The importance of URINETOWN the musical and social determinants of health.

1.8 billion people around the world drink faecally contaminated water.

2.5 billion people in the world don’t have access to adequate sanitation.

Over 1400 children die EVERY DAY from diarrhoea associated with unsafe water and poor sanitation.

At least 1.1 billion people in the world drink water that is of at least moderate health risk – they don’t have access to safe water.

Where there is nowhere safe and clean to go to the toilet – a natural bodily function that we all have to do – people all over the world are exposed to potentially fatal diseases and have to endure a significant lack of dignity and lack of privacy.

The people this affects most in the world are those that are the poorest, have most difficulty getting their voices heard and are the most marginalised.

The eradication of poverty and ensuring that prosperity, health and wellbeing are sustainable are some of the most serious, and pressing, challenges that face the world’s society today. The only way to address these challenges is through a coordinated, collaborative approach stretching across borders.

If you don’t have a toilet you still need somewhere to go and people who find themselves in that situation end up having to urinate or defaecate behind a bush, in a field, beside a road, on a beach or on a street.

No dignity.

No protection from violence.

No protection from infection.

No respect of basic human rights.

So what has this got to do with URINETOWN the Musical?

I was intrigued to be taken to see URINETOWN the musical – third row seats in the stalls to see a musical I had, to be honest, never heard of before but one I came out of wanting to see again.

URINETOWN is set in the future. A future where a terrible drought has crippled a city’s water supply. Water is so scarce that the government enforces a ban on all private toilets in an effort to control water consumption. Not too dissimilar to people all around the world who don’t have access to a toilet at the current time.

People living in that city must pay to use the public toilets owned and operated by a private company full of corruption. At the same time as introducing a law banning private toilets a law enforces the illegality of urinating or defaecating in public. Violators of this law are taken away to a mysterious place called URINETOWN – a place from where no one ever returns.

What happens to you in URINETOWN is something you’ll just have to see the musical to find out – I won’t spoil it that much for you but when you do you’ll realise the serious undertones that this musical has as well as providing a superficially funny performance with great music.

I digress.

The poorest people in this future society are forced to huddle in a line at the filthiest public toilet in town run by Penelope Pennywise and her rebel assistant Bobby Strong. With fee increases about to occur, there is an uprising of the people under the leadership of Bobby to fight the tyrannical regime for the right to make the public toilets free for all to use.

The striking similarities between what this musical talks about for the future and the lack of access to safe water and sanitation for millions of people around the world right now, today, is obvious.

This musical really brings to light the terribly undignified circumstances that the people who are living in poverty without access to safe water and sanitation have to endure every hour of every day and it serves as a clear reminder to us all about where we do not want our global society to end up in the future and where we must not let it go.

If you want to know more then have a look at the work the British Medical Association have been doing with End Water Poverty and WaterAid UK.

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Access to clean water is a basic human right.

Access to proper sanitation is a basic human right.

We all have a duty to make sure that URINETOWN doesn’t become the reality of the future and that we tackle, right now, the situation for the billions of people living around the world who are existing in inhumane situations that those with political and social influence can do something about.

UK law is not consistent with the United Nations Convention on the Rights of the Child

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A quarter of a century after the signing of the United Nations (UN) Convention on the Rights of the Child (CRC) UK law and other laws internationally fall way short of properly protecting children as was agreed by the signatories to the convention 25 years ago. This week marked the 25th anniversary since the signing of the CRC on 20 November 1989 and although there has been significant progress since that time, there is still work to do both in the UK and overseas to ensure that children receive the protection that they deserve and are entitled to.

In the UK parents have not been explicitly prohibited from smacking their children. However, section 58 of the Children Act 2004 limited the use of the defence of reasonable punishment so that parents and those acting in loco parentis who cause physical injury to their children can no longer use the “reasonable punishment” defence where they are charged with assaults occasioning cruelty, actual or grievous bodily harm. The defence of “reasonable punishment” is only available to parents, or others acting in loco parentis (provided they are not expressly prohibited from using physical punishment, for example in schools), where the charge is one of common assault.

Physical punishment is prohibited in all maintained and full-time independent schools, in children’s homes, in local authority foster homes and early years provision. Section 58 of the Children Act 2004 limits the defence of reasonable punishment as follows:

(1) In relation to any offence specified in subsection (2), battery of a child cannot be justified on the ground that it constituted reasonable punishment.

(2) The offences referred to in subsection (1) are –

a) an offence under section 18 or 20 of the Offences against the Person Act 1861 (c. 100) (wounding and causing grievous bodily harm);

b) an offence under section 47 of that Act (assault occasioning actual bodily harm);

c) an offence under section 1 of the Children and Young Persons Act 1933 (c. 12) (cruelty to persons under 16).

(3) Battery of a child causing actual bodily harm to the child cannot be justified in any civil proceedings on the ground that it constituted reasonable punishment.

(4) For the purposes of subsection (3) “actual bodily harm” has the same meaning as it has for the purposes of section 47 of the Offences against the Person Act 1861.

(5) In section 1 of the Children and Young Persons Act 1933, omit subsection (7).

Effectively, physical punishment is illegal if it leaves a mark on a child or an implement (such as a cane or belt) is used to physically punish the child. However, the law in the UK does not go so far as to make all forms of physical punishment illegal and it remains legal for parents to physically punish their child, for example in the form of smacking, provided no actual bodily harm is caused (effectively, provided a mark is not left).

In 2014, in the UK, it is illogical that a parent can hit a child aged under 18 but if that child were to hit another adult this may be considered illegal if the child were above the age of criminal responsibility.

Since the evidence against physical punishment of children appears to outweigh evidence to the contrary, the implications for health care professionals who are committed to evidence-based practice are fairly obvious: when working with families and communities, advice should be concentrated on developing interventions that empower parents to choose not to smack by helping them to develop effective strategies for dealing with stress and by raising self-esteem.

Regardless of whether there is a statistically significant association or not between deaths from child maltreatment and the legal corporal punishment situation in a particular country or state, if there is to be a reduction in the number of cases of child death from child abuse and the number of cases of child maltreatment, given the role that society has in protecting those children, this must begin from a stand-point of taking the moral high ground which is that it is unacceptable to physically punish children, whatever the circumstances, and that there are much more effective and appropriate punishments to administer.

Disciplining children must not involve physical violence against them – indeed so to do perverts one of the origins of the word discipline, that is to come from the Latin discipulus meaning pupil, to educate, to follow (from disciple) or to learn. To discipline children through physical violence merely serves to educate them that such violence is accepted and encouraged by society which may teach them to behave in this way as they grow older. This surely cannot be a society in which the majority of people would wish to live in the future.

The position of a society where physical punishment of children is permitted yet child abuse is forbidden is not a tenable one. Reducing the number of cases of child abuse must begin with a clear message from society that physical punishment of children, whatever the circumstances, is unacceptable.

Either society must come to that conclusion itself and demand a change in the law or, if society cannot do this in a timely fashion, the law-makers in that society, in the form of Parliamentarians, must take the brave decision that, despite some public opinion, the situation is serious enough to introduce aspirational legislation to ban physical punishment of children with the aim of modifying behaviour within society – even if that is way into the future.

Although the law is best seen as enforcing what a society is prepared to accept as appropriate conduct and whilst caution must be exercised when introducing aspirational legislation which may not have the immediate support of a significant number of members of society, the situation for children at risk of significant harm is serious enough to warrant legislative change in a number of jurisdictions, including here in the UK.

Physical punishment of children violates international human rights law. A quarter of a century ago, in 1989, the Human Rights of Children were recognised internationally when the United Nations Convention on the Rights of the Child was signed by world leaders.

Article 19 of the UN CRC states:

States Parties shall take all appropriate legislative, administrative, social and educational measures to protect children from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child.

Physical punishment of children is clearly counter to the UN CRC which confers absolute protection for children against violence while in the care of parent(s), guardian(s) or any other person.

That this convention has almost universal ratification is a testament to the importance placed on children’s rights worldwide. It is deeply worrying, therefore, that Somalia and the USA have still failed to ratify the treaty. Accompanying the Convention are two optional protocols, one on children in armed conflict and one on the sale of children, child prostitution and child pornography which ought, also, to be ratified by those states that have not yet so done.

Within Europe the Council of Europe, Parliamentary Assembly Recommendation 1666 (2004) has stated that:

The Assembly considers that any corporal punishment of children is in breach of their fundamental right to human dignity and physical integrity. The fact that such corporal punishment is still lawful in certain member states violates their equally fundamental right to the same legal protection as adults. Striking a human being is prohibited in European society and children are human beings. The social and legal acceptance of corporal punishment of children must be ended.

Section 58 of the Children Act 2004 is clearly inconsistent with Article 19 of the United Nations Convention on the Rights of the Child as surely any physical punishment of a child constitutes physical violence and should, within our own legislative system, be classified as at least Common Assault.

An offence of Common Assault is committed when a person either assaults another person or commits a battery. An assault is committed when a person intentionally or recklessly causes another to apprehend the immediate infliction of unlawful force. A battery is committed when a person intentionally and recklessly applies unlawful force to another.

In October 2008 the UN Committee on the Rights of the Child stated in its concluding observations on the UK that, “The committee is concerned at the failure of the State party to explicitly prohibit all corporal punishment in the home and emphasises its view that the existence of any defence in cases of corporal punishment of children does not comply with the principles and provisions of the Convention, since it would suggest that some forms of corporal punishment are acceptable”.

The continued legality of physical punishment of children in the UK, and other countries, is a serious violation of the Convention on the Rights of the Child. Until the UK revises Section 58 of the Children Act 2004 and makes explicitly clear, in law, that physical punishment of children is illegal in all circumstances, even if it does not leave a mark, the UK will remain non-compliant with the UN Convention on the Rights of the Child and children living in the UK will not be afforded the protection from physical violence that they deserve and need.

Although it is ten years old, paragraphs 154-156 of this make interesting reading: 

In this landmark year for the UN Convention on the Rights of the Child Section 58 of the Children Act 2004 should be revised, and other legislation introduced as necessary, to make explicitly clear that there is no defence of “reasonable punishment” and that any corporal or physical punishment of a child, aged under 18 years of age, is strictly prohibited in law.

Until that happens UK law won’t be consistent with the UN Convention on the Rights of the Child and children living throughout our country will not be protected in the way that was intended a quarter of a century ago.

Circulation reaches 34 countries around the world

Circulation to 34 different countries around the world

United Kingdom, USA, Cambodia, Malaysia, Australia, Singapore, France, Canada, Thailand, Spain, Russian Federation, Italy, India, South Africa, Vietnam, Hong Kong, Malta, Switzerland, Ireland, Barbados, New Zealand, Republic of Korea, Germany, United Arab Emirates, Finland, Jordan, Kenya, Papua New Guinea, Georgia, Bangladesh, Republic of Tanzania, Brazil, Sweden, Sri Lanka.

Did I expect that in just six months since I started publishing my views on a number of issues related to the protection of children, people in 34 countries around the world would have been reading what I have been writing about?

Absolutely not, and it is amazing to think that what started as a UK-based project has attracted so much international attention. The interest in my report and the topic-based opinion pieces I’ve been writing on this website since April 2014 has been really fantastic.

Report download

The Executive Summary of Living on a Railway Line and the Full 338 page Report can be downloaded here:

http://www.wcmt.org.uk/fellows/news/living-railway-line-turning-tide-child-abuse-and-exploitation-uk-and-overseas

http://www.pat.nhs.uk/news/Report-into-how-different-countries-tackle-child-abuse-published.htm

Next steps

Over the next few weeks I’ll be continuing to meet with key stakeholders to discuss implementation of the recommendations contained within Living on a Railway Line and I’ll also be continuing to give a series of lectures and seminars on the background to the report and my recommendations.

The support I have received from colleagues and friends to ensure visibility and circulation of this report – designed to build strong, healthy communities with children at their hearts both in the UK and overseas – has been superb and I’m very grateful to everyone who has become involved.

Next week marks the 25th anniversary of the signing of the UN Convention on the Rights of the Child and I’m going to be spending the next few days gathering together my thoughts on how successful, or otherwise, the last quarter of a century has been at protecting children throughout the world.

I hope the recommendations within Living on a Railway Line continue to be circulated and that over the course of the next few weeks and months we will see real engagement and action from individuals and groups keen to implement specific recommendations in the UK and in countries overseas, paying particular attention to both the UK-aimed and International recommendations.

You are welcome to contact me with ideas and comments. I can’t promise to reply to all of the comments I receive but I can promise that I will read them all.

Until then, I’ll leave you with a thought from the late Robin Williams from the film Patch Adams:

“No matter what people tell you, words and ideas can change the world.”

The House of Lords must amend the Modern Slavery Bill

Seven key changes are needed to the Modern Slavery Bill to ensure that it properly protects vulnerable children at risk of exploitation, trafficking and modern slavery.

The Modern Slavery Bill will undergo a second reading in the House of Lords on 17 November 2014, followed by the Committee and Report stages, and it is crucial that Members of the House ensure that the changes necessary to better protect vulnerable children are made before the Bill leaves the House.

The Bill, rather than being focused around law enforcement should, instead, be focused around the victims and potential victims so that the emphasis within the Bill is about the identification and protection of those victims and potential future victims, with the consequent secondary law enforcement aspects, rather than vice-versa.

At the time of writing this post, the current version of the Bill before the House of Lords can be found here:

http://www.publications.parliament.uk/pa/bills/lbill/2014-2015/0051/15051.pdf

There are seven key changes that are needed to better protect children at risk of, or suffering from, trafficking, exploitation and slavery:

1. Inserting a clear definition within the Modern Slavery Bill about what constitutes a child: this must be in accordance with the UN Convention on the Rights of the Child and clearly state that anyone below the age of 18 years, regardless of circumstances, is classified as a child. This change is necessary to better protect all children but, particularly, those aged 16 or 17 where confusion can occur.

2. Inserting a more clear definition about what constitutes slavery: at present the definition comes from Article 4 of the Human Rights Convention (HRC) but, in order for the Legislation to be clearly understood by the general public, many of whom will not know what the HRC says in Article 4 (nor that there have been legal cases looking at the potential definition of slavery), there needs to be an unambiguous definition that is widely accepted.

3. Better protection for children and adults with disabilities: a very simple change to the Bill would better protect people with disabilities.

4. Ensuring the Independent Anti-slavery Commissioner is mandated to provide information, education or training: at the present time this power is discretionary and non-specific.

5. Ensuring that the Secretary of State must issue guidance on the sort of things that indicate a person may be the victim of slavery, human trafficking or exploitation: not simply slavery or human trafficking as at present.

6. Providing better protection of victims of exploitation: rather than just providing a potential defence for slavery or trafficking victims compelled to commit an offence and rather than, at present, focusing almost entirely in the Bill on slavery and trafficking and, on the face of it, considering that exploitation occurs purely in relation to trafficking. It doesn’t. Children and adults can be exploited without being trafficked.

7. Refocusing the Bill on the identification and protection of victims and potential victims: rather than, at present, focusing primarily on law enforcement.

The specifics of the changes to the Bill required to achieve 1-6 of the above (with change 7 being an over-arching change that will require much more detailed work and potential re-wording of the main substance of the Bill), are as follows:

Part 1, 1(2): definition of slavery or servitude

This is particularly problematic for a number of reasons. Section 1 currently defines slavery in accordance with Article 4 of the Human Rights Convention (HRC) however Article 4 doesn’t actually define slavery in sufficient detail for the ordinary reader to be able to understand. Therefore it is not possible to properly construe section 1 in accordance with Article 4 of the HRC in any meaningful way, leaving this Modern Slavery Bill without a clear definition of slavery.

Article 4 reads as follows:

“Prohibition of slavery and forced labour

1. No one shall be held in slavery or servitude.

2. No one shall be required to perform forced or compulsory labour.

3. For the purpose of this Article the term “forced or compulsory labour” shall not include:

(a) any work required to be done in the ordinary course of detention imposed according to the provisions of Article 5 of this Convention or during conditional release from such detention;

(b) any service of a military character or, in case of conscientious objectors in countries where they are recognised, service exacted instead of compulsory military service;

(c) any service exacted in case of an emergency or calamity threatening the life or well-being of the community;

(d) any work or service which forms part of normal civic obligations.”

Given the inadequate definition of slavery and servitude it is, in my view, likely that the cases which will be recognised or dealt with will be the headline-grabbing ones, well publicised in the media, rather than the majority of cases where the evidence may be somewhat weaker or the cases themselves may not be as headline-grabbing. It is therefore likely to be the case that professionals may still not recognise cases they are dealing with as ‘slavery’ or other offences dealt with under this proposed legislation. Although this Bill is clearly intended to be a criminal Bill it is important that there is consistency with civil protection rights for children, such as under the Children Act 1989, such that the cases where evidence is weaker, but children are still at risk, are properly dealt with.

At present the Bill is far too vague and needs a clear definition of slavery or servitude to be included within it. Various examples have been stated previously although it would be entirely possible to come up with satisfactory alternatives whilst still referring to Article 4 of the HRC. Example definitions are:

“the status or condition of a person over whom any or all of the powers attaching to the right of ownership are exercised” (Siliadin v. France, § 122).

“a particularly serious form of denial of freedom” including “in addition to the obligation to perform certain services for others … the obligation for the [person] to live on another person’s property and the impossibility of altering his condition” (Siliadin v. France, § 123).

Part 1, 1(4): consideration of people with disabilities

This section of the Bill concerns factors related to an individual’s personal circumstances which may make that person more vulnerable than other persons. The Bill currently reads as follows:

For example, regard may be had to any of the person’s personal circumstances (such as their age, family relationships, and any mental or physical illness) which may make the person more vulnerable than other persons.

This should be changed to the following, also replacing the final “and” with “or”, or another such clause reflecting that people with disabilities may be more vulnerable than other persons – as has been shown to be the case, for example, concerning children with disabilities and their increased risk of suffering from child abuse when considered on a population basis:

For example, regard may be had to any of the person’s personal circumstances (such as their age, disability, family relationships, or any mental or physical illness) which may make the person more vulnerable than other persons.

Part 1, 3(6): definition of a child

This section needs to be explicit, or a further over-arching clause needs to be inserted, applying to the whole Bill, to make clear that a child is someone who has not reached his or her 18th birthday, in accordance with the UN Convention on the Rights of the Child.

Part 4, 41(3)(d): things that the Independent Anti-slavery Commissioner may do

At present, under this section, the provision of “information, education or training” is non-obligatory and this must be changed to ensure that it is mandatory for the Independent Anti-slavery Commissioner to provide “information, education and training on the identification and protection of victims, and potential victims, of slavery, servitude, exploitation and trafficking“.

Part 5, 45: protection of victims

At present the defence for slavery or trafficking victims compelled to commit an offence does not explicitly apply to victims of exploitation. It should. Revision of this section should be made so that it is explicit that protection also extends to victims of exploitation and not just slavery or trafficking.

Part 5, 47(1): definition of a child

This section needs to be explicit, or a further over-arching clause needs to be inserted, applying to the whole Bill, to make clear that a child is someone who has not reached his or her 18th birthday, in accordance with the UN Convention on the Rights of the Child.

Part 5, 48(1)(a): provision of guidance by the Secretary of State

At present, under this section, the provision of guidance that the Secretary of State is mandated to issue only covers “the sorts of things which indicate that a person may be a victim of slavery or human trafficking“. This must be changed to ensure that victims of exploitation, in order to capture, amongst other things, victims of child sexual exploitation, are properly protected. This section should be changed to “the sorts of things which indicate that a person may be a victim of slavery, human trafficking or all forms of exploitation, including sexual exploitation” or other suitable wording to include exploitation in the mandatory guidance.

The substance of the Modern Slavery Bill must be comprehensive enough, and detailed enough, to really make a difference to the people it is designed to protect whether through punishment of offenders or prevention of offences. In its current form the Modern Slavery Bill lacks that detail and, being a Bill almost exclusively aimed at law enforcement rather than identification and protection of victims and potential victims, unless changes are made to it vulnerable children will not be properly identified or protected.

The Bill must be modified to better identify and support victims of slavery, trafficking and exploitation and it is beholden upon everyone involved in our Parliamentary processes to make the changes that are necessary to improve this Bill into powerful primary legislation that will better protect children from exploitation, slavery and trafficking, identify victims and potential victims, and appropriately punish those people responsible for these heinous crimes against society.

Do not forget about boys and young men…

I’m really pleased with the response I have had on Social Media as well as in direct e-mails, texts and calls, to the publication of the Recommendations in my Report, Living on a Railway Line, that was released just under a fortnight ago.

Support for the research I have undertaken has not just been limited to the UK and I’ve received messages from the USA, Malaysia, Cambodia and Singapore about my Recommendations. Of course, now that my report is published I have the difficult task of working on the Recommendations.

This week has been a busy week in Child Protection and Emergency Medicine.

From an Emergency Medicine and Public Health point of view, Ebola has been the hot topic of the week – we have seen the President of the College of Emergency Medicine promoting further guidance on Ebola.

From a Child Protection point of view the departure of Fiona Woolf from the Independent Inquiry into historic child sexual abuse cannot have escaped the attention of many people and we have also seen the publication of the incredibly important Child Sexual Exploitation report, Real Voices, by Ann Coffey MP.

A number of the things that have been Recommended in Real Voices are things that were contained in or associated with my own Recommendations published on 20 October 2014. I very much hope that there will be opportunities to work collaboratively over the next few weeks and months taking forward the combined Recommendations from Living on a Railway Line and those in Real Voices.

To highlight where our two reports are associated I have taken some of the Recommendations from Real Voices and cross referenced them to the relevant Recommendations or paragraphs contained within my own report, Living on a Railway Line.

Real Voices Recommendation: removal of all references to child prostitution in legislation

Living on a Railway Line Key Recommendation FOUR

The Sexual Offences Act 2003 must be revised to remove the terms ‘child prostitute’ and ‘child prostitution’ and additional clauses should be inserted to better reflect the fact that children who were previously classed as being involved in ‘child prostitution’ are actually victims of serious child sexual abuse and child sexual exploitation.

This is also associated with:

Living on a Railway Line Key Recommendation THREE

Section 15(1)(a) of the Sexual Offences Act 2003 must be revised to change the number of times contact must be proven to have been made with a child, prior to meeting with that child with the intention of abusing him or her, from two to one. Consideration should also be given to raising the age in relation to sexual exploitation in section 15 from age 16 to age 18 to reflect that it is possible to treat someone in an exploitative manner who is above the age of legal consent to sexual intercourse but still a child aged under 18 years of age.

Real Voices Recommendation: Focus groups should be commissioned with the public about their understanding of the nature of child sexual exploitation

Living on a Railway Line Key Recommendation EIGHT

A research study should be conducted in the UK comparing professionals’ and the public’s views on the acceptability of various events which can occur to and around children and whether or not these are considered abusive. The results of this study should be used to inform organisations and groups working on primary prevention of child maltreatment in the community. To help facilitate achievement of this key recommendation there should be widespread support of The Academy of Medical Royal Colleges Child Sexual Exploitation Working Group recommendation (September 2014) that the Faculty of Public Health should consider how they can encourage their members to work closely with local safeguarding children boards to improve awareness in parents, communities, and schools of indicators of child sexual exploitation [and of other types of abuse] and of available help. This would also include a focus on primary prevention to help build awareness and resilience in children and young people to prevent them being exploited or abused in any way.

Real Voices Recommendations: Police and PCSO Training

Living on a Railway Line Key Recommendation SEVEN

A standardised, compulsory, multi-professional training programme, to complement the inter-collegiate competency levels, should be introduced in the UK for all professionals dealing with children and families. This must include specific training on the potential signs, features and vulnerabilities of children who are at risk of, or who are suffering from, exploitation including sexual exploitation. This coordinated educational programme would reduce inefficiencies of duplication of educational material preparation and would better quality assure the outcome of the educational programme.

Real Voices Recommendations: Talks in schools & compulsory Personal, Social and Health Education (PSHE) provision

Sections 14.3.4 and 14.3.5 deal with this in my Report in general terms (although Real Voices has been more specific to single out Police Officers in uniform and PSHE):

14.3.4 The Academy Child Sexual Exploitation Working Group recently recommended that the Faculty  of Public Health should consider how they can encourage their members to work closely with local safeguarding children boards to improve awareness in parents, communities, and schools  of indicators of child sexual exploitation and of available help. This would also include a focus on primary prevention to help build awareness and resilience in children and young people to  prevent them being sexually exploited.

14.3.5 Health educators in schools can become a powerful force for a change to empower children to report more cases of child abuse and to facilitate interventions at an earlier stage if child maltreatment were to be added to school curricula on a widespread basis.

Real Voices Recommendations: Community Schemes, Community Engagement, Public Information

Living on a Railway Line Key Recommendation NINE

The UK government should consult with key child protection stakeholders and prepare to launch a pilot Child Abuse Awareness Month as soon as is practicable after the 2015 General Election. This event should be evaluated and replicated in future years if it is found to be successful in either raising awareness of child abuse issues within society or decreasing the incidence of child maltreatment in different communities.

Living on a Railway Line Recommendation THIRTEEN

Organisations working in the community on child abuse prevention programmes should incorporate material relating to Adverse Childhood Experiences (ACEs) and provide community education about the importance of minimising ACEs as well as recognising when they are present in the community and seeking appropriate community-based or professional assistance.

Living on a Railway Line Recommendation FOURTEEN

A formal Health Needs Assessment (HNA), from a secondary care point of view, should be conducted in a pilot community in the UK in relation to child maltreatment and its prevention. The result of this initial pilot should be used to conduct further HNAs in other regions of the country with the aim of building up a societal evidence base of the health needs of children who have suffered from, or who are at risk of, significant harm so that evidence-based preventative strategies can be appropriately designed and targeted.

Living on a Railway Line Recommendation TWENTY-ONE

The ChildSafe initiative, and other similar schemes, should be promoted … [in] areas where child protection issues are abundant and children are at significant risk of harm from issues such as sexual abuse, sexual exploitation and child labour. A pilot region-specific ChildSafe initiative should be introduced, and evaluated, in the UK to contribute towards better protecting children who might be at risk of exploitation in that particular area.

Real Voices Recommendation: Declaring CSE a priority public health issue

Living on a Railway Line Key Recommendation EIGHT

…[The] Faculty of Public Health should consider how they can encourage their members to work closely with local safeguarding children boards to improve awareness in parents, communities, and schools of indicators of child sexual exploitation [and of other types of abuse] and of available help. This would also include a focus on primary prevention to help build awareness and resilience in children and young people to prevent them being exploited or abused in any way.

Real Voices Recommendation: Joint Commissioning proposal

This can be extrapolated to be loosely related to my proposals surrounding child advocacy:

Living on a Railway Line Key Recommendation TEN

A children’s advocacy centre pilot should be launched in the North West of England with an initial evaluation after 12 months, an interim evaluation after 24 months and a full evaluation after 60 months of operation.

Real Voices Recommendation: CPS being part of CSE multi-agency teams

Living on a Railway Line Recommendation TEN

Child protection peer review meetings with clear terms of reference and involving representatives from the local authority (including, as an essential component, local authority, or Crown Prosecution (as appropriate) legal teams), the police and community health services, should be set up in all health organisations conducting child protection clinical work. Such peer review meetings should actively contribute to the case management of individual cases.

Real Voices Recommendations: Questioning and tone of cross-examination

Living on a Railway Line Recommendation TWENTY-TWO

Judges and lawyers involved in all child abuse cases should be required to undertake mandatory specialist training…

This Real Voices Recommendation is also loosely related to:

Living on a Railway Line Recommendation SIX

Institutions training pre-qualification professionals who may in the future work with vulnerable children and families should ensure that their training courses incorporate the necessary training from the Intercollegiate Document on Safeguarding Children and Young People competencies, with an appropriate competency assessment at the end of the training programme to ensure that the skills and knowledge required have been obtained.

Living on a Railway Line Recommendation SEVEN

Current educational programmes in child maltreatment ought to be formally validated including assessing the impact on the competence of the professional, both pre- and post- training, and, if possible, outcomes for children.

There is one final recommendation in Real Voices, the Coffey Report, that deserves specific mention as it has international implications:

Real Voices Recommendation: Reference to CSE should explicitly include boys and young men

Sections 23.1.17 and 23.1.18 deal with this in my Report:

23.1.17 It is important to recognise that child sexual abuse is not something that solely affects girls nor  is it something that does not affect people who do not identify themselves as heterosexual (or who may not identify as having any particular sexuality at present).

23.1.18 Boys and the LGBT community can be forgotten as potential victims of child sexual abuse, exploitation and trafficking and this must be remembered.

It is an opportune moment, having re-read these sections of my report and the Recommendation contained within Real Voices to highlight the fantastic work being undertaken by First Step Cambodia – a local NGO launched in 2010 designed to meet the needs of male victims and survivors of sexual abuse and their families, carers, supporters and communities in Cambodia. These needs are met through social work and other activities related to Prevention & Protection, Support, and Advocacy & Education. Their primary goal is to work in partnership with ALL for positive change and ensure that all male survivors are enabled to achieve their potential with freedom and dignity.

There have been two recent articles published by others in relation to First Step Cambodia. In the first article (http://unicefcambodia.blogspot.com/2014/10/what-about-boys-debunking-myths-about.html) some myths are dispelled about sexual violence against children. Here are some of the myths that exist currently and work needs to take place to educate professionals and the community about how wrong they are:

  • Boys are invulnerable
  • Foreigners and/or homosexuals are primarily responsible for sexual violence
  • When it occurs, violence against boys is not a serious problem

It is the comments on the second article, from Alastair Hilton, Technical Advisor at First Step Cambodia, that are really important: (http://www.phnompenhpost.com/national/tragic-cycle-abuse). Alastair makes clear in his comments that in relation to children with harmful and abusive sexual behaviours there is a complex set of dynamics and circumstances that lead to this behaviour. He highlights the work that First Step Cambodia have done which has found that although many victims and survivors (male and female) sadly continue to be abused (due to the lack of concern, services and other issues), some may become abusive (in the widest sense – so may become aggressive or also harm themselves) but many – and their experience the majority – become ‘protectors’ of others.

Ensuring that all victims of abuse receive the support that they need and deserve and ensuring that they are portrayed accurately in the media is an important part of the work of everyone dealing with children and families.

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The international insights offered by work such as that by First Step Cambodia can be incredibly useful to us here in the UK. Not, for the reasons outlined in the Public Policy Transfer chapter of Living on a Railway Line, because strategies from overseas cannot be automatically transferred unaltered to the UK but simply because having an understanding of what does work and what does not work overseas and the reasons for this, is crucial when we are developing our own policies, strategies, laws and procedures in the UK.

I said at the start that there was one ‘comment’ that I wanted to make and this is in relation to a potential risk that so much resource, time and effort is focussed on Child Sexual Exploitation (CSE) that other aspects of child abuse either inadvertently or deliberately get minimised. Real Voices recommends prioritisation of funding and whilst I agree that this is entirely appropriate it cannot be to the detriment of funding related to other types of abuse otherwise we may find in a decade that the problem of CSE has decreased only to be replaced by a problem of another form of abuse which we ought to have been preventing, recognising and dealing with alongside CSE.

It will be really important that groups carrying out the Recommendations in Real Voices do not lose sight of the other forms of child abuse that children and young people suffer from and that they make sure these other forms of abuse are not minimised. I don’t say this to, in any way, detract from the Recommendations in Real Voices – I think it actually strengthens them – but it is an important point that I think should not be forgotten.

A lot of work needs to take place now that Living on a Railway Line and Real Voices have been published and I’m looking forward to working as hard as I can to see the Recommendations I have made implemented in the UK and beyond.

I cannot do this alone.

What is required is a united approach and collaboration from a wide range of individuals and organisations who have the expertise and enthusiasm to try and make what are currently simply a list of my own Recommendations, and those in Real Voices, into reality.

Will YOU join in to help?