Battered Babies

– in the House of Commons at 12:00 am on 22nd December 1972.

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12.54 p.m.

Photo of Dr Anthony Trafford Dr Anthony Trafford , The Wrekin

I have three reasons for raising this subject and am glad of the opportunity to do so. The first is to alert people to the widespread existence of the problem and its very complicated nature. The second is to raise the specific case of Graham Bagnall which has caused such public concern in Shropshire and, indeed, more widely. The third is to mention some of the difficulties of handling these questions and the exceptional difficulty of make inquiries into any errors, defects or mistakes.

The syndrome of battered babies seems to have aroused widespread interest only in recent years, though evidence of it was certainly known as long ago as 1946. Its nature was not properly realised until 1962 when Kemp, who is probably the leading world authority on the subject today, and his colleagues drew attention to the prevalence and gravity of the situation, and in 1969 the NSPCC published a report on 78 battered children. By accepted definition this applies to children under two years of age who are not only the most vulnerable but the most helpless and defenceless in the whole population.

A battered child is usually found as the result of attendance at a casualty department or hospital unit with unexplained injuries or with the finding of injuries incompatible with the story presented by the parents. Indeed the parents often appear to be astonished at the state of the child. A consultant paediatrician recently told me that a frequent feature of these parents is an apparent but obviously superficial charm.

It is important to realise that the social class or income group is not related to the occurrence of battering. Employment, housing, social circumstances, and the level of intelligence and educational standards are also virtually unrelated.

Who batters these children? The mother or the father? It seems to vary from series to series as to which has the higher incidence, though I think it could be said that it is generally thought to be more often the mother. Unfortunately, it is often impossible to tell.

Why do they do it? There is great controversy on that question. In a recent publication Caroline O'Kell of the NSPCC stated, I think accurately, that often the battering results from an unrealistic investment of affection in the child v,hich it cannot return"— therefore, there is a certain frustration— and often the parents themselves were deprived of affection as children". A large number of such parents came from disturbed backgrounds. Some 10 per cent. are either frankly psychotic or certainly grossly abnormal.

The overall incidence of this syndrome is not really known in this country although figures are being acquired. But extrapolating from American experience it seems likely that this is not a small problem. It is probably of the order of six per 1,000 live child births—in other words, about 3,000 babies a year. Of these 50 per cent. are physically battered and are often seen with multiple injuries. Some are not always immediately apparent. For example, the retinal changes in the eyes which may give away the diagnosis are not widely known, even amongst those who are fairly experienced in this sphere. The other 50 per cent. of the children are battered in the sense that they are deprived and neglected.

This syndrome is an example of the theory that the more one looks, the more one finds. It is absolutely vital that the index of suspicion should be high. People likely to come across such a case must always be alert and on the look-out, because in these cases early detection might indeed be life-saving.

Therefore, in this rather tragic picture we have a mixture of our old acquaintance that anybody dealing with social services would recognise of the deprived child cycle, about which my right hon. Friend the Secretary of State made such an impressive speech recently, the disturbed background of parents' lives, and often the situation known as mother's overload. But I cannot stress too much that it is the child who is defenceless, not the parents.

All too often those concerned lean over backwards to help the parents when their primary concern should and must always be the child. In dealing with this difficult and complicated problem we need a high index of suspicion, extremely alert social and medical workers and, above all, an over-riding need for the care of the child.

Follow-up in these cases—even suspected cases—is vital. The incidence of rebattering reported nationally is said to be as high as 60 per cent. with a mortality—and in this case we are talking about mortality not from disease, but from homicide—manslaughter or murder—of 10 per cent. and permanent damage in the sense of brain damage of about 15 per cent. This is a terrible picture and a frightful record but it can be reduced substantially by proper and careful assessment and follow-up.

This subject is enormously time-consuming. It involves social workers, doctors, health visitors, the police and other local authorities, but if one applies the follow-up with the care that is practised in some areas, such as almost daily visiting of the child if it is in its own home, weekly visits to the clinic and continual follow-up by doctor, by social worker and by health visitor, the incidence can be reduced.

I now turn to the case to which I wish to draw the attention of the House, namely, little Graham Bagnall. Unfortunately his life was all too short. He was born illegitimate on 20th May 1970. His mother married Benjamin Smith on 2nd January 1971. At that time Mr. Smith had 14 criminal convictions, mainly for dishonesty, but three of them were for offences involving violence. One was a particularly peculiar one, an important one in respect of this case. As a juvenile he was convicted for maliciously killing five pigs by some peculiar form of strangulation—surely a sign of a very disturbed background and a curious personality. He had spent two substantial periods in a mental hospital, the latter occasion as a result of a committal order in January 1968 following a conviction for house-breaking. He went absent without leave many times from the mental hospital before being discharged at the end of 1968.

There were three times, according to the prosecution barrister at Shrewsbury Crown Court, when Graham was suspected of being ill-treated by his mother or his stepfather, or both, in the year 1971. In February he was found to have a broken leg. In May he was seen by a doctor because of his stunted growth, his retardation and his generally deprived state, and he attributed it to neglect and malnutrition. In June he was admitted to Copsthorne hospital with injuries caused by blows or a blow.

He was fostered out with a Mr. and Mrs. Harris of Childs Ercall, near Market Drayton, on 20th August 1971, and by all reports this was the happiest period of his short life, because he began to behave like a normal child and not to shrink from contact with adults and hide in a corner for fear of being hit. The foster-parents were asked to return the boy to his mother and stepfather on 19th April 1972, and on 29th May Graham was killed.

It seems difficult for us to appreciate the position, but who was warned about this family and their child? How did it arise? Who followed it up? There were three admissions. Why were three admissions needed? I have made inquiries into this case and I have received some rather disturbing answers. I received a letter from the Director of Social Services of the Salop County Council in which he said: On 6th June Graham was admitted to hospital with injuries consistent with `battering' and on 13th August 1971 we received him into care.…It was not until 24th September that the Department received a copy of a letter from the medical authorities indicating that the injuries sustained by the child were incompatible with the history and that it was very difficult to prove how he sustained the injuries. It does not seem a good form of follow-up to rely in part on copies of letters received six weeks later. There appears to be a lack of communication, or evidence of communication, between the medical and social authorities.

The director of social services writes further: Graham first came to the notice of the Department in March 1971 when an allegation was made by a member of the public that the child had bronchitis and that the mother would not seek treatment. The health visitor was asked to visit and we asked the NSPCC to investigate. From that time onwards the NSPCC inspector worked closely with the family and my department was kept closely informed of events. The director says that his department was kept closely informed. I should hope that it was, but what did that mean? The director—any director—of social services, once alerted, should have left no stone unturned to try to prevent disaster —a pædiatrician should have been called in and social workers and the police informed, but I have it on authority that the police were not told anything about this case until the death of the child—but the director gives no evidence that he turned any stone in this case. It was merely that his department was kept informed.

He says that later the department managed to rehouse the family, but merely rehousing a family, changing a hut for a house or a tent for a caravan, is not a solution, and anybody with any knowledge of this syndrome and its difficulty would know that it was not enough. It suggests a certain failure to understand the nature of this problem.

The director writes further in this case In April 1972 the parents felt that they could resume the care of Graham, but because the NSPCC Inspector wanted more time—there was a possibility that they might change their minds—no action was taken to return Graham until the 19th April. The inspector was not given very much time during that period in April. Did he agree with the eventual decision? Who took the decision? What doubts or views were expressed, and by whom? Who was informed and what on this occasion, knowing the previous history, was the follow-up?

The director writes further: There appeared"— perhaps this is the crux of the case— to be insufficient evidence to take care proceedings once the return of the child was demanded by the parents. With a background such as I have outlined for the stepfather and the mother it seems a curious thing to say that there was insufficient evidence.

I wrote to my right hon. Friend the Secretary of State about this case, and perhaps I may quote from my own letter. I said: I am fully aware that it is easy with the advantage of hindsight to criticise the decision made by the Director of Social Services and his Department but I cannot believe that had I been presented with such a case history, I could ever have come to the conclusion that a chance should be taken with a child by returning him to such a family—especially in view of the stepfather's disturbing record. I have gone further since then and taken advice from others who are deeply concerned with and greatly knowledgeable on this subject. Not one of them disagrees with my opinion that this was a bad decision on all grounds.

Finally, the director of social services says: The decision to return the child was made in the light of expectations of parental care which did not materialise. Surely this is self-evident, because if he had returned the child expecting parental care not to materialise nobody would have criticised his decision or charged him with neglect. Anybody would have thought him insane.

He ends by saying, almost as though it were a justification for the decision: Graham's death in fact occurred as a result of a single savage attack on 28th May 1972. Homicide usually is the result of a single savage attack.

It seemed to me from all this that all was not well in the social services department in Shropshire in dealing with this type of problem and this sort of matter. I happened to know that on the register in that area there were 34 other known cases, and if this was the way in which the department dealt with them it seemed that it needed more guidance and more advice. I was rather horrified by the complacency which seemed to exude from that quarter. Everybody makes mistakes, but those worthy of responsibility should not ooze complacency, but should admit some distress about the situation and learn from the results.

There was, of course, immediate and great public concern and a call for a public inquiry. The Salop County Council set up an internal inquiry. This was a difficult decision for the council, but in these circumstances I believe it to have been a wrong one. It should have included outsiders who were unconnected with the case or with the department and probably, best of all, unconnected with the area. It is indeed difficult to be judge, jury, defence and prosecution all in one, and especially in one's own cause. In all fairness, public anxiety will not be satisfied; for although justice may well be done, it will not have been seen to be done.

I know that my right hon. Friend the Secretary of State has circulated local authorities with a considerable amount of advice on this subject, not least notably a full memorandum in May of this year. I have so far heard nothing much about how this has been implemented by the social services department in Shropshire. I therefore ask my hon. Friend the Under-Secretary, whose interest in this matter I know, three questions. First, will he ensure that some sort of outsider, perhaps an experienced officer from his own Department or from the regional office of his Department is not only present but is allowed to ask questions at this inquiry and, if necessary, to make a separate report to the Secretary of State?

Secondly, will the Minister personally send for and look at all the papers in the case and also at the inquiry and its report? Thirdly, will he agree today that if, in his mind, after looking at these papers, there is any doubt at all about the quality and the nature of the social services, he will institute a full inquiry and survey of his own into this matter and the social services of the area?

These cases are shocking and disturbing and I know that my right hon. Friend the Secretary of State himself is concerned, not only about this case, of which he is aware, but about many others, and that he is doing the best he can to alert all those concerned. If today, by raising the case of little Graham Bagnall, we can further alert those concerned who are likely to meet such cases, and if by a continuing process of education we can establish a better local liaison, better social services and a better organisation for dealing with such problems, tragic though this case is its occurrence may have helped others.

1.12 p.m.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

My hon. Friend the Member for the Wrekin (Dr. Trafford) has chosen a subject for this debate which concerns me and my right hon. Friend directly and greatly, and a subject which he, as a doctor, will recognise is of very special difficulty. He has presented this subject with a degree of concern and compassion that I hope I can match, but also with an expert and professional insight which it would be difficult for me to match. I hope that he will impart to me the necessary degree of indulgence in that dimension at least.

The battering of babies is a simply ghastly phenomenon. It understandably stirs up very deep emotions, immense public concern and often public anxiety and indignation. There also often follows, in the public dimension, an inclination to think in terms of drastic retributive punishment rather than the sort of treatment and care which is often the best way to approach those responsible for these appalling deeds.

There is also often a desire in the public mind for a witch hunt in the case of those who have responsibility for rehabilitation of the children or child concerned and of those who, from hindsight, seem to have made an error of judgment or simply a wrong decision. I can sympathise, as I am sure can my hon. Friend, with those often emotional reactions, although I cannot fully approve of some of the measures which the public would instinctively want to take. Clearly, investigation and prosecution have a very important part to play, but the matter cannot end with investigation and prosecution, however important they may be.

What the authorities have to do, and have a duty to do, is to provide an organisation as watertight as possible and a professional service of the highest quality actually to come to grips with the underlying realities of the problem, in all its psychological, its environmetal and perhaps, as my hon. Friend suggested, its pathological dimensions.

This is, alas, no new problem. I am afraid that, throughout history, children have been deprived, neglected, emotionally as well as physically, and even perse- cuted. It is not without irony to reflect, as we debate this matter under the very shadow of Christmas, that Christmas itself took place under the very shadow of the Massacre of the Innocents. It is only relatively recently, indeed, that society has come to recognise the needs of children and the duty to do something practical and constructive about these things.

My hon. Friend will know that the present pattern of service in this field consists, first, of statutory and voluntary bodies working within a local framework, whose task is to provide for the children's welfare, backed up by a framework of law which attempts to deter or to punish adults where an actual case of battering or maltreatment occurs.

Turning to the real character of the problem, the "battered baby syndrome", to give it its rather complicated technical, if quite common, title, is at once simply one facet of a wider problem of maltreatment which arises all too generally, and, fortunately, something which has some clear and characteristic features of its own which enable us to isolate it and to make, as it were, a self-contained appraisal of diagnosis and treatment.

Most people probably see this problem dramatically presented, for example on a television programme or in a newspaper report. The typical ingredients are usually the presence of a young child, generally under three, cared for by a potentially violent adult. The potentiality of that violence my hon. Friend described in his own speech. It conies all too dramatically to mind in the light of the background details that he grave. Usually, the child and an adult are living in adverse social circumstances. At a time of crisis, this combination of factors produces simply a damaging physical response against the child.

The child himself or herself is often unwanted and has failed to secure an adequate emotional relationship with the adult concerned. There is excessive crying, perhaps vomiting, a lack of response to the parents, a general lack of a rewarding relationship from the parent's point of view. All these are so often the characteristics of children who in the end get battered or otherwise maltreated. My hon. Friend will know of other significant pointers in this sort of situation.

Similarly, the parents have recognisable characteristics in this framework which trained social workers would be able to spot. Probably they are themselves the product of a disturbed childhood. As my hon. Friend made plain to us, they are not necessarily confined to one social class. They are often high IQ, intelligent people, but they are obviously possessed of some flaw of personality, temporary or permanent, which produces a deficiency of the normal parental feelings of loving emotion and outgoing goodwill towards the child, plus a tendency to give violent expression to tension where it becomes intolerable.

My hon. Friend used the striking phrase "the mother overload" in this context. Incidentally, it is not improper to reflect that when we isolate groups in society which are clearly reprehensible in what they do, it all comes close to home to normal adults. Any hon. Member who has tried to compose an important speech late at night with crying children around him or her will know how instinctual is the capacity to lash out and how very common is the power in all of us to do the dreadful deed which we are here putting under the microscope.

I have specified these particulars in some detail because I want to illustrate that there are readily discernible telltale marks in the situation which the skilled social worker can recognise. Thus it is possible to be preventive in this matter, to detect the risk situation before it detonates.

Doctors, health visitors and social workers whose task is to come into contact with a particular family should always be alert to the needs of families where the antecedents and ingredients for battering reside. My hon. Friend used the striking phrase "the index of suspicion". Very often the index is open and discernible. So prevention followed up by family support to keep this vital human unit intact if possible and functioning safely and happily as a family must be the most important aspect of managing the syndrome. But where a battering occurs —in the very nature of the syndrome, I am afraid that we have no national figures for its frequency—my hon. Friend will appreciate that many of his professional colleagues, confronted with the patho- logical condition, may be very reluctant to draw conclusions from what they are faced with, and will only be concerned, rightly in some ways, to get on with the cure. Against some lack of national figures, we have nevertheless to plan as best we can the organisation and management to deal with the problem.

Perhaps I could outline a little of what the Department of Health and Social Security has done about it. My hon. Friend referred to the 1969 NSPCC report emanating from the battered child research unit of the society, entitled "78 Battered Children: a Retrospective Study". I may add that the Department has certainly not been backward or negative concerning research. But the society's research unit publication was extremely valuable and important. It was clear from the society's study that there was still at that time a lack of awareness of the syndrome or a reluctance to become involved in it, and that recommendations on possible action which had been published by the British Paediatric Association three years earlier, in 1966, had not been fully effective.

So in February 1970 my Chief Medical Officer wrote to all medical officers of health and children's officers about this subject, jointly with the Home Office Children's Department, and the Department followed this up later in the year with a booklet "The Battered Baby", about which my hon. Friend will know. What we did, in effect, was to describe the medical picture and give advice on the general and individual management of the syndrome.

Recognising that the crux of the whole issue was co-ordination of information coupled with good communication, we gently pressed on the responsible authorities the idea of a team approach. Children's officers, now directors of social services, and medical officers of health were asked to consult together on the topic and to bring into the discussions all the others who were involved, for example, representatives of the local medical committee, paediatricians, consultants responsible for running accident and emergency departments, the police, and other local agencies such as the NSPCC. Such a group, having been brought together, forming a sort of policy action committee, should then get cracking on surveying and reviewing the features of the local situation. It would then decide what had to be done to be quite sure that timely help could be brought to the children specially exposed in this context, to others who may be at risk in the same family of siblings, and to the parents. We see this kind of policy action committee as having a permanent and continuing function in the context of the authorities directly responsible.

Moreover, we also saw value in a smaller committee, perhaps less of policy and more of action, to be established to keep under surveillance individual cases of battering or potential battering. The purpose of this smaller committee, perhaps a sort of regular case committee, was yet further to minimise the possibility of breakdowns in communication and to provide a yet more knowledgable group, yet more intimately involved, to ensure proper attention to the needs and the adequate follow-up of that attention for the exposed child or family.

Here co-ordinating conferences before discharge from care or hospital, or whatever the case might be, by these case committees bringing together all the appropriate agencies is seen in the Department to be a sine qua non of any action which they might regularly engage in as a case committee.

From reports to the Department from local authorities during 1971 and 1972—I am glad to say that almost all local authorities to which we wrote replied to us about this—we have been enabled to prepare an analysis of practice and problems, which has been widely distributed since the end of May this year in the memorandum to which my hon. Friend referred.

Without going into too much detail, I am glad to report that the organisation and management patterns established by most local authorities closely reflect the advice that the Department has given them. We enjoy good co-operation and good communications with the authorities grappling with this problem in the field. The Department's aim is to monitor the situation so as to be able to disseminate new ideas and standards of the most intelligent and good practice. We are also in touch with leading authorities in the medical profession and the social service professions, and we look forward to a developing partnership in this matter and the growing practice of cross-fertilisation of ideas.

However, a tidy and effective organisational framework is one thing; actually to make it work, to breathe a spirit of life into the dry bones, is a different question, and it must involve highly trained, highly motivated officers, using the very best professional practices and methods.

I have already touched on preventive work, and I return to that point, emphasising that the preventive approach is both the logical and the strategic point at which we should seek to bring our forces to bear upon the problem. We can look for greater and greater dividends in tackling the syndrome from a massive concentration on the preventive aspect. However, preventive work cannot be 100 per cent. perfect, so we shall continue to get the battered baby, and when these terribly maltreated children are healed mentally and physically the problem which has to be faced is what do we do with them. There will always be certain parents whose personalities are so permanently damaged that it would simply be irresponsible and completely inadvisable for the child concerned to be returned to the family. But in the main there is often hope, and it should be the aim of the agencies that a family should be brought together again.

Here the crucial decisions must rest unavoidably on the professional judgment of the highest possible quality exercised in the light of all details known of the circumstances of the case by the professional people to whom I have referred. Decisions as to whether or not the child should be returned home are very difficult to reach, and it depends on the most skilful diagnosis of the family situation. Restoration to the family is bound to depend in large measure on the ability of the parents to develop the nurturing relationship to the child, the amount of local authority support, perhaps the central Government support, which is available, and the degree to which environmental difficulties can be eliminated. Most authorities, in facing up to this difficult decision, have adopted a method of using the case committee procedure which I have already suggested. Only in this way can all the circumstances be fully known and evaluated, the best possible advice drawn on and the risk of human errors of judgment minimised.

I have dealt at some length with the general background to this problem, both to pinpoint the complexities and underline them, because my hon. Friend drew attention to them so graphically, and also to demonstrate the active involvement of my Department in this problem and the emphasis which it lays on prevention and solid team work.

I turn now to the particular case which my hon. Friend raised, I have made it clear that this is never an easy matter for the person or body responsible, and sometimes a decision, with the benefit of hindsight, turns out to be wrong in the field of restoration. It would be wrong of me to make any further comment on this individual case because the Shropshire County Council is carrying out its own internal inquiry. Indeed, at the invitation of the county council, one of my Department's own professional social work service officers from Birmingham is attending the meetings. The county council has said that it intends to submit any report to my Secretary of State for any comments he may wish to make in due course. This seems to me a very proper and desirable course of action and one which is most acceptable.

The answers to the questions about the case which my hon. Friend has put to me are these. First, there will be an audit, as he calls it, of the case in the form of the inquiry to which I have referred. Indeed, it has already started. Secondly, my Secretary of State has an observer—what my hon. Friend described as an outsider—at that inquiry. Thirdly, a report from this inquiry will be coming to my Secretary of State, and I undertake to study it personally. Fourthly, most certainly if we feel dissatisfied about the outcome—although I hope this is a hypothetical difficulty—we will certainly consider what further steps might be necessary.

Battered babies form a topic which deeply stirs our emotions. It is a subject which is generally treated with great concern and responsibility by all concerned —public authorities or private professional individuals. We are heavily involved in it in our capacity to give advice and to disseminate good practice from the centre to the periphical authori- ties which are also involved in other ways. We are looking at research projects which have been submitted by the National Society for the Prevention of Cruelty to Children for special units to be set up. Indeed, the society is experimenting with this idea itself. We are also considering an application from the Hospital for Sick Children, Great Ormond Street.

Photo of Dr Anthony Trafford Dr Anthony Trafford , The Wrekin

May I stress one point in general terms? When my hon. Friend is putting out all this advice and information, of which I thoroughly approve, will he stress that it is the child and the child's safety that matters far more than concern over the parents, who are much better able to defend themselves? The important question is the vulnerability and the defence of the child. I hope my hon. Friend will stress this in any circulars which he may put out.

Photo of Mr Michael Alison Mr Michael Alison , Barkston Ash

Yes, I am grateful to my hon. Friend, with his wide and professional background, for stressing this aspect of the case, though in considering the welfare of a child one is by definition involved in considering the well-being of the total family. A child isolated from his family is a child already deprived.

We are also considering a recent report from the Battered Child Research Department of the NSPCC entitled "A Study of Suspected Child Abuse", which deals with the problem of registries or registers. We are conscious, too, of some anxiety in the country to be able to quantify the problem, but, as I have had to tell the House, it would not be practicable to call for any national statistics in this field. We are able to get into the homes of every general practitioner quite regularly, through "Health Trends", a quarterly review which we publish in my Department for the medical profession, in which as recently as November Professor Oppé, Professor of Paediatrics at St. Mary's Hospital, wrote about battered babies.

I have taken careful note of the professional comments that my hon. Friend made about practice in this field in the light of the circular that we have issued. We are far from complacent in my Department about this problem, and I am sure that my hon. Friend acknowledges that. But we are hopeful for the future. There will be no complete answer, of course, but I am sure the way ahead is by a continuing process of education of parents, the multi-professional teams involved, police, magistrates and the public, by looking for answers through steadily improving preventive social work with families at risk, and better local authority organisation for managing the problem. In all this we are receiving co-operation from those concerned with what everyone agrees is a dreadful problem, and I am encouraged by the amount of good progress that is made by many local authorities.

I conclude on a hopeful note. My right hon. Friend the Secretary of State for Social Services has spoken recently, in what I believe was an epoch-making speech, about the cycle of deprivation. My hon. Friend, I am gratified to hear, actually referred to this in his speech. This is a cycle with which we are very deeply concerned in my Department. The thought and analysis which have gone into the preparation of the cycle of deprivation speech is almost without precedent in the records and performance of my own Department. My right hon. Friend has had a number of meetings—since he delivered the speech on 29th June, with many social workers and other bodies concerned with the whole complex of the cycle of deprivation, and he is developing a strategy for doing something positive about this problem based upon what he has gleaned from these consultations.

The battered child syndrome is the extreme example of transmitted social and psychological deprivation which fits in very much with the considerations which underlay my right hon. Friend's presentation of the cycle of deprivation. Through a developing strategy of research and services it is hoped that the children, above all, and their families will be helped.