Scandals where social workers fail to protect children from appalling abuse and cruelty are both shocking and tragic. The frequency of such scandals suggests that lessons are not being learned. Instead of reacting defensively social workers must try to understand why scandals happen so that practice can be improved and confidence restored in the profession.

The case of former foster mother Eunice Spry (in 2007) revealed serious failings in the system designed to protect children from abuse. She was found guilty of multiple charges of abuse and cruelty towards three children in her care over a 19 year period. The punishments she used on them included ramming sticks down their throats and making them eat their own vomit. One of the victims was imprisoned in a wheelchair by Mrs Spry after a car accident to maximise the compensation payout she could get from the insurer.

Managers in Gloucestershire claim that Mrs Spry deliberately set out to deceive agencies and say that the problems that existed in the past are now being addressed. However, they do little to explain why social workers failed to spot the cruelty and abuse inflicted on the children, leaving many questions unanswered.

Clearly there was a failure of the system for dealing with the children in Mrs Spry's care who had been privately fostered. Social workers would have monitored their situation but there was poor professional judgement in the handling of this case. According to the Serious Case Review: 'Mrs Spry's application to be a foster parent, and then an adoptive parent, eventually went through without any strong challenges, or dissension. Concerns were noted about Mrs Spry's abilities as a parent at the time but, on balance, it was felt to be in the children's interests to remain with Mrs Spry and to have legal security of placement with her. The placements appeared to be outwardly satisfactory meeting the children's needs. There is some suggestion that Mrs Spry's dominant personality was allowed to drive relationships with the statutory agencies.' This non-interventionist approach reflects an unthinking assumption that private fostering arrangements made by a parents should be respected and supported uncritically.

The involvement of social services ceased after Mrs Spry obtained legal responsibility for the five children in her care when residence orders or adoption orders were granted by the family court. In allowing these orders to be made social services effectively gave away their statutory powers and lost any leverage to continue working with Mrs Spry to raise her standards of care. Shortly afterwards Mrs Spry removed the children from school and undertook their home education.

Child protection concerns were reported to social services on a number of occasions and investigated but the concerns were not regarded as serious. This happened at a time when child protection procedures were well established and the necessary legal powers to intervene were in place. Investigations were apparently hindered by other professionals holding back vital information, possibly due to concerns about confidentiality. Nevertheless, background information in social services records should have shown an ongoing pattern of concerns. The only conclusion that can be drawn is that Mrs Spry's excessive punishments were not investigated fully and the children were not given the opportunity to speak openly about their unhappiness.

In its defence Gloucestershire claimed that the fact that Mrs Spry had removed the children from school made it harder to monitor the situation. Its sweeping attack on home educators merely diverts attention from the failings of social services in monitoring the situation during the 14 years leading up to the children's removal from school. The statement from the Gloucestershire Safeguarding Board lists a number of changes in procedures and improvements in inter-agency communication but does not address the core problem of poor professional practice, particularly the need for a clearer focus on investigative skills of social workers and child protection duties of managers.

Sound professional judgement is the key to protecting children, together with appropriate confidence in the use of authority, otherwise social workers can appear weak and ineffectual. The failure to act decisively can be seen in three recent cases where social workers failed to protect children at risk living in appalling circumstances. Aaron Gilbert in Swansea was beaten to death by his mother's sadistic boyfriend. Kimberley Baker in Swindon was allowed to starve to death by her parents. And Leticia Wright in Huddersfield was beaten to death by her mother and her boyfriend. In all these cases referrals had been made to social services but social workers failed to recognise the warning signs and missed opportunities to intervene.

People in positions of power are promoting the view that the role of the children's social worker is to support families and provide services for those in need. In recent years social services departments have been re-focusing services from child protection to family support and introducing the Common Assessment Framework to develop a more needs-led service. In practice this means that more initial referrals are treated as child-care problem enquiries as opposed to child protection investigations. However, it can be difficult for social workers carrying out an initial assessment of needs to shift the focus to a child protection investigation if new information emerges. The emotional tendency to resist changing direction is very strong, especially if social workers see themselves as having a caring role. Whilst much social work combines protection with support, a child protection investigation requires a different mindset on the part of the social worker, similar to that for detective work.

Problems can arise when social workers investigating concerns have to deal with aggressive, resistant parents who are dishonest, evasive, devious or manipulative. It is essential that social workers have the skills and confidence to act authoritatively in these situations and receive good managerial support. Many departments now have a centralised child protection team dealing only with referrals that need an urgent response, which ensures clarity of roles and responsibilities and a consistency of approach. In view of the variations in social work practice across the country it is appropriate that all authorities have access to such a team.

Many social workers recognise that the child protection system is biased against poor families. They understand the alarm and distress caused to parents when social workers makes unannounced home visits and want to avoid adding to the stress on parents living in poverty who are struggling to cope. Some are reluctant to make judgements about people's parenting abilities, being sensitive to class prejudices amongst certain middle class professionals. In addition, they recognise that the social work process of 'helping' within the framework of a 'safeguarding' intervention is often experienced by parents as the opposite.

The gulf between those in positions of power and front-line workers is apparent in the fact that the government is pressing ahead with plans to abolish child protection registers in the face of enormous opposition from social workers. The current system for identifying and monitoring children at risk of significant harm has been developed and improved over many years and now provides an excellent framework for practice. The child protection register is not just a means of recording information; it is also a social work tool for working with children who have been identified as at risk and ensuring an appropriate balance between support and protection. Some influential people within the profession show an ignorance of the complexities of post-registration work and naively assume that the stigma of the register can be removed by transferring the child protection plan to electronic records, as if it was simply an administrative matter, not a method of working.

Problems in working with children and families where concerns have been identified are likely to continue because of under-resourcing and staffing difficulties. The way forward is for everyone involved in children's services to find ways of effectively integrating protection and support and to achieve an appropriate balance. While a heavy-handed child protection approach ultimately leads to resentment, refusal and ultimately failure, a blind emphasis on support leads to an absence of boundaries and a failure to contain risks and dangers. It is important that the inevitable practice dilemmas are openly discussed with managers and the views of social workers who really know their families are given due consideration. Social workers providing support may sometimes become aware of child protection concerns that change the nature of their work and indicate a need for a more formal and authoritative approach. They must have the wisdom to revise their judgements and the skills to adopt a different style of working if this becomes necessary.

Social services has the lead role in child protection with responsibility for conducting investigations under section 47 and legal proceedings. In recent years an emphasis has been put on concerns about sexual abuse but we should not let our horror at this blind us to other forms of abuse. We cannot afford to overlook the more common problems of cruelty and neglect which can result in the tragic deaths of children.

On average two children are killed by their parents or carers every week in the UK, according to the NSPCC. This has not reduced for the past thirty years, and is widely believed to be an underestimate. Unless social work practice is of a consistently high standard the number of child deaths will not be reduced.

Hilary Searing

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