Published: 06/12/2001, Volume III, No. 5784 Page 32 33

Working together or pulling apart? The National Health Service and child protection networks

By Carole Lupton, Nancy North and Parves Khan

Publisher: The Policy Press.

ISBN: 1861342446. 144 pages.£15. 99.

Reviewer Christopher Cloke, Head of child protection awareness, National Society for the Prevention of Cruelty to Children

Yet again, child abuse is in the news. The death of Victoria Climbié and the ensuing statutory inquiry mean that the child protection system is again being scrutinised. It is hoped that this time lessons will be learned and Lord Laming's recommendations will prove to be a turning point in the development of child protection.

It is already clear that, as with many other cases that led to inquiries, the heart-rending, tragic experience of Victoria Climbié involved the actions and inactions of a number of health service professionals.

In this context, Working Together or Pulling Apart? is a timely publication that will be of interest to both child protection practitioners and policy-makers alike. Given its strong theoretical underpinning - drawing on organisation theory and analysis and the application of new public management - this well researched and meticulously referenced book will also be of interest to social policy students.

It forms a fascinating case history on the application of social theory.

In the authors'words, its central aim is 'to assess the nature of the 'mandated cooperation' of the child protection process and to identify those factors which undermine its achievement'.

Lupton and her colleagues trace the development of the NHS and its relationship with the child protection system that has developed over the past 30 years or more. It will come as a surprise to few practitioners that child protection does not fit comfortably into the health service and that collaboration is thwarted by the system and those who operate it.

This, in no small part, is due to the dominance of the medical profession and 'scientific' or medical knowledge and opinion, which often goes unchallenged. It will be interesting to see how these dynamics play out in the newly formed primary care groups/trusts, which seem, to date, to be paying scant attention to child protection.

A thorough analysis is given ofthe roles of key staff, including GPs, health visitors, designated and named health professionals, in child protection.

Given that all health service professionals need to respond to child abuse, it would have been interesting to have seen greater consideration given to the roles of other professionals - for example, child and adult psychiatrists, accident and emergency staff, paramedical workers and pathologists.

It would also be interesting to apply the authors' analysis to the low status that often appears to be accorded to paediatricians, compared to consultants in other specialisms.

As has been found in other studies, the role of many GPs in child protection is shown to be lacking. Often, they are not good team-players and do not participate in child protection networks.

Their record in attending case conferences is poor. Some show little regard for the designated and named health professionals. Yet they exercise considerable power and influence over the primary healthcare team.

Lupton and colleagues tellingly point out that 'the most significant stakeholder of all within the child protection sector, the state, has acquiesced in the division of state-employed or state contracted labour'.

Working Together or Pulling Apart? offers a number of ways forward, building on the movement away from the competitive ethos of the NHS internal market and the development of 'cross cutting' approaches between the NHS and other agencies, backed by financial incentives.

On the basis of their evidence, however, the authors appear to be pessimistic about the likelihood of greater prominence being given to child protection.

It is to be hoped that they will be proved wrong