Thursday, July 23, 2009

RIP: Freedom

I blogged about the NICE consultation on 'when to suspect child maltreatment' back in January, when it was underway. It was open to stakeholders only, of which Education Otherwise was one. The resulting guidelines [opens pdf] were finally published on Monday of this week. They are every bit as devastating for our freedom to make lifestyle choices as the consultation threatened they would be.

These are guidelines for health practitioners to follow whenever they are presented with a sick or injured child, "providing..

.. a summary of the clinical features associated with maltreatment (alerting features) that may be observed when a child presents to healthcare professionals. Its purpose is to raise awareness and help healthcare professionals who are not specialists in child protection to identify children who may be being maltreated.

So far, so reasonable - just in case a 'health care professional' can't recognise a suspicious set of bruises and/or cigarette burns, starvation symptoms or a child in fear and trembling at the sight of its parents. You might think.

Of course, the things I just listed would need attending to in the proper way and I think it's a good idea that government (or one of its quangos, whatever..) provides guidance to explain the correct procedure in such eventualities. It's only common sense, you might think.

But this is not what these guidelines are actually about. Of course not. Nothing could be so simple and straightforward in 21st Century England, could it? 'Healthcare practitioners' in this day and age apparently need to be looking for far more than a suspicious set of bruises and/or cigarette burns, starvation symptoms or a child in fear and trembling at the sight of its parents. They must now be the lifestyle police, trained and measured by their ability to, for example:

Consider child maltreatment if there is an unusual pattern of presentation to and contact with healthcare providers, or there are frequent presentations or reports of injuries.

So your child had better not be frequently ill, or injured. You know, when I was a child - thirty odd years or so ago now (halcyon days) - there were some children whose health was just never good. No reason, per se: it just happened that way, life being naturally a bit messy and all, but the thing was that nobody raised an eyebrow. Such variations were just accepted. Some people had a lot of time off school. Some were often at the doctors, others never went. I don't think either was a problem: certainly not cause for official concern. And injuries? Well, children are children, aren't they? Most of them like to take risks and play rough at some time or another and when I was young we were allowed to, which did us no end of good.

And yes, there probably were, from time to time,

unusual pattern[s] of presentation to and contact with healthcare providers, or .. frequent presentations or reports of injuries,

- but so what? In those days, it was called "living", and most families quite cheerfully indulged in it with impunity.

Not so any more: "Unusual pattern[s] of presentation" etc, blah blah, are just the tip of the iceberg.

For home educators, this will leap, blaring, off the screen:

5.8 Inappropriately explained poor school attendance

Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and formally approved home education is not being provided.
[My emphasis.]

So, just in case that's not quite clear... if you take your child for any kind of medical attention and you are exercising your current legal right to home educate him or her without being registered and 'formally approved' by your local authority, you will now be suspected of mistreating your child!

This needs to be urgently revised and at least made to reflect the current legal situation, because it will bring in de facto compulsory registration without any need for the Badman report [opens pdf] or the Select Committee inquiry announced this week.

Besides that, these NICE guidelines [opens pdf] go on to instruct practitioners to:

Consider neglect if a child’s clothing or footwear is consistently inappropriate (for example, for the weather or the child’s size).

Oh, but:

Instances of inadequate clothing that have a suitable explanation (for example, a sudden change in the weather, slippers worn because they were closest to hand when leaving the house in a rush) would not be alerting features for possible neglect.

I wonder whether the parent-or-carer has to provide documented proof of leaving the house in a rush, before the aforementioned slippers are deemed to be appropriate footwear?

Honestly. My two year-old goes to the supermarket with us to sit in a trolley seat in slippers quite regularly, just because she prefers them to her proper shoes. Who could possibly be offended by this? What harm could it possibly do, to her or to anyone else? How could it possibly suggest that we're mistreating her? On the contrary, it demonstrates that we take her preferences seriously, and allow her to have some control over her own life, what she wears and what she does. Hmm. Therein lies the problem?

• child seen at times of the day when it is unlikely that they would have had an opportunity to become dirty or smelly (for example, an early morning visit)

But in the case of home educators, we're sometimes out doing activities until bedtime. I know late morning or lunchtime baths are a regular occurrence around here. Until now, there was no law that said a bath had to take place in the early evening, before bed. Are health visitors going to be checking the clock, then checking a child's fingernails on home visits? It beggars belief. Since when was a dirty child a mistreated child anyway? In my experience, the ones who are spotlessly clean all the time are perhaps the ones to be more worried about.

6.2 Supervision

Achieving a balance between an awareness of risk and allowing children freedom to learn by experience can be difficult. However, if parents or carers persistently fail to anticipate dangers and to take precautions to protect their child from harm it may constitute neglect.

Consider neglect if the explanation for an injury (for example, a burn, sunburn or an ingestion of a harmful substance) suggests a lack of appropriate supervision.

Two incidents in my family spring to mind. In the first, I made a cup of tea and had to leave it, quite well back on the kitchen surface while I dashed to attend to my new baby in the other room. Meanwhile my toddling child must have inexplicably reached up for tea (I didn't even know he could reach that far, let alone think him likely to) and pulled it onto himself, suffering 11% burns. 19 years ago, this was seen for the pure accident that it was, and I was treated with sympathy and understanding by doctors and nursing staff. Nobody ever suggested that I was anything other than a good mother, even though I was only just 21 at the time, and had two such young children very close together in age. In fact, I'd left the tea due to good mothering, in a sense, because I was dashing to pick up the baby before he got too upset. I couldn't really have foreseen the accident, but how would I be treated if it happened now? Quite differently I think.

As recently as five years ago, I took another toddler up to the bathroom while I went to use the loo, but she grew bored of waiting for me and wandered into her teenaged sister's room next door. The next thing I knew, she was screaming, with nail varnish in her eye, that she'd mistaken for mascara and decided to play with accordingly. I washed out the nail varnish and called 999: she was being checked by an eye specialist within 20 minutes and we were home again just over an hour later with a clean bill of health and no suspicions of 'maltreatment'. This would presumably not be the case under the new guidelines.

Accidents happen. They can't all be prevented, all of the time. A good parent-or-carer makes reasonable checks for safety and takes reasonsable precautions, but people have to live - go to the loo, attend to their other children, turn their backs sometimes, for whatever reason. Maybe even trust their child to go off and play at her own request, unsupervised. It's not good to have a parent-or-carer breathing down one's neck all the time. It is good to enable a reasonable amount of risk-taking and unsupervised play to facilitate the learning process and the child's general development. Is this still to be allowed? The guidelines make no mention of it.

6.3 Ensuring access to appropriate medical care or treatment

Consider neglect if parents or carers fail to administer essential prescribed treatment for their child.

So, this outlaws alternative health philosophies, pure and simple. It also removes the traditional parental authority to make decisions about their children's medical treatment, as does the rest of 6.3:

Consider neglect if parents or carers repeatedly fail to attend essential follow-up appointments that are necessary for their child’s health and wellbeing.
Consider neglect if parents or carers persistently fail to engage with relevant child health promotion programmes which include:

• immunisation
• health and development reviews
• screening.

Consider neglect if parents or carers have access to but persistently fail to obtain NHS treatment for their child’s dental caries (tooth decay).

Even tooth decay in milk teeth? In an older teenaged child's teeth? What if the child resists? Isn't the parent the last bastion in the defence of their child's autonomy? I've seen the health effects on very young children of surgical tooth removal, and it's not something I would unnecessarily put a child of mine through. Do I still have this choice? According to these guidelines, I don't.

I'm not even going to start on immunisation, except to say that this document renders it now de facto compulsory. I don't know if the relevant pressure and support groups are aware of this.

7.1 Emotional and behavioural states

Consider child maltreatment if a child or young person displays or is reported to display a marked change in behaviour or emotional state (see examples below) that is a departure from what would be expected for their age and developmental stage and is not explained by a known stressful situation that is not part of child maltreatment (for example, bereavement or parental separation) or medical cause. Examples include:

• recurrent nightmares containing similar themes
• extreme distress
• markedly oppositional behaviour
• withdrawal of communication
• becoming withdrawn.

Goodness me. One of my children is extremely emotional and imaginative and suffers from nightmares sometimes without any known cause: I think it's just genetic. Another is very choosy about who she speaks to and when and is quite likely, in her regal two year-oldness, to decide not to acknowledge someone's presence if and when the mood takes her. These would both be marked changes in behaviour, seen from certain perspectives, not explained by a known stressful situation that is not part of child maltreatment (for example, bereavement or parental separation) or medical cause. I do not maltreat my children - far from it. But, like Philip Pullman (whose excellent books I've just got into reading) et al., it seems that we parents are to be presumed guilty until proven innocent.

There's more, far more, but this has taken enough of my time away from my own children today. You will go and read the rest of the document if you're interested, and formulate your own views of it. Meanwhile (assuming you agree with me) what can we do? If you're an EO member I'd urge you to lobby the management there to try to get this changed, as they're listed as stakeholders. If not (and I'm not) then it might not be a bad idea to just talk to people about it. I don't know if writing to complain about things actually helps, but a groundswell of public opinion might, and this affects all parents.

(As does this, especially if the Badman recommendations are enacted. We won't even be allowed to support our children's natural resistance to the school system. There will be no leeway for anyone, anywhere. Only total and unquestioning obedience.)


Blogger Merry said...

I'm going to jail.

In fact, i might just go and hand myself in.

10:18 pm, July 23, 2009  
Blogger mamacrow said...

oh dear. I'm going to defend the wording in the document here...

it says 'consider neglect if' etc etc.

It dosn't say - there is neglect if - the parents refuse to imunise etc etc.

It's just that all these things that they list CAN be signs of there being abuse/neglect going on.

Just as a couple of dozen symptoms CAN be indications of swine flu, and if you have several of them you may want to CONSIDER that you have it. You may still not, you may just have hayfever, or a common cold, or any number of dozens of other things that have similar/same symptoms.

Sorry.. but really, compared to many I've seen this doc really wasn't that bad - ON PAPER.

AS EVER this is going to come down to the teams and individuals impliementing it and how they do that, and therein lies the rub!

11:23 pm, July 23, 2009  
Blogger Gill said...

Merry, same goes for me and every other normal parent in the country.

Mamacrow, the procedure for 'considering' is set out as follows:

"• discuss your concerns with a more experienced colleague, a community paediatrician, a
child and adolescent mental health service colleague, or a named or designated professional
for safeguarding children
• gather collateral information from other agencies and health disciplines, having used
professional judgement about whether to explain the need to gather this information for an
overall assessment of the child
• ensure review of the child or young person at a date appropriate to the concern, looking out
for repeated presentations of this or any other alerting features."

All that, for not using schools, immunisations or NHS dentistry? For allowing your child to leave the house in slippers?

I don't usually disagree with you, but I think this document really is THAT BAD.

Having said that, it's published now. The damage is done. Maybe I should just shut up about it.

It's just that if I ever have to take a child to A&E again, which I doubtlessly will because children are children and I don't keep them wrapped in cotton wool, I want to know exactly what I'm being considered for and why.

Each to their own, I suppose.

7:06 am, July 24, 2009  
Blogger Barry said...

It could depend on one's definition of 'consider'. One definition given by the Cambridge dictionary is 'to believe someone or something to be, or think of them as' which would give a different slant from the more innocuous 'spend[ing] time thinking about a possibility or making a decision'.

As with a lot of these documents recently, it gives a certain degree of leeway for interpretation. Of course, someone seeing signs of possible abuse should have a degree of leeway for interpretation rather than relying on a mechanical process, but these guidelines are being followed by nervous healthcare professionals terrified that they will miss something, and were put together by people with - and I think this is fairly clear to all - a political agenda when it comes to health, to education, and to all other areas of life.

To be gracious, let's assume its primary intention is indeed to capture actual cases of physical or emotional abuse - hitting with an implement, restricting access to food etc. Such terrible things do happen, and such guidelines are not aimed solely at good, albeit alternative, parents. But 'abuse' is such a loaded term, and including things such as vaccines is obviously an agenda. Ditto for behaviour that seem odd to some families but may be de rigeur in a (happy) home educating family - the child going out in slippers, or answering back to eg a GP if they feel they're not being listened to, or the family being out and about at what, for a school-going family, might be odd hours. Conversely some mainstream practices seem abusive to me - babies being in a different room, controlled crying and so on.

So even if we see the primary intention here as being to stop real physical harm being done by deliberate acts of violence, it nonetheless also sweeps up all sorts of potential 'undesirables' who are unknown to LAs, question vaccines, and don't follow the herd as potential 'abusers'. Would this mean we are seen as abusive if we refuse to allow our daughter to be injected with a rushed-through swine flue vaccine? Or if we don't 'engage with relevant child health promotion programmes' because we're fine and we have no need to?

9:27 am, July 24, 2009  
Blogger T-bird Anni said...

I think this one is going to come down to how it's interpreted. Certainly it leaves enough doors open to drive several bus-loads of Little Hitlers with clipboards through in their bid to have us all nice little conformists but I'm sort of hopeful that it's the sort of overbearing advice that most HCPs roll their eyes at and go "Oh God not again" then use as loo paper. There is an awful lot of this kind of crap foisted on HCPs.... most of them manage to pay it token service by way of citing it in a bit of CPD once every 3 or 4 years then get on with using their common sense in the real world.

9:38 am, July 24, 2009  
Anonymous Anonymous said...

Strange how listening to your child and taking their concerns seriously could be construed as 'neglect' by these guidelines.

My son likes to be barefoot. He frequently asks me to remove his footwear when we are out and about - the park, the supermarket, town, anywhere - and in the past if I have refused he has become upset. So now I just remove his shoes if that's what he asks for - why not? He obviously likes the feel of different surfaces on the soles of his feet, and it's no problem.

Presumably, under these guidelines, a child out and about with no shoes on would be marked as possibly neglected, so it looks like I'm going to jail along with you Merry, and Gill and thousands of other mums.

These guidelines are so ridiculous. They swing wildly from *obvious* situations where abuse could be considered as a possibility (the sexual injuries section, for example) to such meaningless matters as wearing a winter coat in the summer, which nobody should be giving any thought to at all.

10:02 am, July 24, 2009  
Blogger Barry said...

In response to Debs, yes, some clearly terrible things interspersed with some that are just silly. And surely an important factor here is choice, or lack of? Is a child wearing no shoes because they like not having shoes on, or because you refuse to let them wear their shoes when going out as a punishment for something? Clearly a world of difference.

10:35 am, July 24, 2009  
Anonymous Anonymous said...

"I'm going to defend the wording in the document says 'consider neglect if' etc etc."
"AS EVER this is going to come down to the teams and individuals impliementing it and how they do that, and therein lies the rub!"

Indeed, and that is a serious problem as many support groups such as AIMS can testify and provide numerous examples. What is "considered" an accident in one PCT Trust is "considered" abuse in another. I have an example of this as proof.

1:05 pm, July 24, 2009  
Anonymous Lucy said...

in 7.1 the list of examples that might indicate maltreatment:
• recurrent nightmares containing similar themes
• extreme distress
• markedly oppositional behaviour
• withdrawal of communication
• becoming withdrawn.

With the exception of the oppositional behaviour, SCHOOL caused all these in my children. The authorities found this acceptable. This type of document would have more validity if directed at the institutional abuse which a huge percentage of children experience everyday.

scary orwellian times we live in :(

3:13 pm, July 24, 2009  
Anonymous Anonymous said...

I wonder what is behind it all? Of course, one can suspect the pharmaceutical companies for pushing their drugs.

It seems a lot of these things are aimed at reducing a child's autonomy (not to mention parents' autonomy) and it is all very, very sinister indeed.

I'm also thinking of all the false positives that these anal retentive social workers etc. will latch onto. You know, you're a perfectly great parent choosing autonomy for your child and facilitating your child's choice to be barefoot but A. Hitler comes along and decides you are an abuser. I imagine we will have many more incidents like this. Then the huge mill of bureaucracy grinds into action to crush you, your family, your children and your life.

I hate this country.

3:44 pm, July 24, 2009  
Anonymous Elizabeth said...

@ Lucy

Same here, all cool now thanks to HE except sporadic opositional behaviour, but that's now understood to be child having better ideas than parents, evolution!

9:55 pm, July 24, 2009  
Anonymous Jeremy said...

Healthcare professionals are also supposed to record every instance where they "consider" abuse, according to the flowchart in the document.

11:55 pm, July 24, 2009  
Blogger Elizabeth said...

I sent a letter to them to complain about their wording in section 5.8--they said HE parents had to '...make[ing] arrangements in conjunction with the LA.'

That alone annoyed me to no end, especially that it could be considered enough of a point to consider for abuse to get it's own bulletin point. But every health person I have met so far has looked on HE as an interesting choice--but none so far have asked if I had to register or be known to any--I'd hate for that impression to be given-especially as it is not current law.

9:41 pm, July 25, 2009  
Blogger Allie said...

I'm pretty sure that any of the things mentioned in this report might well have *always* been enough to make health care professionals consider abuse. Sometimes for good reason - sometimes completely mistakenly. The definition of neglect has always (right back to Victorian times anyway) been partly characterised by children being dirty, for example. Sometimes that is a sign of neglect (I have heard a tale from an ex-social worker in my family of a child so filthy that a dirty old headscarf was actually matted deep into her hair, which was alive with lice). There is a difference between a situation like that and a child who isn't over keen on baths and currently enjoys a lot of play in a muddy environment. Nothing will stop different practitioners interpreting things in different ways and you might get some clean freak health visitor who reckons the latter case is 'undesirable'. But then again, you might not...

I don't know about this report. It has some clearly worrying elements - not least 5.8. But I was quite pleased to see a delineation between considering and suspecting abuse. Also, sometimes these things being documented and formalised can actually be a protection against erroneous accusation. Better that than a building whispering campaign against a family.

10:33 pm, July 25, 2009  
Blogger Ruth said...

Thinking of my welly wearing son in the heat of summer, the fact none of them have been near a doctor for over 8 years ( some 12) and I am currenty engaged in battle over a vaccine my dd does not want, I might as well give myself up.

10:54 pm, July 25, 2009  
Anonymous Anonymous said...

We have no Nhs dentist within a reasonable access area.
As for appropriate clothing, someone better tell the manufacturers who make those tarty dresses for 5 year olds.
My youngest is still waiting for asd assessment. Under these rules he could be classed as abused due to his odd behaviour.


8:33 am, July 26, 2009  
Anonymous Jax said...

I bought Small new shoes this week. He told me they fitted. The Clarks woman in the shop checked them as well. Yesterday we walked around FoH for a while, then he told me his foot hurt, and I discovered he had blisters on each foot and a hole in the back of his heel.

Is that neglect? How do you deal with a child who can't tell you the things they need to? He is frequently "inappropriately" dressed as in when I let (hah!) him go out in dressing up clothes such as a spiderman outfit, or Captain Hook, or his chainmail and cloak. Actually these are often related to the places he is going, so he'll wear knight's costume if we are going to a castle or history event. So maybe not that inappropriate after all?

He is always covered in bruises that he can't explain, and right at the moment has a healing scratch down the middle of one cheek which none of us know how it happened.

And when we recently went to a GP, the guy didn't know home education was legal, and certainly didn't know you didn't have to be registered, monitored and so on.

They are going to need bigger jails.

12:31 pm, July 26, 2009  

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