Better Health For All

by Professor John Ashton, County Medical Officer and Director of Public Health for Cumbria

In one of his brilliant short films in the 1960’s, Ingmar Bergman depicts an extravagantly dressed clown, rolling into a small Swedish town, amusing all the children with circus tricks as he passes through. He then goes on to call at a house where he carries out a murder, changes into everyday clothes and strolls out of town unnoticed.

Over the past few weeks, as the scale of Jimmy Savile’s alleged abuse continues to grow, I can’t help but be reminded of Bergman’s character’s wicked genius.

The enormity of Savile’s alleged crimes spanning four decades would seem to be equalled only by the failure of safeguarding and governance at a range of institutions.The apparent breakdown in those systems now extends well beyond the BBC to include local authority adult and children’s social services, the NHS and the media and press who we look to to expose crime and matters of public interest.

But the real lessons of the Savile affair go much wider. They extend to weaknesses in our democratic institutions and processes where powerful men sitting on the top of bureaucratic hierarchies are all too often themselves the product of closed institutions of one kind or another. They lack a 360 degree moral and social compass. This is compounded by systems that we have developed based on over-dependence on professionals and technico-managerial, box-ticking exercises. These systems are not fit for purpose and fail those very people – the young, the frail, the vulnerable – who they are supposed to guard and protect.

If there is to be any kind of a positive side to this major tragedy of epic proportions it is that it has revealed the bankruptcy of our attitude and arrangements to safeguarding the most vulnerable among us to whom we all have a duty of care. It does take a village to raise a child.  We are all our children’s keepers.  If social workers have claimed territory that they are unable to occupy fully we have all colluded in a hideously flawed paradigm.

What is missing is a systematic, three strand, public health approach built on the secure foundations of full public engagement and  involvement rather than an abdication to a small but dedicated cadre of professionals.  Civic society has been squeezed by the professionalisation of everyday life coupled with the growth of an overpowering obsession with individualism and consumerism.  We have all become bystanders watching and waiting for somebody else to intervene.This has to change if we are serious about safeguarding.The voice of the child must be paramount and we all need to listen and act,  not just those paid to do so.

Secondly, the dysfunctional relationships between agencies has to change. Joining up the dots is impossible if front line workers don’t talk to each other. And thirdly those who have safeguarding in their job description must accept their wider responsibility to share it with the whole community. Whether they be social workers, clinicians, teachers, police or professional groups, these professionals need to be accessible and responsive when their unique skills and powers need to be deployed. Safeguarding must move upstream into prevention, into tackling abusogenic environments and into preparing the vulnerable and at risk to be able to speak out.

Yes, bureaucratic tick box arrangements do have their place. We are entitled to ask: who was ‘It’ for safeguarding on the BBC Board and in each of the NHS, Local Authority and other bodies where Savile was apparently able to prey unchallenged?