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An Abuse and Misuse of Professional Power
by Charles Pragnell

In early summer 1987, the United Kingdom and the world were rocked by allegations of child sexual abuse occurring in Cleveland, a major industrial conurbation in the North-East of England.
The Cleveland area was mainly comprised of three major towns, Middlesbrough, Stockton-on-Tees, and Hartlepool, and was administered at that time by a single local authority, Cleveland County Council, which had been formed in 1974. The area has since been divided into four local authorities and the name Cleveland only forms part of one of those councils.   

Historically, Middlesbrough only came into existence at the beginning of the 19th century when iron ore was found in the nearby hills and it became a steel-making area, attracting workers from Ireland, Scotland and many other areas of the U.K. and from Eastern European countries such as Poland. Being at the mouth of a major river, the River Tees, the area then began to develop as a shipbuilding centre, and in the early part of the 20th century, petro-chemical industries were introduced and it became one of the largest centres in Europe for chemical and plastic production.

In the 1970s the steel-making, ship-building, and chemical industries went into rapid decline leading to high levels of unemployment which still persist among the mainly working-class population.

In the years leading up to 1987, the incidence of allegations of child sexual abuse for Cleveland was no greater than other parts of the U.K. but in January 1987 the numbers began to escalate rapidly, reaching a peak in May, June, and July. The total referrals to Cleveland Social Services for all forms of child abuse during the period January to July 1987 were 505 referrals compared with only 288 referrals in the equivalent period in the previous year.

Increasing numbers of allegations of child sexual abuse were being made by two consultant paediatricians at a Middlesbrough hospital and were based on an unproven medical diagnosis termed the anal dilatation test. Once these allegations had been made, social workers were removing the children from their families on Place of Safety Orders, often in midnight and dawn raids on the family home where children were taken from their beds and placed in foster homes and residential homes.

The initial crisis came when there were no more foster homes or residential home placements to accommodate the numbers of children involved and a special ward had to be set up at the hospital to accommodate the children who continued to be diagnosed as having been sexually abused.

Increasingly the diagnosis using the anal dilation test was being challenged by the police surgeon, who questioned the validity of such a test, and the police gradually withdrew their co-operation in the cases referred by the consultant paediatricians. Relationships between the police, social workers, and the paediatricians broke down as the dispute in medical opinions escalated.

It is alarming to note that there is no requirement for paediatric diagnoses to be scientifically-based, despite the present emphasis on `evidence-based' social work and medicine, and there is no system of verifying and validating paediatric diagnoses on which child abuse allegations may be based, before they can be used in clinical practice. This was acknowledged by John Forfar, the then President of the British Paediatric Association, who wrote to one of the paediatricians involved, Dr. Marietta Higgs, in July 1987 and gave an admonishment in regard to the use of the anal dilatation test :

"The regulation of medical practice is achieved best when it is accomplished within the medical profession. New stances based on a new awareness of clinical signs, or new significances being attached to them, require first to be established within the profession. This takes some time and requires persuasion and scientific evidence of validity, based on the accepted method of communication to professional journals or scientific meetings."

In the early months of the crisis, the allegations involved working-class families, who were confused, bewildered, and angry at being accused of sexually abusing their children, but they were powerless against middle-class professionals with the authority, power, and legal sanctions to support their actions. Gradually, however, the allegations began to involve middle-class families who were highly educated, employed in professional occupations, and with access to legal and political advice and to the media. They were to use such powerful allies to considerable effect. From a sociological perspective, therefore, the events in Cleveland could be seen as a punitive form of middle-class oppression of working-class families by middle-class professionals and an imposition of middle-class values on the working classes. Some aspects of the Cleveland Child Sexual Abuse Scandal have been likened to a mediaeval witch-hunt by at least one author (`When Salem came to the Boro' - Rt. Hon. Stuart Bell, Member of Parliament for Middlesbrough - 1988).

In the initial months of the crisis, public sympathy and concern was strongly in support of the social workers and paediatricians and the media, pursuing their simplistic analysis of all situations as having `goodies' and `baddies', also supported the social workers. Several social workers and managers within the Social Services had serious doubts about what was happening, but although they voiced their concerns to senior managers, they too were powerless to change events.

Public concern centred on the removal of children from their beds at all hours of the night and fear spread among the local population, as these were painful reminders of events which occurred in Germany between 1933 and 1945, when there were similar misuses of state power by police and government officials.

The turning point of events came in late May on the day that the parents decided to march from the hospital where their children were being held to the offices of the local newspaper, and they began telling their versions of events, which of course varied considerably from the narrative constructions of the paediatricians and social workers. Gradually, the media turned to support the parents, and the social workers came under intense public and political scrutiny, which eventually led to the setting up of a Public Inquiry led by Justice Butler-Sloss.

The Inquiry examined the cases involving 121 children where sexual abuse was alleged to have been identified using the anal dilation test and the actions of the paediatricians and social workers involved. Of these 121 cases where sexual abuse of the children was alleged, the Courts subsequently dismissed the proceedings involving 96 of the children, i.e. over 80% were found to be false accusations. There are some social workers and medical professionals who have found difficulty in accepting the findings of the Courts and are `in denial' that they were wrong in their allegations. They have sought to use the findings of a medical panel which claimed that, on the basis of an examination of cases involving 29 of the children, 75% of the children had been sexually abused. Medical opinion is not, of course, proven fact, whereas opinions and supportive evidence given in courts can be challenged and tested under cross-examination as to their validity and veracity.

One of the major findings of the Butler-Sloss Inquiry was that children had been removed precipitately by social workers who had failed to seek corroborative evidence to support the allegations of the paediatricians and had failed to carry out comprehensive assessments of the children and their families. Consequently a requirement was introduced that social workers should not act solely on the basis of medical opinion.

Concerns were also expressed at the Inquiry regarding the use of video-recording equipment for surveillance of interviews with children and the use of anatomically-correct dolls in the questioning of children where sexual abuse was alleged. During such video-recorded sessions, social workers were seen to threaten and attempt to bribe children in order to bring pressure on the children to confirm the social worker's views that they had been abused and leading questions were asked of the children which would not have been permitted in courts. The interviews of the children by the social workers also confused the investigatory nature of such interviews with a therapeutic purpose. Where interviews containing a therapeutic element with children where abuse is alleged are conducted before trial, courts could take the view that such interviews contaminated and corrupted the children's evidence.

Anatomically correct dolls can now only be used by professionals who have undertaken intensive training in their use, and serious doubts have been raised by some psychologists regarding the use of such dolls, citing the difficulties of interpretations of children's behaviours which can be made and how readily false assumptions can be made.

One of the key issues in the Cleveland Child Sex Abuse Scandal was the power of professional groups in U.K. society, and how those powers can be misused and abused in the absence of accountability in law and for professional practice. Social workers are not personally liable in law for their actions in child protection matters, as they can be in mental health work and it could be argued that this is a necessary development. It is only recently that a General Social Care Council (G.S.C.C.) has been introduced in the U.K. under which social workers will now be registered and can be held responsible for their professional practice. However there is little public confidence in the General Medical Council to which medical practitioners are accountable for malpractice and misconduct, and it remains to be seen whether the G.S.C.C. is effective in its role and is thereby able to command public confidence.

There is a belief in some quarters that the events in Cleveland in 1987 led to the Children Act 1989 but this is incorrect. The need for the reform of child care legislation, both public and private law relating to children, had been identified several years earlier by the House of Commons Social Services Select Committee of 1984 (Children In Care) which described the then situation as "complex, confusing, and unsatisfactory". A Review of Child Care Law followed and led to a White Paper, "The Law on Child Care and Family Services", which was published before the findings of the Butler-Sloss Inquiry were known. The Law Commission was also examining the reform of private law relating to children and published its findings in July 1988.

There had been numerous Public Inquiries during the 1970s and 1980s into the deaths of children whilst under the care and supervision of social workers e.g. Maria Colwell, Kimberley Carlisle, Jasmine Beckford, Stephen Meurs, Tyra Henry, etc, and these cases had a major impact on the preparation of the Bill which led to the Children Act 1989. The other major influence on the Children Act was the need to encompass the provisions of the United Nations Convention on the Rights of the Child which was finally signed by the U.K. government in 1991.

There was some delay in publishing the Act during the Inquiry into the Cleveland Child Abuse Scandal and the effects on the Act were the introduction of the Emergency Protection Order lasting only seven days and which could be challenged in the courts by the parents after 72 hours. The previous Place of Safety Orders used extensively in Cleveland could not be challenged for 28 days. The guidance to the Act also required that in Care Proceedings, courts should seek to reach decisions as quickly as possible, as in many of the cases concerning children involved in the Cleveland Scandal, they were left in the limbo of Interim Care Orders, lasting in some cases up to two years. Wardship proceedings had also been used in Cleveland where difficulties would have been experienced by social workers in bringing Care Proceedings and so changes were made to Wardship Proceedings restricting such uses and may now only be used in specific circumstances.

Since 1987, the people of Cleveland have sought to move on from this unsavoury episode in the area's history and to gradually remove the slurs and scars to the reputation of what has always been a vibrant industrial and commercial community.

Perhaps the most lasting effect has been the climate of fear which was created and engendered in the parents of young children by events in Cleveland in 1987, not only in Cleveland but the rest of the U.K. In the 1980s male parents were becoming more accepting of their role as direct carers of their children and to share roles with their female partners, commonly referred to as the `Sensitive New Age Guys' [SNAGs]. This involved the male parent in bathing and dressing their children and performing other acts of personal care. Following Cleveland, many male parents withdrew from these activities from fear that their actions might be seen as unhealthy by social workers and might be misinterpreted by social workers as having an unnatural interest in their children, and they feared allegations of child abuse could be made against them..

In 1987, Charles Pragnell was the Head of Research and Management Information Systems with Cleveland Social Services Department and was involved in the collection and collation of the data and statistics concerning the events which took place.

Our newer, high-speed computer was in the shop for repair, and my son was forced to work on our old 386 model with the black-and-white printer. "Mom," he complained to me one day, "this is like we're living back in the twentieth century."