.

The motion argues that paediatricians are treated more harshly than other
specialists and that, as a result of the Southall hearing involving Stephen
Clark, doctors 'may therefore be less likely to report child protection
concerns'.

However, Scott said that only three out of more than 600 cases since 2004
that led to disciplinary panels involved paediatricians accused over child
protection issues: two of those were the Southall and Meadow cases. 'The
cases do not concern jobbing paediatricians going about their daily work.
They were all undertaken under procedures that are no longer in place,'
Scott said.


Click for Observer piece

Click for David Southall Exposed

I suspect that Dr Davis will be found to have a full attendance record for Professor Southall's special barking classes.

Interesting how PACA has basically said that the Foundation is hell bent on a witchhunt against paeds in particular. Once again I make the point that if they are doing their work correctly then they have no cause for concern. And they keep banging on about the idea that paedatricians will not be wanting to come forward to be involved with child protection, SORRY! NOT GOOD ENOUGH!!!
Sounds like running scared to me. There are good and honest working paedatricians out there including my local one who was an absolute star so PACA and anyone else who wants to debate bring it on and I say
HOW VERY DARE THEY!!

I posted the following 'rapid response' early yesterday.

"Pity the children

It seems that the fear of being struck from the medical register is detering paediatricians from the job of protecting children. Thus, fears for their own safety would appear to overwhelm the physicians’ duty to protect their patients. Pity the doctor.

Competing interests: None declared"

My words are yet to see the light of day in the world of rapid commentary at the BMJ.

ditto

I have just posted another “rapid” response to the BMJ …

“The jeopardy within … the PACA double standard

PACA member, consultant paediatrician Dr Paul Davis, considers that the fear of being struck off is a “powerful deterrent” to professional child protecting.

However, paediatricians everywhere will be aware that Dr Andrew Wakefield and paediatric Professors John Walker-Smith and Simon Murch are currently defending their research work against a long running and expensive GMC prosecution. Paediatricians will recognise that such prosecutions are likely to deter further research into childhood inflammatory bowel disease and some of the possible causes of autistic spectrum disorder.

Of course, paediatricians will understand that the success, or even failure, of such prosecutions will inevitably leave children vulnerable - and unprotected - far into the future.

The great and the good of paediatrics are gathering for their spring meeting at the University of York and will soon debate a motion of no confidence in the General Medical Council. It is reassuring to know that paediatricians will express their disquiet directly to Sir Graeme Catto about the GMC’s disciplinary handling of these hapless paediatric professors … and the deleterious effect it will have on the future of child protection.”

Of course, there is absolutely zero chance of the above being posted, rapidly or otherwise.

There's zero chance of anything even getting close to opposing views getting published - interestingly I had telephoned the editors to state that Dr Davis's statements were misleading and that as a "prestigious" medical journal, the facts should have been checked first (still waiting to hear back from the Home Office who don't seem to have a clue about how many child homicides there are ... great eh!) - I was told "go and tell John Sweeney" - Sweeney and I dont get on tabloid telly or any telly isn't my thang. Which, I am afraid, elicited a "go forth and fornicate" response - so it will be the press complaints instead, because, to be frank, I have had enough of the BMJ allowing crap to be published as fact and in particular never giving me the right to reply even when the articles name me. And believe me I don't play to take part, I play to win.

I'm off to play with my baby corn snake for therapy! At least it warns you when it's about to constrict!

It's an outrage! Doc Spencer is to be dragged kicking and screaming before the big docs regulator ... after more than a decade! Poor Doc Spencer ...

http://www.bmj.com/cgi/content/full/328/7442/774

.. and Doc Samuels too ... outrageous!!

http://www.bmj.com/cgi/eletters/328/7442/774#54626

Let us weep for the poor baby docs ...

Child doctors court witness fear

The motion suggests some doctors are now too scared to appear as witnesses
Paediatricians are being put off appearing as expert witness in court cases because of the heavy-handed approach by regulators, doctors say.

The GMC's "disproportionate" ban on two paediatricians for their conduct in child cases has led to a climate of fear among doctors, it is claimed.

A no confidence motion is to be tabled at the Royal College of Paediatrics and Child Health's annual meeting.

But the GMC said child doctors very rarely face disciplinary action.

There have been two high profile cases in recent years.

They did not present a danger to their patients, they were simply doing their job in the way they thought best

Dr John Bridson PACA

The first involved Sir Roy Meadow, who was struck off by the General Medical Council in 2005 for his "misleading" evidence in the trial of Sally Clark, accused of murdering her two sons.

He had said the probability of two natural unexplained cot deaths in the family was 73 million to one, a figure later widely disputed.

The second involved Professor David Southall, who was struck off after accusing a mother of drugging and murdering her son. The claim was made in an interview with the mother about the safety of her surviving son.

It was the second time in three years Dr Southall had been found guilty of serious professional misconduct, after previously accusing Sally Clark's husband of murdering their children.

"These were leading paediatricians - people devoted to the wellbeing of children," said Dr John Bridson of Professionals Against Child Abuse (PACA), a group of leading doctors which is tabling the motion.

"They did not present a danger to their patients, they were simply doing their job in the way they thought best - and their treatment at the hands of the GMC means many doctors now think twice before reporting their concerns or agreeing to appear as expert witnesses.

"That is not good news for children or their families."

Thorny issues

Some 32 members of the RCPCH have signed the motion which calls on the GMC to review its procedures in child protection complaints "as a matter of urgency".

It is the latest move by some paediatricians against what they see as the "vilification" of their profession by other members of the medical establishment, the media, and parents.

GMC PAEDIATRICIAN CASES
May 2005: Camille De San Lazaro is cleared after admitting to overstating accounts of abuse at a nursery
July 2005: Professor Sir Roy Meadow struck off after his "misleading" evidence in the Sally Clark case
Dec 2007: Dr David Southall struck off after accusing a mother in an interview of murdering child


Paediatricians fear backlash

But the GMC alleges these doctors may themselves be "creating or adding to the very problem they say they wish to resolve".

"It is extremely rare for a paediatrician to appear before a panel in connection with child protection work. Since 2004, panels have considered more than 600 cases. Only two could reasonably be said to be have been about paediatricians involved in child protection work," a spokesman said.

"Our critics are trying to create the impression that the GMC is intent on unfairly persecuting paediatricians involved in child protection work. Nothing could be further from the truth."

The RCPCH notes that even if the motion were passed, it would not automatically become the policy of the College.

"Nevertheless, we are of course aware that the difficulties of working in child protection are a concern for many of our members and we are working with the GMC and other organisations to resolve these issues," said president Dr Patricia Hamilton.


Why is it nobody mentions the breach of patient confidentiality he was found guilty of, or the storing of files marked SC away from the main body of the medical files inaccesible to anyone else or tampering with records?

Funny how the phrase "no clear and present danger to a patient" materialises just 6 days before Southall's appeal against suspension, call me a cynic, but isn't this yet another blatant attempt to influence the outcome of a hearing, is this not a veiled threat to the courts? As in "put this doctor back on the register or there will be consequnces" - I think the GMC should take very strong action against this lot who are putting their own agenda before the lives of their patients. Sickening.




Link to BBC article

The big baby docs (Samuels and Spencer) have been very slowly processed through medical 'death row' over more than ten years. Debbie and Carl Henshall first made complaint in 1996. In my view, it's time the warrant was signed and the baby docs put out of their misery.

The new corporate manslaughter laws came in two weeks ago - Let's see how "wonderful" the doctors who "do no harm" are thought to be when the evidence of C Sections carried out on women who were not in labour and whose babies were not distressed comes out; babies removed prematurely just to have the full quota to randomise into the CNEP study. And before I hear the cries that this is not true, UHNS paid out!

Penny Mellor wrote: And before I hear the cries that this is not true, UHNS paid out!

I thought UHNS had exonerated the CNEP boys of all felony and misdemeanour. What is all this?

Parents are tied into a secrecy clause - you know we'll pay, you can't tell. Except I know and I know who they are and I know why they had to go down this route, which I can't put on this forum e-mail me.

Penny Mellor wrote:Parents are tied into a secrecy clause - you know we'll pay, you can't tell. Except I know and I know who they are and I know why they had to go down this route, which I can't put on this forum e-mail me.

That's outrageous! These guys want locking up ... though I have thought of another cunning plan ...

PS. No wonder they're getting all agitated and intimidatory about coming up before the regulator.

Oh you watch and see what happens, since the Griffiths Inquiry so much more evidence has been gleaned, it's amazing what you get under the FOI Act.

RCPCH statement - Annual General Meeting (AGM)

For immediate release

Dr Patricia Hamilton, President, Royal College of Paediatrics and Child Health (RCPCH):

"The proposed vote of no confidence was not supported by the AGM. Instead the wording was amended to read 'the College continues to have grave concerns over the current GMC procedures in child protection.' This amended motion was passed by the AGM, but still has to be taken to Council for a final decision. We look forward to continuing to work with the GMC to resolve these issues."


Notes to editors:

The ammended AGM motion now reads:

For the above reasons, the College continues to have grave concerns over the current GMC procedures for dealing with cases related to child protection. We call upon the GMC to review these procedures as a matter of urgency and involve in the review this College and other bodies such as the Department of Health, Department for Children, Schools and Families, Social Services Inspectorate and National Children's Bureau, who have an understanding of the relevant legislation and practice, in order to support continued quality work by paediatricians in this field to the ultimate benefit of children and their families.

What a paca plonkers!

http://www.bbc.co.uk/radio/aod/shows/rpms/radio4/pm.ram

Starts at around the 35 minute mark

OK ... So the upcoming GMC hearing into David Southall is about child protection is it? Really, amazing, could have sworn it's about CNEP and unethical research. Still Nigel Speight is consultant paed, member of PACA and he wouldn't mislead the public would he.

There is a determined campaign to deny the reality of child abuse


Wednesday December 5, 2007
The Guardian


We are extremely concerned at the direction taken by child protection in this country. This concern is made more acute following yesterday's decision at the GMC to strike David Southall's name from the medical register. There is a determined campaign to deny the existence and reality of child abuse in all its forms, led by a small group, aided and abetted by some journalists and politicians. This group targets prominent professionals in the field, especially paediatricians. Unable to respond publicly, there is no counterbalancing voice for the cause of abused children, so the media presents a completely one-sided picture.


In recent years, numerous competent, sincere and committed paediatricians have suffered at the hands of this lobby, both from complaints to employing bodies, but more seriously to the General Medical Council. The GMC overreacted in the case of Roy Meadow, where their decision to erase him from the medical register was reversed on appeal. We have also denounced the GMC's 2004 decision about David Southall ("GMC Fails Child Protection", Pediatrics 2007).

The recent decision in David Southall's case (Controversial paediatrician reprimanded again, November 28 ) further shows their lack of understanding of child protection practice. The GMC has failed to understand the dilemmas faced by paediatricians when the circumstances around a child's death raise concerns of child abuse and the emotional conflict it generates when this diagnosis needs to be discussed with bereaved parents, devastated by the loss of their child.

The GMC's recent finding discounted the testimony of David Southall and the accompanying senior social worker. This means that no doctor can rely on an independent professional witness who testifies that they acted appropriately and professionally in a consultation. Given the sensitivity around discussing possible life-threatening abuse, paediatricians appear to have no defence against complaints from aggrieved parents who may have abused their children. This will mean many more paediatricians will avoid engagement in this work. The decision is thus not only a major injustice to Professor Southall, but also to vulnerable children.

The GMC ignores the law: "The well-being of innumerable children up and down the land depends crucially on doctors and social workers concerned with their safety being subjected by the law to but a single duty: that of safeguarding the child's own welfare." Paediatricians and social workers in this field must be supported rather than vilified in their efforts to protect children. The GMC decision inhibits doctors from acting within a multi-agency team to protect children.

John Bridson, Martin Samuels, Nigel Speight, Margaret Crawford, Dominic Croft, Malcolm Coulthard, Stephen Cronin, Loretta Davis-Reynolds, Alison Earley, Charles Essex, Gareth Evans Jones, John Gibbs, Rodney Gilbert, Frank Hind, Chris Hobbs, Sherin Jackson, Diarmuid Kerrin, Barbara Ley, Paddy McMaster, Nadeem Moghal, Jacqueline Mok, Peter Morrell, Hazel Needham, Simon Parke, Sue Nicholson, Chris Rittey, Jeremy Osman Heather Payne, Michael Plunkett, Ximena Poblete, Umesh Prabhu, John Puntis, Tabitha Randell, Asha Ravi, Rob Wheatley, Catherine Williams, Leonard Williams, Stephen Williams
Professionals Against Child Abuse

Link to PACA Letter

Dr Nigel Speight and how hehas now shifted his position.


How can you tell

Posted: 06 December 2001 | Subscribe Online


Are paediatricians and social workers on the same wavelength when it comes to deciding whether children have been the subjects of an induced illness, as opposed to suffering from a genuine one? Rachel Downey examines the difficulties posed by Munchausen's syndrome by proxy and how professionals can protect children from it.

The idea that a parent would deliberately induce or fabricate an illness in their child is hard to fathom. That they would then repeatedly present the child to doctors appearing to seek treatment makes their behaviour even more unbelievable. But that is what those suffering from Munchausen's syndrome by proxy do.

It is one of the most complex and difficult conditions for health and social care professionals to tackle. And the difficulties have been made worse by controversy surrounding the detection of the condition, also described as fabricated or induced illness, in the UK.

High court injunctions, allegations of conspiracy, senior paediatricians' reputations placed on the line, parents being secretly filmed abusing their children in hospital, and mothers standing outside medical conferences with empty pushchairs all play a part in the highly divisive drama which has surrounded MSBP. The medical journals have bustled with claims and counter-claims. The Department of Health has been forced to admit that one inquiry into a leading paediatrician's work in the field was wrong in parts. And standing in the middle of this medical minefield are social workers.

However, an uneasy calm appears to have settled over these highly troubled waters as a result of guidelines from the DoH, consultation on which ended last month.1 These draft guidelines emphasise the need for a multi-agency approach and recommend that the investigation of MSBP cases should be viewed in the same way as other child abuse investigations.

This emphasis may reflect a subtle shift taking place within the sector in response to concerns that "high status" referrers - such as paediatricians - are dominating decisions in MSBP cases. Some groups involved in the consultation argued that social workers, because they are not medically trained, lack the confidence to challenge a consultant paediatrician who wants to initiate care proceedings because they suspect a parent is deliberately harming their child.

The draft guidelines propose a wider, more holistic approach to assessment. Social services will have the lead responsibility for co-ordinating strategy meetings, and assessment of children in need and their families should be carried out via the normal child protection framework.

Ian Johnston, director of the British Association of Social Workers, welcomes the guidelines' emphasis on the role of social work, arguing that detection of abuse "should be second nature to social workers and less so to medical staff".

But Andrew Webb, a member of the Association of Directors of Social Services children and families committee, believes the guidelines merely "set out for all professionals a code to follow about weighing up potential harm", putting "what was seen as a highly technical process in a wider context".

Webb also maintains there is no hierarchy of views at decision-making meetings. "When it comes to the strategy meeting, you make some presumptions about all the professionals being there and contributing in good faith from the best position of understanding of the medical evidence. Medical experts should both advance their views and argue the other side of the coin. You canvas them and push them to come up with evidence, because if you are the considering the care proceedings route, you have to be clear about the strength of evidence."

However the Royal College of Paediatricians and Child Health's (RCPCH) own guidelines on MSBP, published last month,2 appears to see a need to reinforce the importance of the social worker input from the outset. It suggests that doctors are finalising their own views before social workers begin to assess families.

"Paediatricians are concerned about the concept of a threshold for referral to social services departments. Some social workers and police believe that paediatricians will not make a referral until they are virtually certain that there is fabrication or illness induction." The result is long stays in hospital, which are damaging to the child.

The British Association for the Prevention and Study of Child Abuse (Bapscan) is also concerned that the balance between the rights of the child and the rights of parents is tipping in favour of parents. It is calling for explicit guidance about sharing information. Jonathan Picken, a member of Bapscan's national executive committee, says: "There are a small number of families where we cannot always apply the same principles of partnership - a small number of parents who can be very manipulative. We do not want to suggest that we ride roughshod over parents' rights but we must keep reminding people that children's welfare is paramount."

But these guidelines have so far failed to resolve the issue of false allegations or misdiagnosis of MSBP. Two conditions in which MSPB can seem a possible factor are ME and autism. Campaigners wanted the guidelines to include a recognition that false allegations do occur.

Jill Moss, director of the Association of Young People with ME (Ayme), estimates that 15 to 20 per cent of case conferences hear suspicions of MSBP or emotional abuse even if they are quickly dismissed. The organisation deals with about six to eight cases of ME a year which lead to child protection registration - about two a year result in care proceedings - when in fact the children have ME. "The numbers are small but the impact that this has on families is massive. It's borne out of non-understanding of an illness."

[quote]The RCPCH guidance states that "in complex disorders like chronic fatigue syndrome there's a risk that differences of opinion can lead to the suspicions of fabricated illness". Nigel Speight, consultant paediatrician at the University Hospital in Durham, has been involved in 13 cases of ME which have been wrongly diagnosed as MSBP. Speight, who was a member of the chief medical officer's recent working party on ME and the RCPCH working party on MSBP, says social workers should use their judgement in these cases. Most social workers usually just follow instructions from their paediatric colleagues.

"Beware of listening to just one school of medical thought," Speight counsels. "Beware of the fact that ME drives professionals mad and people cannot tolerate the child not getting better. Look at the functioning of the family before the child became ill. Reluctance to co-operate with one school of medical thought should not be regarded as evidence of abuse."[/quote

]Jill Moss is hopeful that the report from the chief medical officer on ME, expected imminently, will put an end to misdiagnosis of MSBP as it says the latter has no part to play in ME. But the National Autistic Society (NAS) is warning that if the draft RCPCH guidelines on MSBP are not fundamentally altered an "epidemic of MSBP and actions similar to Cleveland" will ensue. "A huge responsibility is placed on social services staff by this guidance and yet they cannot be qualified to recognise the wide range of conditions which might affect a child and which must be ruled out before this `extremely rare form of child abuse is suspected," it states.

The NAS wants the "checklists" in the draft guidance removed, saying they are classic pointers of autistic spectrum disorder (see box). It wants a full developmental history carried out to rule out developmental disorders such as autism; awareness training for practitioners, particularly social workers, area child protection committees, and the police. The NAS hopes that a meeting with health minister Jacqui Smith will ensure changes are made.

But while the NAS and Ayme are concerned about misdiagnosis, one of the most contentious issues remains the methods used to gain concrete evidence of MSBP. Secretly filming parents shows that some will attempt to injure and in some cases, kill their children while in hospital. But the field is divided as to whether covert video surveillance is an acceptable method of obtaining evidence.

The new DoH guidelines were produced in response to a request from a panel set up to evaluate the research into MSBP by David Southall, a consultant paediatrician at North Staffordshire hospital. His research covered a period of eight years in which 39 parents suspected of abuse were covertly filmed in hospital. All but one were caught on camera attempting to harm their children. A total of 33 parents or step-parents were prosecuted and children placed in care.

But this controversial method of detecting abuse sparked ferocious criticism. A campaign group was formed, complaints made, and Southall and a colleague were suspended while the North Staffordshire Hospital NHS Trust began an investigation. Meanwhile, Southall was also being investigated by the DoH and the General Medical Council for involvement in trials of a new ventilator for premature babies, after parents claimed they did not give their permission for the trials. He was reinstated in October when the trust said there had been no professional misconduct or incompetence and no evidence to suggest inappropriate use of covert video surveillance.

Ian Johnston, director of BASW, says parents should be told they are being recorded. But Andrew Webb finds no problem with using covert video surveillance "as long as it is not setting up to entrap people and as long as the child's safety is protected". In one instance a child's arm was broken. "It needs to remain in the tool kit."

Johnston maintains there are other ways of protecting the child by "making sure we are alert to possible signs of unacceptable behaviour". Terry Thomas, reader in social work at Leeds Metropolitan University and an expert on the use of covert video surveillance, agrees. He argues that the fact that, in David Southall's study, 38 of 39 suspected MSBP parents were caught on film harming their child suggests that the evidence was already there for people to see, without anyone having to resort to surveillance. He describes the way covert video surveillance has been used by paediatricians in these cases as "vindictive and nasty".

The DoH guidelines state that the police should take the lead in co-ordinating the use of covert video surveillance - a move welcomed by both sides of the ethical debate. Thomas says this will "stop doctors playing policemen". The use of CVS, already low in these cases, is expected to continue to fall, partly as a result of the impact of the Regulation of Investigatory Powers Act 2000, which regulates police surveillance.

The new guidelines on MSBP may have provided a clearer pathway for social workers through this contentious area, but campaigners who raised concerns about the way in which MSBP was being handled remain uneasy. Only a public inquiry will reassure them.

Link to Community Care Speight Article