to the hospital. She died the next day which was the day planned for the church ceremony to cast out her devils45. The inquest found 128 separate injuries and scars, cigarette burns, evidence of being tied up for more than 24 hours, hit with bike chains, hammers and wires and the pathologist described it as “the worst case of child abuse I’ve ever encountered”46. Victoria’s plight was known to four social services and three housing departments, two child protection police teams, two hospitals, an NSPCC* centre, and a few local churches, all of whom noted abuse and did nothing to prevent her death. The trial judge described this as “blinding incompetence”. A public inquiry found that there had been at least 12 opportunities for protection agencies to have saved her life and none did47.
Administrators revealed that child protection services were under-staffed, under-funded, and poorly managed. A chief executive conceded that her department was “seriously defective”, that many cases were closed inappropriately, that children were placed unaccompanied in bed-and-breakfast accommodation, and children in need of care were turned away48. Child protection had a low priority in funding and Haringey Council diverted £18.7m to more popular projects to gain votes while Brent Council diverted £26m. Both authorities under-spent their budgets for children’s services by £28m and Haringey Council admitted failing to assign social workers to 109 abused children in May 1999. The CEO had restructured the department which, according to the union, paralysed child protection services49.
You would have thought that all the local authorities in the country would have put their child protection services in order after Lord Laming’s (2003) 400 page damning report that made 108 recommendations for child protection reform50. The report led to the introduction of Every Child Matters: Change for Children, a framework to improve the lives of all children; the introduction of the Children Act 2004 51, that provided the legislative base for reform; the creation of ContactPoint, a database that would hold information on all children in England and Wales; and the Office of the Children’s Commissioner with a Commissioner for Children. Regional and local committees for children and families were to be set up, with members from all groups involved in child protection52. Each local authority managed their own child protection register and no national register existed; this, combined with their tendency to suppress information about child abuse cases, led to the recommendation to establish a national database. Two organisations to improve the care of children, the General Social Care Council and the Social Care Institute for Excellence, had already been set up by the time the report was published.
* National Society for the Prevention of Cruelty to Children
The reforms introduced by the Every Child Matters: Change for Children paper were expected to be in place by 2008. Before the year ended however, the horrendous death of “Baby P*” (Peter ConnoIly) exploded into the media53. It became clear that changes to government policies do not necessarily translate into changes in practice. In 2007 and 2009, the British public was shocked yet again by the brutal death of the toddler and the trial of his mother and her partner Steven Barker (aged 33). Baby Peter was born to Tracey ConneIly on March 1st 2006. Barker then moved in with her. In December, a GP noticed bruises on Peter’s face and chest. His mother was arrested and Peter was put into the care of a family friend, returning home a few weeks later. Over the next few months, Peter was admitted to hospital twice suffering from injuries, bruises, scratches and sweIlings on his head. ConneIly was arrested again in May 200754. In June 2007, a social worker again observed signs of abuse and informed police. A medical examination confirmed abuse and the baby was placed with a friend. On August 1st 2007, Peter was examined at St. Ann’s Hospital in North London by locum paediatrician Dr Sabah Al-Zayyat55. Two days later, he was dead. The post-mortem concluded that the doctor failed to notice more than 50 injuries, a broken spine, eight fractured ribs and the fact that Peter was paralysed from the waist down56,57. He was punched so hard that he swaIlowed a tooth58. His ears were torn, fingernails and fingertips were missing and his lips were ripped. The subsequent neck injury that affected his breathing was probably the fatal blow.
Although Baby Peter was on a child protection register, social workers, doctors and police failed to take action to stop the abuse despite seeing him at least 60 times over eight months59. Newspapers printed front-page photographs of the child with disturbing details of his injuries, triggering yet another urgent review of child protection policies60. It was later revealed that Peter’s mother and Barker had been tried in secret in May 2009, for the rape of a 2-year-old girl61. Barker was sentenced to life imprisonment for the rape and received a 12-year sentence for his role in the death of Peter, the sentences to run concurrently. His brother, aged 37, who slept in the same filthy house with a 15-year old girl, was also jailed with a minimum sentence of three years62,63.
The Children, Schools and Families Commons Committee (2009) argued that the threshold for admitting children into state care was too high. Not only should Baby Peter have been removed long before his death but, worse, his situation was not perceived as unusual64.
* A suppression order was in place throughout the court hearing and the dead child was referred to only as Baby P.
It should have been clear to social workers that “family support” could never have been effective in this household. Barker was a 95kg sadist who allegedly enjoyed torturing animals. He lived with three dogs, including a Rottweiler which he used to terrify the baby. He collected knives and Nazi memorabilia, while the mother spent her days on the internet, drinking alcohol and watching pornography. When he was not abusing the toddler, Barker, who had a pet snake, would skin live frogs and break their back legs to see if they could still jump. Dead mice, chicks and dismembered rabbits were left lying around the house, along with pornography. The Barker brothers had a long history of violence and were previously charged with assaulting their grandmother, Hilda Barker, aged 82 (1995), locking her in a wardrobe to make her change her will in their favour. The case was dropped when she died65.
Newspapers carried sensational headlines such as “Blunder Scandal of Baby Battered to Death” (Daily Mirror, 12 November). “Blood on Their Hands” (The Sun, 12 November), “50 Injuries, 60 Visits – failures that led to the Death of Baby P” (The Guardian, 12 November), while the largest seIling daily tabloid newspaper, The Sun, ran a campaign to have the professionals sacked, creating the “Beautiful Baby P: Campaign for Justice” (The Sun, 15 November). This mirrored earlier media campaigns directed at galvanising the government into action. Two weeks later the newspaper delivered a petition to the Prime Minister containing over 1.3 miIlion signatures, claiming this to be the largest and most successful campaign of its kind. Facebook groups, comprising over 1.6 miIlion members, were set up seeking harsh punishment for Peter’s kiIlers. This weight of expressed opinion put major pressure on the government to be seen to be acting and in control of the situation66.
The Secretary of State67 responded to the furore by:
establishing a “Social Work Task Force” to identify barriers that social workers face and make recommendations for the long-term reform of social work
ordering an urgent Joint Area Review (JAR) of safeguarding children by the responsible authority. On receipt of the report (which he described as “devastating”), the Secretary of State announced that he was using his powers under the Education Act 1996 to direct Haringey to remove the Director of Children’s Services. The Council also dismissed four other employees involved in the case
ordering the preparation of a new and independent Serious Case Review
appointing Lord Laming to carry out yet another urgent national review of child protection and report within three months
The central principles of the legislation encouraged negotiation with families and their involvement in agreed plans. The regulations required professionals to work in partnership with parents although quite clearly some parents are unwilling or unable to change their parenting or life-styles. For that reason, some demanded a return to the adoption of children born to seriously dysfunctional parents.
Lord