Working Together - words that could save lives

Dr Peter Moore

Dr Peter Moore - Credit: Archant

During my career, I witnessed some terrible events. I dealt with cases of abuse, suicide and murder.  

I thought I could read most news stories without too much emotion but when I tried to read the details of the awful torture and murder of the six-year-old Arthur Labinjo-Hughes, I could not finish the article.  

It is easy to become angry. I find it impossible to understand the psyche of anyone who could harm a child at all, let alone in such a horrific way. We have to wait for the detailed review but it appears that vital signs were missed. It is important not the blame the professionals. All the blame must rest with the perpetrators. But there are lessons from the past.  

In the 1990s we were worried about a young toddler in our practice. There was no objective evidence of any problem. The parents always said the right things and appeared supportive but I had a nagging feeling in the back of my mind.  

One night, the family called the out of hours GP. Normally, when a patient was visited out of hours, the visiting doctor simply sent a fax through with the details. But this time, as well as the formal report, he rang me.  

Although the child only had a minor respiratory infection, the very experienced GP on call left the house worried but could not explain why. Again, there was nothing specific, which is why he could not put this on the notes.  

We had an excellent health visitor who had worked in our practice for some years. One afternoon, after a clinic, we met up to discuss this child. She had the same gut feelings. He was known to social services but they were not concerned.  

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The next time the child had a minor illness we arranged for him to be seen at Torbay Hospital. Behind the scenes, we also arranged a skeletal survey; he was X Rayed all over. They found twenty-one fractures of different ages.  

He was taken into care and the parents charged.  I spent a long time thinking through how I missed so many broken bones but in young children it is not always obvious.  

So, what lessons did I learn? Child abuse can be very difficult to pick up and, most important of all, listen to your gut feelings. If an experienced colleague who had never seen the child before shared our concerns, it was telling me something.  

If is also important for GPs to work closely with health visitors, social services and other colleagues. Today, it might have been difficult to send the child to hospital and perform X rays without explaining everything to the parents. Even at the time I was unsure of the ethics.  

In today’s NHS, it would be impossible for a GP and health visitor to spend the time talking it through. And with the pressure on GPs today, there may not be time to stop and listen to gut feelings.  

Little Arthur Labinjo-Hughes was not one-off case. There have been many other tragedies, including Victoria Climbie and “baby P”. The lesson is often the same, communication.  

Every professional, whether a social worker, GP practice team or teacher, may only have one piece of the jigsaw. The family and friends may have other pieces. It is only when these pieces come together that we get the full picture. In many of these cases where things went wrong, concerns from other members of the family were ignored or some professionals were not kept in the loop.  

Social workers have a very difficult job. In some cases, they will miss abuse, in other cases they will be accused to taking away a child unfairly. They can never explain their side of the argument in public, as details are confidential.  

After the scandal in Cleveland in 1987, when there appeared to be a wave of child sex abuse the final report was called “Working Together”. Thirty-four years later lives might be saved if those words became a reality.