Lamb and Hemming on Child Protection

3.01.57pm GMT Sun 14th Dec 2008

• ' . . I THINK that there are lessons to be learned, and it is important to reflect on them for a moment, particularly the situation in the local health service, because serious concerns have been raised with me.'

Norman Lamb (Shadow Secretary of State for Health, Health; North Norfolk, Liberal Democrat): I welcome the opportunity both to reflect on the state of these vital public services and the Government's intentions, and to explain our alternative vision.

This debate coincides with the Healthcare Commission report on the state of health care in the UK. It is right to acknowledge, first, that that report had lots of positive things to say about progress in the national health service. The Secretary of State mentioned that progress has been made on survival rates for heart disease, stroke, and cancer. Survival rates for those serious diseases have improved, which is something that we should all welcome. We should welcome, too, the substantial improvements in access to care, compared with the position 10 or 11 years ago. There has been a dramatic improvement, and it would be churlish to fail to recognise that-

Simon Burns (Whip, Whips; West Chelmsford, Conservative): But?

• Norman Lamb: But the Healthcare Commission drew attention, too, to the fact that there were areas of serious concern. Ian Kennedy, the chair of the Healthcare Commission, focused on patient safety, and I want to concentrate for a few minutes on the area of most significance-child protection, particularly the tragedy involving baby P. Again, it is important again to acknowledge that the Secretary of State for Children, Schools and Families acted commendably fast in recognising the seriousness of the failings and in mapping out a way forward. However, it is also right to say that so far, the emphasis and focus, particularly in the media, have been on the failings of the local authority-and there were many-rather than on the failings of other agencies. I think that there are lessons to be learned, and it is important to reflect on them for a moment, particularly the situation in the local health service, because serious concerns have been raised with me.

I understand that the paediatric service for child protection in the borough was outsourced to Great Ormond Street. I understand that there was a team of four doctors, of whom two have resigned, one has been on special leave for a year, and one is off sick. Given the fundamental importance of that work-I make these comments not in any sense in a partisan way, as we all have a common view of the importance of addressing these issue-that is an alarming situation in itself. Incidentally, if either Secretary of State is unable to respond to these points today, I am happy for them to respond in writing later. What factors have led to this situation? Why has one of the doctors whom I mentioned been on long-term special leave for a year? Is it the case that the primary care trust cut funding for a designated doctor post, and is it the case that the paediatrician who did not recognise the broken back and ribs in the case of baby P was a locum employee?

I have heard concern expressed that when children are brought into St. Ann's hospital in Tottenham as possible victims of abuse, there is a tendency for no information to arrive with the child to put the medical team fully in the picture about possible concerns. That relates to the issues of co-ordination and the sharing of information between agencies dealt with in the report released by the Secretary of State for Children, Schools and Families. I understand that when one doctor filled in a critical incident form at that hospital, in relation to another case, he was told not to do so because it would show up poor record keeping. I do not know whether there is any truth in that allegation, but it is a serious matter and it clearly needs to be investigated. What short-term steps have been taken to ensure that there are proper safeguards in place for other vulnerable babies and children in that borough? What are the longer-term lessons for the NHS-as opposed to the local authority, which has had its fair share of attention-particularly with regard to the responsibility and accountability of the clinicians involved?

That takes me to the wider question of child protection. Such tragic cases open up a debate on parenting and on how we can best protect children. The case of baby P is a stark case of failure, but throughout the country, every day, social workers are grappling with the genuinely difficult dilemma of whether to remove a child from their parent or parents and to place them in care. It is massively challenging work, and the last thing we should do is to stigmatise social workers and make that an unattractive profession, thus putting able people off going into it. After such a disaster, there is a risk that policy is shaped in response to it, and that there is a swing of the pendulum into a different approach, which may not itself be right.

I would like to mention the other side of the coin. There are many cases in which there are genuine concerns about the failure of authorities to remove a child who is at risk, but in my constituency I have been dealing with the case of the Webster family, which was covered in the national press last year. They had a little boy who was taken into the Norfolk and Norwich hospital complaining of pain, and it turned out that he had multiple fractures. The child was removed, along with his two siblings, and after a long process the three children were adopted. That family lost their three children. Subsequently, it was proved through further medical evidence that they were innocent, and that there was an innocent explanation for the fractures-a nutrition deficiency. That case is a disaster. It is a disaster in the system and a gross miscarriage of justice for a family to lose their three children when they are innocent. It cannot get much worse than that. My plea is for us to avoid another swing of the pendulum, and to focus instead on ensuring that procedures are exacting, rigorous, thorough and professional, and that we focus on standards of professionalism in social care and in the NHS.

• John Hemming (Birmingham, Yardley, Liberal Democrat): My hon. Friend is well aware that I have been concerned about both false positives and false negatives in the public family law environment. Does he share my concern that it is difficult for parents to get a second, expert opinion because they require the permission of the judge, which is often refused in family court proceedings?

Norman Lamb: I share that concern, and because it is so fundamentally important that we get such decisions right, the opportunity for a second opinion ought to exist in all cases. Had it been available in the Webster case, we might have avoided the miscarriage of justice that subsequently ensued. If we focus on standards of professionalism in reaching the right judgment, we stand the best chance of avoiding those dreadful miscarriages of justice, and of ensuring that children who are genuinely at risk are protected and withdrawn from their parents, if necessary. There should be no rush to put children into care, but the right decision, based on absolute professionalism, must be made.

Sure Start is one of the Government's genuine successes. The WAVE Trust is a good organisation, which has been influential in guiding Government policy development-I believe that it has engaged with all parties. It focuses on the first three years of a child's life, recognising the importance of getting things right in those years. It concentrates on parenting and ensures that children avoid adverse, damaging experiences that can affect their life chances, including their future health. Mr. Duncan Smith and Mr. Allen produced a good pamphlet, which focuses on the importance of investing in the first three years of life.

A recent article in The Lancet on a research report shows that Sure Start has started to make a difference. We should acknowledge that and recognise that it has been a positive policy move. However, an article by Rachel Sylvester in The Times earlier this week warns that there are signs that the approach in children's centres and in Sure Start is moving away from parenting skills and towards education. I hope that the Secretary of State for Children, Schools and Families, if he is listening, will ensure that the focus on parenting in children's centres, which has been so valuable and, according to the research, shows success, is maintained and not lost.

I want to deal with the Government's proposals for a national health service constitution. It is hard to object to the warm words and aspirations in the proposed constitution, but the Government must answer the key question of whether it will make a difference. Ten years down the line, will patients be able to say, "Ah, we're being treated better because of that NHS constitution"? Does it tackle the key challenges that face a publicly funded health system?

Greg Mulholland (Shadow Minister, Health; Leeds North West, Liberal Democrat): First, the draft constitution specifically precludes discrimination on the basis of race, gender, disability, religion or sexual orientation, but not of age. How can that be right? Secondly, we all agree that the divide between health and social care can be a problem. Should we therefore also consider the possibility of a social care constitution, so as not to entrench that divide further?

Norman Lamb: I would prefer something that encapsulates both, and acknowledges that there is an artificial divide between health and social care, which is often damaging to the care that an individual experiences.

Ian Gibson (Norwich North, Labour): The equality Bill is to deal with the first point that Greg Mulholland made. We do not know until we see the detail, but the Government are well versed in the need to ensure that age is included in anti-discrimination proposals.

Norman Lamb: I welcome the equality Bill, but one has to ask why age has been left out of the list of discrimination that the NHS constitution seeks to tackle. We all know that age discrimination happens in the NHS. There is clear discrimination in mental health services: for example, elderly people who suffer from depression and anxiety do not have access to cognitive behavioural therapy. My hon. Friend Greg Mulholland is right that we should deal with discrimination based on age as well as that based on other matters.

The amendment encapsulates the priorities that we should address, although I do not believe that the Conservative programme tackles them properly or effectively. They include quality of care and outcomes, on which it is right to focus, as well as accountability. Sadly, the Conservative approach-establishing an independent national quango-would reduce rather than increase accountability, but the amendment is right to refer to it. It also mentions the need to tackle bureaucracy, to ensure value for money, to have a renewed focus on public health-the area that has so often suffered when the finances have got tight-and to tackle health inequalities.

Earlier this year, a King's Fund report said:

"If the NHS constitution did not confer any legally enforceable rights or guarantees it would, similar to the Patients' Charter"-

that was the thing that the Conservatives came up with-

"before it, be seen as a political device that simply raises expectations, which then cannot be met. Indeed it would hardly be worthy of being called a constitution."

That identifies the real risk of this document, which is that it will raise expectations. People will assume that will deliver something to them that is not being delivered, but ultimately it will amount to motherhood and apple pie, and there will be no extra delivery.

Will there be any legally enforceable rights or entitlements within this constitution? It seems that there will not be; the sanctions for breaching the NHS constitution do not appear anywhere. Trusts will have to "have regard to" things-that wonderful legal phraseology means, of course, absolutely nothing, because one can be acting entirely within the legal framework if one has regard to something and then entirely ignores it. [Interruption.] I shall ignore the abuse from Rob Marris, which is so uncharacteristic. The proposals contain a reference to the responsibilities of patients, but what does it amount to? There is no substance to it.

What about the issue of missed appointments? Missed appointments cause the NHS enormous additional costs, and many are avoidable. We can do a lot to reduce the number of missed appointments, by using technology and sending text messages, emails and so on-but should we not be considering the idea of charging people, where appropriate? We should recognise that some people's condition means that they may be unreliable -[Interruption.] Well, there was a great intake of breath from Mr. Chaytor, but if we are talking about responsibilities, where are they set out? They appear to be entirely nebulous. If we are not talking about responsibilities in any meaningful sense, we should not even use the word.

David Chaytor (Bury North, Labour): Does the hon. Gentleman not realise that in most general practitioner practices and in most hospitals the normal practice would be, as it is in other areas of our public and commercial life, to overbook the number of appointments in the first place? That happens with aeroplanes, trains, coaches and MPs' surgeries; that is how one deals with this. Does he not also realise that many people who miss appointments do not do so wilfully? Such people miss appointments because of varied and complex pressures in their personal life, and fining them for missing an appointment would be too extreme.

• Norman Lamb: I made the point that there would be many circumstances in which such an approach would be inappropriate, but we should consider having such a power, and run pilot schemes. The hon. Gentleman raises the point about a system of overbooking, but if he were to talk to any GP or hospital clinician, he would find that there is a massive problem with missed appointments. If we are having to deal with delivering health services in a much tighter financial situation, we must examine ways of saving wasted costs, and this is one area that we should examine. The main point I am making is that if the constitution talks about responsibilities, those must be genuine responsibilities. If they are not, we ought not even to refer to them, because the concept is meaningless.

The King's Fund also discusses whether the constitution will endure and whether it will be vulnerable to change by successive Governments for political reasons, suggesting that if it is to have any real value, it ought to be a document that does endure, and cannot simply be changed on a whim by successive Governments. However, the constitution appears to contain no mechanism to prevent that from happening, which is also a criticism. It says nothing, either, about continuing health care or the funding of people with complex needs, which is surely a critical aspect of health care. If the constitution fails to address that at all, it is surely weak. The idea of having second opinions in child care cases has been mentioned, but the constitution says nothing about the right to a second opinion either. That, too, should be addressed.

Let me turn to smoking. We all agree that action should be taken to enable people to give up smoking and to warn people, particularly youngsters, of the risks of taking it up. There is clear evidence that a proportion of young people buy their cigarettes from vending machines, so we readily support action to clamp down on the sale of tobacco from vending machines. Indeed, we might need to go further than the Government have proposed, so as to avoid any risk of youngsters below the legal age buying tobacco in that way.

However, the Government's case on displaying tobacco is not as good. The Conservative spokesman, Mr. Lansley, referred to the risks of misinterpreting the statistics, but it was fascinating to read that the real price of cigarettes in Canada increased by 159 per cent. between 1979 and 1991. That led to the teenage smoking rate falling from 42 to 16 per cent., which clearly shows a direct link between price and teenage smoking rates. We know that price has an effect, but there has been no proposal on price. Canada cut the tax in 1994, because of concerns about smuggled cigarettes, and the real price fell by a third. That led to the teenage smoking rate increasing, from 16 to 20 per cent. We know that price is a relevant factor-it was referred to by the World Health Organisation-yet the Government have made no proposals on price.

We advocate other measures. We should establish a criminal offence of supplying tobacco to an under-age smoker. The Government appear to be flunking that one and have not come forward with any proposals. It is a criminal offence to buy alcohol in order to supply it to an under-age drinker, but why is it not a criminal offence to supply tobacco in the same way?

As for smuggled tobacco, the current statistics show that one in six cigarettes purchased in this country has been smuggled, as has 50 per cent. of the rolling tobacco. A recent article in the European Journal of Public Health highlighted the link between smuggled tobacco and deprived communities, saying:

"the people with the highest likelihood of having bought smuggled tobacco...are...heavier smokers with higher levels of addiction, living in socially deprived areas and with low educational attainment."

People in deprived communities are obtaining their tobacco across the table in the pub or at the front door, yet we are talking about removing displays from shops-a controlled environment, after all-which will do very little to address health inequalities.

Edward Leigh (Gainsborough, Conservative): The hon. Gentleman and I represent similar rural constituencies. Although I have absolutely no brief for the tobacco industry, what worries me about the proposals is the fate of village shops. Does he think that one way round would be to have the ban, but to exempt small village shops and corner shops?

• Norman Lamb: That is certainly an option. I share the hon. Gentleman's concern that village shops are under enormous pressure already. Many are teetering on the brink-indeed, many have already closed-and any further loss of income could tip them into closure. That is something that we should all be concerned about.

I understand that it is already the practice in many areas for shops to sell smuggled tobacco under the counter. Dr. Gibson has confirmed that he is aware of the practice, and I have heard of it happening in Haringey. If that is true, then removing the display of legally sold cigarettes in shops will only open the door to a vastly greater risk of smuggled tobacco being sold under the counter. How on earth can that be policed? This is one of those cases in which the law of unintended consequences might well apply.

I also want to mention smoking cessation, because there appears to be little evidence that the steps that the Government are taking having any real effect. At the moment, under the quality and outcomes framework- QOF-system, GPs get paid for mentioning smoking cessation to their patients and for telling them to suggest a date by which they could have given up. That is it; they get the payment just for doing that. There is no requirement to demonstrate success in the strategy of encouraging their patients to give up; they get the payment simply for mentioning it. In California, however, under the Kaiser Permanente insurance scheme, there is a much more intensive focus on counselling, on prevention, on mechanisms to encourage people to give up smoking, on smoking cessation programmes and on nicotine replacement therapy. Within that community of insured people in California, the smoking rate has been reduced from 18 per cent. to 9 per cent. It has been halved, and people benefit much more from that intensive approach.

Rather than taking a nanny state approach, or, as Mr. Leigh has pointed out, taking steps that could push small village shops into closure, we should do things that are effective in helping people, and which will actually facilitate their giving up smoking.

Rob Marris (PPS (Rt Hon Shaun Woodward, Secretary of State), Northern Ireland Office; Wolverhampton South West, Labour): Does the hon. Gentleman agree that it is nonsense that in the European Union-of which the United Kingdom is a member state-there are still subsidies for tobacco producers? That is crazy.

Norman Lamb: I absolutely agree with that. It is remarkable that that still occurs in this day and age. This is why international action on such issues, and on finding much more effective ways of tackling tobacco smuggling, must be a real priority.

I shall finish by addressing some of the things that the Queen's Speech does not deal with. It is a massive challenge to make the NHS secure, sustainable and more effective, particularly in tackling the very poor provision of care for elderly people, at a time when we are seeing rapidly rising costs in our health system. Costs are rising because of lifestyle conditions such as obesity and alcohol abuse, and also because of the dramatically ageing population and the availability of new medicines. Costs are also rising at a time when the likelihood of sustained real-terms increases in funding is surely at an end. The Secretary of State mentioned a real-terms increase for the forthcoming year, but that provision is likely to end in 2010-11, after which the position will become much more difficult. The state of the world economy, and the impact that that is having on this country, will surely mean that focusing on ensuring that our health system is sustainable must be our highest priority. Unless we can get better value for money, we will surely be heading for a crash.

The Secretary of State said that the Darzi review pointed to a direction in which prevention became the real priority, but simply stating that it is a priority, without providing any real mechanisms to make it happen, will not result in any meaningful change. Our approach involves dismantling the wasteful, secretive, central bureaucracy and creating real accountability and financial responsibility locally. It also involves getting the finances working-we are talking about spending about £100 billion a year-to achieve the objectives that we all want to see: prevention, better self-care and better health for our citizens. As Derek Wanless said when he made the case for increasing spending on the NHS, our health system will be sustainable in the long term only if we are much more effective at helping people to care for themselves and to improve their health. So far, we have failed to achieve any meaningful change.

There has been a massive increase in funds for the health service, but the increase has been particularly at the acute end-for repair services. Meanwhile, community care and social care have been under intense pressure. Over the years of funding increases, the NHS has had five times the increase in funding that social care has had-without any explanation as to why that should be the case. Yet if we get our preventive services right, we will reduce pressure on acute services.

Thirdly, then, we must surely look at ways of integrating health and social care. The silo approach that we have is crazy: the patient does not understand the difference between health and social care, yet the system divides up care and budgets according to those dividing lines. We must ensure that we get better integrated care. We need to reflect on areas such as Torbay, where health and social care have been brought together at a service level, in order to avoid the crisis admissions to hospital that are so costly for the NHS.

Fourthly, we must ensure that we have more effective use of funds in our acute hospitals. At the moment, without good enough commissioning of care from our primary care trusts, the payment by results tariff is sucking money through the system. With social care under intense pressure, as I have said, many acute hospitals are making surpluses. Surely that is crazy.

The NHS needs to be better at adopting innovation. I want to refer specifically to photodynamic therapy, in which I know Dr. Gibson has shown some interest. Pioneered at University College hospital, London, this is a cancer therapy that avoids invasive surgery and means that the patient may be able to leave hospital within two days of treatment. It has been shown to be effective with many cancers and it has the potential to be effective with many more cancers. It was recommended for further analysis in the cancer strategy a year ago, yet a year later, that further analysis has not even started.

If photodynamic therapy realises its potential, it will be massively cheaper to the NHS than invasive surgery, chemotherapy and radiotherapy. Patients who have the good fortune to end up in UCH-if they have head or neck cancer, for example-will benefit enormously from this therapy. However, one of my constituents contacted me to ask why he was never told about the possible availability of photodynamic therapy. Surely these innovations going on in our hospitals should be spread around the country much more effectively.

Finally, it is important to put more power in the hands of patients, so that they can vote with their feet-empowered with information and support to make the right decisions about their care. The Secretary of State referred to the pilots for developing personal budgets. We support them, but we believe that they should go further, as they have enormous potential to give patients real power and put them in charge of determining what their priorities are, particularly when they are suffering from long-term chronic conditions.

So far, very little of the public debate has been about how to avoid the crash, with massively increasing costs at a time when no more money will be made available. It is always the most vulnerable who are affected if we fall into crisis. That has been the case in the past with long waiting times, and it will be the case in the future unless we get it right. Surely the Government have to start mapping out a way forward to make better use of the available £100 billion to invest in preventive services, to keep people healthy and to ensure that the NHS is sustainable in the future.

Barry Sheerman (Huddersfield, Labour): It is a pleasure to be called to speak in this important debate.

Sometimes we on the Back Benches wish that there were a curb on Front-Bench speeches. Norman Lamb spoke for 35 minutes. I almost lost the will to live. I say that because half of the debate time today has been taken up by Front-Bench spokesmen. No wonder the Chamber is so sparsely attended on an important debate on education and health, when Back Benchers turn up and have to wait so long to make a short contribution . .

• . . John Hemming (Birmingham, Yardley, Liberal Democrat) Link to this | Hansard source | Watch this

I am pleased to see that the Secretary of State for Children, Schools and Families is back in his place, because, as hon. Members will not be surprised to hear, I intend to talk about the child protection system. For some years, I have been concerned that the system makes the wrong decisions, including both false positives, when it intervenes when it should not, and false negatives, when it fails to intervene when it should.

For some time, I have been trying to identify how many serious case reviews have taken place following the death of a child, because that would provide a threshold from which we could track trends. The Department has been singularly unhelpful. In fact, when I gave up trying to get information out of it and went to all the local children's services authorities, the Department kindly instructed them not to give me their lists of serious case reviews. I am pleased to say, however, that the Chairman of the Select Committee has agreed that the Committee will work to try to find out that information. Ofsted has given us all the figures-including the 210 figure from yesterday-but it has only been tracking the figures from 1 April 2007. The serious case review process has been going on for some time, but it was strongly emphasised by the Laming report. It is a good process and it gives us a mechanism for tracking what is going on.

We should not focus only on one case: we must look at the system and where it is going wrong. We also have to consider the wider aspects, such as the Laming review. Lord Laming is obviously the ideal person to review the extent to which his proposals have been implemented, but he is not the ideal person to review to what extent other proposals should be implemented. The Government have gradually moved towards the idea, which I proposed, that we need to look at the whole system of public family law. That starts with the initial references, moves on to the assessment processes and the integrated children's system, and-if there is a reference-it moves into the family courts, and we have not yet decided to look at how those work. I am still hoping that in January the Committee on Legal Affairs and Human Rights of the Council of Europe will agree to investigate the family division of the High Court. I shall go into some of the reasons why the family division is part of the problem.

In the initial process, the local authorities initiate proceedings. They often start with child protection conferences, which are often organised to prevent extended family members from attending. I had such a case today. One of my members of staff agreed to go to a child protection conference in Birmingham with a constituent-I do not know what has happened because I have been in the Chamber-and the time was changed at the last minute. We could say, "Well, that happens sometimes", except that it happened previously with another constituent. We arranged to accompany that constituent to the child protection conference and act as an advocate, but the authority-this was Solihull rather than Birmingham-changed the time of the conference. We were told, "You've missed it, it's already happened." That is an abuse of process and it should not be tolerated. In a sense, though, it is a symptom of the attempt to drive out the extended family.

We need to be straight about the fact that such things do not always happen. I work with many social workers, and there was a conference in Stafford-also attended, not surprisingly, by Mr. Kidney-arranged by Rachel Bramble that looked at why things are going wrong in social work. The fact that people are being driven out of the profession is evidenced by all the vacancies that exist, but why do people not want to work in the sector?

The existing process is almost designed to exclude people, but then cases go into a court environment that is frightening and bewildering for people who have never been there before. Indeed, it has taken me some time to understand the processes involved. The House will be aware that I co-ordinate the Justice for Families campaign, and we are approached by people from across the country who are facing care proceedings. We refer matters to local constituency MPs, try to find volunteer McKenzie friends and so on, because there are great difficulties with the legal processes in the courts.

In an earlier intervention, I said that the single-expert system meant that people could not get a second opinion without the judge's permission. Judges tend to refuse that permission, and they pride themselves on the efficiency of the system under which an expert is appointed jointly by the local authority and the parents involved. The problem is that the system is a machine for miscarriages of justice. A number of social workers have complained to me, and last year one explained how he used to collude with parents' solicitors to ensure that the parents would lose their case. That is a criminal offence, and it is very difficult for me to take the matter further, as that would mean the social worker involved having to give evidence against himself.

A case in Oldham would serve well for a review of the single-expert system. The parents were refused a second opinion in both the county court and the Court of Appeal. When they applied again to the Court of Appeal, they were told that they could have a second opinion, which confirmed that the baby had not and could not have been hurt by them. Not only were the parents not guilty; they were provably innocent.

In one sense, the failure to allow a second opinion is based on practice on the continent, where the parties involved have their own experts as well as the one appointed by the court. The idea is that the court-appointed expert can make a decision about the truth of the other expert evidence. In this country, what happens with experts' meetings is a move in that direction.

I see a great many cases, of which the Webster case is a good example. Once initiated, a case like that will trundle through the system. Everything happens and the children are adopted, but then all of a sudden it becomes apparent that once again the court has got it wrong. Such problems are driven by the single-expert system.

I proposed an amendment to the Children and Young Persons Bill that would have enabled people to get expert evidence. At present, when the court has gathered all the expert evidence, it is illegal for a parent's solicitor to telephone a doctor and ask whether he or she knows anything about a case. That would be a contempt of court, and it is another example of how the single-expert system is a machine for generating miscarriages of justice. Given that some solicitors also conspire against parents in such cases, the House will see that the situation can be very difficult.

I received a letter from the eastern region of the Legal Services Commission, dated 31 October 2008 that refers to legal aid for a case involving a Mrs. M. It states that

"funding will continue on the basis that Mrs. M should accept that her case is being publicly funded, and that contesting Interim Care Orders, where there is no change of circumstances, is not an issue on which she would expect to be legally represented."

Basically, that means that Mrs. M is allowed non-means-tested funding as long as she does not say no to the interim care order. In other words, she can have a solicitor at the hearing, but she has to agree to the order. That is not the way towards a proper judicial process, and, as I have said, such an approach drives everything else. The Department for Children, Schools and Families has done some good statistical work. Earlier this year, it analysed about 400 cases, and table A2.42 of its report shows what a low proportion of cases are chucked out of court.

There is a problem with the single-expert system. Sometimes, people cannot get legal aid when they want to contest a case; they simply have to accept it and work with it. We need to look at the criteria used to determine when a child is taken into care. The phrase in the section 31 threshold is "risk of significant harm", but that could mean many different things. Obviously, everyone accepts that baby P and Kyra Ishaq should have been in care, and there are many similar situations, but should we put a 16-year-old in care because his parents have split up and he will not talk to one of them? I do not think so, but some judge does.

Domestic violence is a difficult area, and it is challenging for kids. If parents split up and do not see each other because Mum was a victim of domestic violence, should we still be trying to take her children off her? I do not think so. We learn from women's refuges that women are so frightened of losing their children that they do not actually report domestic violence. Margaret Halliday of the Salisbury women's refuge will provide that information, and I, too, can provide lots of evidence.

Another criterion is secure care for welfare reasons. In some of those cases, children should not be in secure care. There is no evidence that it does anything for them, and they are, in effect, suffering imprisonment without having committed an offence-much like the boy who will not talk to his mum. Not co-operating with professionals is another reason that does not seem sensible. The mere fact that somebody does not immediately snap to and do exactly what they are told should not be good cause to remove their children and have those children adopted. That does not mean that if the children are missing medical attention because the parents never take medical attention seriously, there is not a grave issue. Another reason is "comments eroding children's self-esteem"; so if the parent tells the kids they are stupid, the children need to be taken into care. I do not think so. Then there is missing school. Obviously kids should be going to school, but we have a one-trick pony-a system whereby at a certain point the child is taken into care. We need much better scrutiny of the operation of the section 31 threshold.

There are important reasons why the system correlates with the false negative environment. It is in part caused by the way the integrated children's system pressurises practitioners into making an early decision about the truth of the case and not changing it thereafter. That is the basis of an article that I have written with Sue White, who is professor of social work at Lancaster university, and Allan Norman, who is a social worker and lawyer based in Birmingham, where he runs his own practice-Celtic Knot. The article has been published on the Community Care and Family Law websites and in The Birmingham Post, and I have also sent a copy to the Minister, so there is no sense in my re-reading what is available on the internet.

Haringey, like many authorities, has a target, for the number of children in care which is kept for budgetary purposes. The target for March 2007 was 365, and the target for March 2008 was 352. In part, the objective of reducing numbers in care is laudable. That is also true of trying to reduce the weekly costs, which have run at higher than £800 per child per week. On 3 October 2006 it was noted that the deficit forecast for Haringey council was £4.6 million, which included a forecast overspend for children's services of £2.3 million, including a figure of £500,000 for looked-after children. The executive member for finance said, "I will be working closely with the services concerned, and I will be looking to them to identify ways to bring the budget back on target." It was recognised at that time that the placements budget was running at 381 children and was very tight, and the figure had crept up to 392 by November 2006.

By 31 March 2007, the financial situation had improved, although there was still an overspend of £500,000 on legal fees. The number of children in care had reduced and a new target was set of 352. At the end of the 2007-08 financial year, however, the number of children in care had increased back up to 373, which was 21 more than budget. It appears that controls on the number of care proceedings were tightened up in November 2006 with the 12-month rolling number from November 2006 going below 40 for the first time they were released in August 2007. The number then went back up above 50, its historical level in recent years. Sadly, baby P died in August 2007.

Given the inherent constraints on the number of children in care, if children are put into care who should not be in care-one of my examples was from Haringey-it pushes resources in the wrong direction, so we have difficulties with that. That is a bit of a run through; I could go on for a long time about other aspects, but two other Members want to speak, and if I can do another five minutes that would be quite reasonable. [ Interruption. ] They are both smiling.

I want to raise mental capacity and the RP case. It is not sub judice, simply because it has been through all the domestic courts and has got to the first stage in the European Court of Human Rights. That case is absolutely appalling in my view. An expert was appointed who said, "Mum's too stupid to instruct a solicitor and therefore isn't allowed to operate her own proceedings." The Official Solicitor was brought in and said, "Sorry, we're going to concede this case. That's it. You've had it." So there was no trial. There was a 10-minute hearing, at which everything said by the local authority was accepted as gospel, and that was it, except for the fact that we have taken it up and said that audi alteram partem-hearing the other side-is a key part of a trial process. Interestingly, although the expert at the time said, "Mum didn't have the capacity to instruct a solicitor," another expert has said more recently, "Well, she's obviously got the capacity to instruct a solicitor." In fact, she has done quite well at presenting her own case in the Court of Appeal. I have the transcripts of those hearings if anyone wants to read them, and the case is now in the European Court.

Good news from my point of view is that the Equality and Human Rights Commission is showing some interest in mental capacity and what is happening in the Official Solicitor's office. We have about 180 cases a year where parents are basically excluded from judicial proceedings. They have no locus-something that is not allowed in criminal proceedings, which people have been able to contest since a case in the 1800s. In family court proceedings, it is seen as perfectly acceptable to put parents in a situation where they cannot contest the proceedings.

I have another case, which I call the HP case, in which a lady who does not speak English was given an IQ test in English, did rather badly-whoops-and contacted the Official Solicitor. We went to the Court of Appeal, which said, "Tough." So that quite appalling case is going to Europe as well.

We have international cases where it is thought more important to ensure that no one escapes the family courts in Britain than to look after the children better. I know of two such cases: the one that is well known from The Times, and another one that is not so well known, where the court's objective is to get an eight-year-old back to England, away from his or her mother and leave the mother with another baby in situ. When I suggested to the Government that it would be better to put the child first and to transfer the case to the local jurisdiction, the response was, "Oh, no, we can't do that; the courts have to win," even though it is better for the child for the case to be transferred to the foreign jurisdiction.

I want to make a few points about Ofsted, which has been very good in this area. It has started to reveal in its reports some of the truth about how the Children and Family Court Advisory and Support Service operated. It has also revealed the truth about the serious case review. Baby P died in August 2007, and Ofsted started taking responsibility for the sector in April 2007. I do not think that those two things can be correlated. It is a ray of light in an area that has involved people covering up for one another for years.

The problem is that secrecy tends to prevent accountability. In fact, secrecy is often used to prevent Members of Parliament from finding out about such cases. Generally, what the Government say should happen is the right thing. I do not think that the Government's objectives are wrong. The problem is that something quite different actually happens. What is needed is a much wider inquiry, which is independent of people who make money out of the area. Perhaps the departmental Committee can look at that-perhaps the Justice Committee should do so as well-but we need people to look at it who are not interested in sweeping things under the carpet and saying that everything is perfect and that everyone is doing a brilliant job. Some people are doing a brilliant job. Another whistleblower came to me who had faced disciplinary action for telling the truth, which I thought was not very clever. I do not know what has since happened in that case. There are some very good people doing a very good job in difficult circumstances; the problem is that the secrecy has allowed bad practice to develop in unaccountable way.

I will be happy to meet the relevant Minister and the departmental Select Committee to go through all the details. I met Lord Laming on Monday, although I think the terms of reference of his inquiry are far too narrow. What we need is a wider inquiry, because this matter cannot be kicked into the long grass. Problems arise every day across the country, particularly in England and Wales. Scotland generally has fewer problems, for reasons that I could go into at length, were it not five minutes to the hour-I have said that I will speak for only so long. This is an important issue and both sides of the coin matter. I ask the Government to consider instituting a wider inquiry.