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The importance of safeguarding

Coalface tales

James Booth

Monday, 18 March 2019

AdobeStock_154754393.jpegAmidst all the news about Brexit this past week, there have been a couple of other stories that have led me to reflect, with some anger, on attitudes towards something that I feel very strongly about as a professional. As you can see from my bio, I’m the Named GP for Child Safeguarding locally. The protection and welfare of our younger patients is at the heart of my work as a GP.

The first rage-inducing story concerns our erstwhile Foreign Secretary. Boris Johnson, in an interview this week, spoke of money spent on historic sexual abuse cases as being wasted. He employed the term “spaffed up the wall”. For those of you unfamiliar with that slang term let me just assure you that it has no place – at all – in any discussion on this topic. That it was chosen deliberately to express a contempt for these issues is something I do not doubt. We also learnt that the Liberal Democrats were belatedly suspending David Steel, after it emerged that he had been aware of Cyril Smith being a sexual and physical abuser, but chose not to act, as he felt it was nothing to do with him. I’ve heard comments about the late seventies being a different time; they were, but these acts were still illegal and immoral then.

Historic sexual abuse cases ARE important, and both the investigation of their perpetrators and care of the abused, should be of concern to us all. The need for survivors to feel heard, the need for us all to understand the trauma they have experienced, and the need for justice are crucial. As a profession, we also should not forget that too often in the past, doctors have overlooked, ignored and excused abusers, and have indeed been abusers themselves. A stark fact that emerged in the Jimmy Savile enquiry was that in all the years he was forcing himself on patients at the Leeds Royal Infirmary, he received just one complaint…from a consultant annoyed that he’d found his private parking space used by him. I do believe we are better now at acting on behalf of victims; but we have work still to do.

Part of my anger towards both the men above stems from the fact that I see the consequences of historic abuse all the time at work. I’m currently spending a lot of time managing an intensely vulnerable but highly challenging patient; they have a very longstanding history of personality disorder, self-harm, destructive behaviour and they have a trail of failed professional relationships in their wake. I fear ours will soon join them, but I shall try to avoid that. I am aware, though, that truly dreadful abuse in a now pretty distant childhood has been the root of this. Those experiences are still living on in the anguish they cause this patient and have coloured their every relationship since. I wondered this week about the doctors who looked after those abused by Cyril Smith, both then and now. Who of them received sympathy, and who received judgementalism? Who was heard, and who was written off as a heart sink? The psychological morbidity that the survivors of abuse can experience is appalling, and it is us on the frontline of the NHS who will so often be the professionals dealing with it.

This brings me on to another point. We should all, in our daily practice, be very mindful of how common child abuse has been and continues to be. We all have protocols and guidelines in place for managing a disclosure, how to report and cascade it, how to ensure safety and so on. But we should also be asking ourselves if our practices are places where patients can feel safe to make a disclosure; are we people they can feel safe doing so to? I’m as guilty as the next GP of sometimes seeing a name in a busy on-call day and feeling frustrated - do I try enough to look into the past of that patient and see if there were experiences there that have had a huge impact on them? This is work that can never be completed, but it is of such importance to the care of those patients affected by it. Far too often in today’s world we see abuse being minimised, shrugged aside and ignored, and it is no less wrong for that to be abuse that happened a lifetime ago. For that lifetime is also very much living memory, and knowing what we do about the inner lives of our patients, we can begin to imagine how painful the callous disregard of the men above must have been to some people this week.

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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