Switalskis full written submissions (IICSA Lambeth Council Inquiry)



  1. These submissions are divided into the following sections:
  • Summary on the Extent of Child sexual Abuse in Lambeth;
  • The death of LA-B2;
  • Michael John Carroll and North Wales;
  • The position of children in care and recommendations;
  • Criminal Justice System;
  • Civil Justice System and the Lambeth Redress Scheme;
  • Conclusions and Recommendations for Training, Regulation and Mandatory Reporting.



The Extent of Child Sexual Abuse in Lambeth

  1. The Inquiry has heard detailed evidence for 4 weeks followed by short oral submissions. The details of what happened to our Core Participants (“CPs”) are referred to in the Thematic Gist Table produced by the Inquiry legal team after consultation with Core Participant legal representatives.  Its contents will not be repeated here, but below follows a summary of the conclusions that can be drawn from this and from the evidence before the Inquiry; and following that, written submissions on matters which came into focus during the Inquiry of particular concern to our CPs and included in each section, our recommendations for change.
  2. There can be no doubt that for decades the London Borough of Lambeth was beset by poor practice, corruption, racism, inadequate management and repeated failures to make the changes that were repeatedly highlighted as necessary. In this unhealthy environment the physical, psychological and sexual abuse that was already taking place, for example, to LA-A305 in the late 1950s/early 1960s was able to continue and then to flourish.


  1. From the time that Lambeth Council was created in 1965 the result was the widespread sexual abuse of Lambeth children over decades by multiple perpetrators, mostly males but sometimes female. Some older children also abused younger children, such as LA-A302, LA-A303, LA-A310 [Thematic Gist table E15], LA-A324, LA-A327 (who gave live evidence on 6 July 2020) and LA-A217.


  1. LA-A304, her brother and another boy were forced to engage in sexual activity with one another by the man who sexually and racially abused them [Thematic Gist table F35; H35].  In LA-A299’s case (who gave live evidence on 1 July 2020) his rape by an older boy was orchestrated by an adult who then watched him being raped.


  1. Even abuse which might at first appear to have been opportunistic (for example, the rape of LA-A305 in swimming pool changing area) can only have happened because the perpetrators had been informed of the availability of children to abuse and had been encouraged to do so. Even though the abuse was hidden from many at Lambeth it was coordinated, well-organised and so deeply embedded that it had become part of its culture.


  1. The abusive treatment of children began as soon as they entered care. Their abuse continued and their abusers became virtually untouchable.  The damage done to those who suffered child sexual abuse has been long lasting and extensive, undermining their very identities, whether because they were told that their parents did not want them, that they were nothing or because they were racially abused.


  1. The sexual abuse affected not only them, but also their families. Children were removed from their homes, often without any or adequate explanation of what was happening.  Many were separated from siblings, the only link they had to home, again, without any or adequate explanation.


  1. While there has been widespread reform in the procedures, rules and laws governing the care and protection of children, it is clear that even before they were abused, the most vulnerable in society were treated with total disregard for their mental and emotional health and well-being. What happened to the Core Participants we represent and many others, raises many questions about how Lambeth, as a corporate parent, and by logical extension, how the wider society of which it is a part, both as an institution and as a group of individuals responsible for the care of children, regarded such children.


  1. In summary, we say that the admitted failures by Lambeth in corporate parenting are, in part, a reflection of society as a whole. These children simply did not matter; they had no one to speak up for them. Their parents as a group did not have a collective voice: they were not members of an influential group who could necessarily use their votes to change the behaviour of those in their local government.  They were not powerful people who had the ability to lobby or influence their local politicians.  It is hardly surprising then, that the status of these “have nots” was: “out of sight, out of mind”.  Their experiences of abuse situation were exacerbated by:
  • Complex political structures;
  • A lack of clarity about the responsibilities of senior management and the chain of command;
  • A lack of any real interest by those who had the power and oversight over children’s services, with some exceptions;
  • Very poor social work, again, with some exceptions.


  1. Historically, senior officers have been willing to admit to failures and to take credit for proposed remedial action and policies which were supposed to protect children but such admissions meant little because for decades Lambeth failed to implement the changes that were so urgently required. Too often, after Social Services Inspectorate or an Inquiry, senior people moved on and little or nothing was done. There have been too many missed opportunities.


  1. The attitude to the children in Lambeth was also characterised by a failure of imagination and empathy: you do not need to know about paedophilia and grooming as concepts to consider children are or may be at risk. The Sexual Offences Act 1956 contained a variety of offences against children so such concepts were not new.  If anyone had cared to listen properly to these children at the time, for example, LA-A7 among (but there are many others) who complained to staff and police, Leslie Paul, whose prolific abuse included photographing and filming children could have been stopped from abusing more children.  By the time he started work at South Vale Children’s Home on 3 September 1979, s1 of the Protection of Children Act 1978, which prohibited the taking of indecent photographs of children, had been in force for over a year and should have been fresh in the minds of those whose duty it was to look after children and protect them.  In this case, the Local Authority and the Metropolitan Police.  Instead, warning signs and complaints were ignored or not properly followed up.


  1. It is appreciated that there were many difficulties faced by those working for Lambeth, but those who have attended this Inquiry at SW and senior level and have said, by way of explanation or excuse that they were not aware of the risk or existence of sexual abuse insult those who suffered forms of abuse that were recognised by the law and punishable by sentences of imprisonment.


  1. Document OHY008782 is a Report to the London Boroughs Children’s Regional Planning Committee regarding a child sex abuse ring in Kilburn, North West London and part of the London Borough of Brent. The report dated 5 October 1989, was disclosed to CP legal representatives after the public hearing had concluded. It is not known whether any Lambeth Officers or elected members had seen this report, but it is reasonable to infer that this is likely.  The report was to be circulated because the purpose of the meeting was to explore issues of child sexual abuse and there was a recommendation to share information with other London Boroughs which had previously been made by Peter Bibby on 12 July 1989, following a MPS investigation into a paedophile ring that had started in 1987.


  1. Those we represent want Local Authorities to be held to account and in as detailed below, ask the Inquiry to recommend changes to the law and current regulatory provisions.












  1. LA-B2 died between 17 and 18 October 1975, unnecessarily, as a result of compression of her neck just a few days before her first Birthday. The circumstances of her death suggest strongly that it was the result of neglect. While no evidence has been obtained to suggest that LA-B2 was sexually abused, her death is relevant to the issues before the inquiry because it is evidence of the general state of neglect of children’s homes in Lambeth at the relevant time; and the bleak outlook for children who were unfortunate enough to be placed in them.


  1. Regrettably, LA-B2’s inquest file, which would have included relevant evidence such as witness statements and the Coroner’s report, no longer exists (please see references to DI Simon Morley’s statement below) but a significant amount of relevant information is known about her death, some of which Counsel to the Inquiry put to DI Morley when he gave evidence on 22 July 2020:
  • The identities of the staff on duty on the night/early morning LA-B2 died were known [INQ005873_05];
  • A summary is available of the actions of each member of staff who had been at work at the time; and
  • There was no justification for using the harness on LA-B2:
    • It is unlikely or at least unclear that the harness, apparently a Clippasafe harness was being used for its intended purpose (either on LA-B2 or on the other children over the age of 3 on whom it was used – apparently to prevent them getting to the fire escape stairs) [Exhibit LA A243 1, p31 (internal p2): report of final meeting of the Social Services Committee as part of its Internal Inquiry into LA-B2’s death, dated 9 December 1975];
    • LA-B2 was crying and it was felt better to place her in a bedroom on an upper floor with younger children from the age of 2 under the age of away from her sister and school age children as she might disturb them (even though the night of 17 to 18 October 1975 was a Friday/Saturday) [INQ005873_26];
    • Even though she was a child under the age of 1 but still mobile, she was placed in an upper bunk and harnessed to the bunk bed when the risk of her slipping out of the harness either partially and completely and falling or entangling herself in the harness was or should have been obvious;
    • LA-B2 was known to sleep on her stomach but was placed on her back when it was also known that she “sometimes tended to wake up again after being settled down” [INQ005873_27];
    • It was known by the member of staff who put LA-B2 to bed that if a child in a harness tried to lie on its stomach, it would be in difficulty by getting tangled up [INQ005873_40];
    • It was known that LA-B2 was or had been suffering from an upper respiratory tract infection (making it more likely she would become unsettled or wake during the night, even if Phenergan, a sedative, had been administered);
    • There was no or no adequate supervision: there were no night staff at the Home. It was said that there was always an officer sleeping within hearing of the nursery, but on the night of LA-B2’s death the person who slept closest to the nursery was off duty at 3 p.m. on 17 October and returned at 8.15 p.m. then slept with her door closed.  The member of staff on call slept downstairs on the floor below LA-B2 and could not hear the children.   No checks were made between 9pm and the following morning when she was found dead. [INQ005873_05]; [INQ005873_27]; and


  1. It was accepted by the Social Services Committee that:
  • the bunk bed and harness should not have been used;
  • neither the lower nor upper bunk of a bunk bed should ever be used on a child of LA-B2’s age;
  • a harness of this type should not be used on a child of this age, on a cot or on a bed [INQ005873_28].


  1. In his evidence to the Inquiry on 22 July 2020 DI Simon Morley agreed that there was clear evidence that a crime may have been committed and it should have been investigated as a crime by the police at the time [transcript p106-107].


  1. He agreed that it would be a reasonable starting point to say that if what happened to LA-B2 were to happen today, as well as an investigation into the acts and omissions of individuals, it would be appropriate given the appalling circumstances of LA-B2’s death, to investigate whether Lambeth, as a corporation, had committed corporate manslaughter. He then said that one would have to look at all of the details and the circumstances and that while this was his personal opinion, one would need to ask that question of a more senior and more experienced detective, possibly from one of our murder teams.


  1. DI Morey said he had not seen any of LA-B2’s files and could “get an opinion from one of our murder investigation teams, and I think that would be more benefit to the inquiry than me attempting to be helpful with my personal opinion and with my experience and my background.”


  1. DI Morley has provided a ninth witness statement to the Inquiry [MPS004574], dated 31 July 2020, in which he sets out the enquiries he made to obtain further information about LA-B2’s death. On behalf of the CPs we represent, we are grateful for DI Morley’s efforts. He found that, unfortunately, the Coroner’s file was held for 15 years before being destroyed (in 1990) and states that that the Metropolitan Police Service does not retain Coroners’ files so that details of the identities of the police officers involved at the time and copies of any witness statements taken no longer exist.


  1. It is plain that information relating to child abuse, including child sexual abuse continues to emerge years after the events themselves took place. To find that potentially relevant evidence no longer exists because it has been destroyed is highly unsatisfactory, although it is acknowledged that this situation might not arise today.[1]


  1. Given that relevant original documents have been destroyed, DI Morley also indicated that without access to the relevant witness statements he is unable to say what information they contained, what other steps, if any, police took in investigating LA- B2’s death and therefore what evidence was available to the police in 1975. The MPS do not retain copies of Coroner’s files. As a result, he is unable as a result to comment on the quality of the police investigation at that time: witness statement MPS004574, page 13, para. 32.


  1. DI Morley acknowledged that if a death such as LA-B2’s death occurred today in a children’s home, he would expect the first police officers on the scene to secure it and arrange for the attendance of a Detective Sergeant or Inspector, who would in turn request the attendance of the Homicide Assessment Team. He commented that it is not unusual for the death of a young child to be disguised by those responsible as an accident and the assessment and investigation of such tragic incidents requires specialist expertise and experience [DI Morley’s 9th witness statement MPS004574 p13, para. 34(a)]. While thankfully rare, unexplained or suspicious deaths of children in circumstances which may not at first appear to be so, do occur.  There is a recent example in which police failed to take the steps that DI Morley suggested were necessary would expect: London Borough of Southwark v US, also known as Re L (A Child) [2017] EWHC 3707.  This was a case in which a child was discovered dead in her bedroom in the family home, having died from compression of the neck.  The police failed to treat the scene as a crime scene and the lead investigating officer closed his mind to the idea that her death could have been the result of a homicide.


  1. What happened to LA-B2 and indeed, the Re L case, suggest that even today, whenever a child dies, those responsible for investigating the cause of such a death must vigilant and keep their minds open to all possibilities, so that a full and thorough investigation can take place. Sadly, it does not appear that this was the case for LA-B2 and the jury’s open verdict is likely to have been a reflection of their concern about this.


  1. DI Morley is unable to provide a definitive answer to the question of whether the circumstances of LA-B2’s death provide grounds to investigate Lambeth Council on suspicion of corporate manslaughter, as it would depend upon the evidence available. He states that he would be happy to refer this matter to the Metropolitan Police Services Specialist Casework Investigations Team for further consideration and examination, should further information about the circumstances of LA-B2’s twos death be provided to him.
  2. Although DI Morley’s willingness to assist is appreciated, those who would wish LA-B2’s death to be investigated are left in an impossible position: without relevant evidence the police are apparently unable to comment or take matters further; but without further steps being taken by those with the ability to investigate such matters it is unlikely that it will be possible to obtain such evidence.


  1. The Metropolitan Police are therefore invited to reconsider the file exhibited to LA-A243’s statement, which contains details of the identities of the staff who were working at the time and to check whether there is any record of any investigation, perhaps stored or archived on microfilm. Efforts should be made to trace such people to see whether they are still alive and whether they have relevant evidence to give before any conclusions are drawn about the availability of relevant evidence and the MPS has the means and the ability to make such enquiries. Without such steps being taken, the injustice of LA-B2’s death will continue. The available information suggests that there is a clear case to answer for gross negligence manslaughter and every reasonable effort should be made to carry out a thorough investigation.









  1. Michael Carroll abused children over many years. The Inquiry has heard detailed evidence of how this was able to happen and about his contact with political figures such as Lord Paul Boateng.


  1. We submit that there is insufficient evidence to suggest that any named political figure has been involved In child abuse, however the very fact that members of the political class and/or the establishment and/or the management of Lambeth Council would only have served to emphasise to Carroll’s victims, that he was untouchable and unaccountable.


  1. It is clear that Michael Carroll was able to perpetrate abuse for several reasons:
  • Lambeth had no proper system in place for verifying declarations about the lack of any relevant previous convictions so it failed to uncover his deception in obtaining employment when he’d failed to disclose his Schedule 1 offence against a child; that was left to another LA, Croydon Council;
  • He made himself indispensable and appears to have had a reputation for working with challenging children, becoming a “go to” man in Lambeth. In short, he made himself indispensable.
  • He was one of several people who were utterly corrupt and most likely corrupted others.
  1. When concerns were raised about him, for example, by Anna Tapsell. This stifled the ability of others to speak out.


  1. Carroll was able to run Angell Road CH like a private fiefdom and in effect had free reign to abuse children. Even though senior management at the Council such as Robin Osmond visited the home, the children who lived at Angell Road were at that time beyond help and assistance.
  2. Thus, Carroll was easily able to groom and then attempt to care for (by either adopting or fostering) siblings LA-A181 and LA-A109 and to groom their father in the early 1980s. [LA-A109 witness statement, INQ005956, para 106-110; Thematic gist table F29]. If Lambeth had had an effective system to discover previous convictions in place, it would have known about this.  Given that Lambeth negligently continued to allow Carroll to have contact with children when he attempted to foster two brothers in 1986, it is not possible to  say that contact between Carroll and LA-A181 and LA-A109 would have ceased if his conviction had been discovered earlier, but he could have been prevented from grooming and abusing them.


  1. We submit that the social workers involved with LA-A181 and LA-A109’s family failed to consider whether it was appropriate for Carroll, who signed a written agreement indicating that he would be involved in supporting the family, to continue his involvement with the family.


  1. From document LAM030357, a Lambeth Officers Report regarding LA-!109 and LA-A181 dated 12 May 1981, disclosed to CPs on 21 August 2020, it is clear that the children, who were living at Highland Road Children’s Home, continued to visit Carroll, who had started work at Angell Road Children’s Home in January of the same year.


  1. It is at the very least surprising and concerning that the social workers involved, Simon French (deceased) and Chris Hussell, did not consider that a conflict of interest might arise between him supporting a family and at the same time working in a role that required him to safeguard and care for children. Questions should have been asked about the arrangement but instead, the proposed arrangement was met with bind acceptance by Lambeth staff.


  1. Once Michael Carroll’s conviction had been discovered and Lambeth had been notified of it, those at a senior level were either unable or unwilling to appreciate the significance of his offence and of his dishonesty; and the motivation for withholding such information. It is now known that the person presenting Carroll’s case on behalf of Lambeth was himself involved in dishonesty, but that does not explain why senior managers did not take even rudimentary steps to safeguard and check on children with whom Carroll was or had been in contact.


  1. Even after this was discovered in April 1986, Lambeth failed to take appropriate action at his disciplinary hearing and shockingly, certain people at Lambeth continued to support his application to foster.


  1. There was an unquestioning “carte blanche” acceptance of Carroll’s version of events of “horseplay” explanation: minutes of the SSI report, CQC000298 referred to in evidence by David Pope on 8 July 2020 [transcript p47].


  1. The approach of Lambeth contrasts to that of the London Borough of Wandsworth, which concluded that the Carrolls were not appropriate people to be foster parents and was concerned that Lambeth had allowed the children in question to effectively live with or stay with the Carrolls for long periods of time as their social uncle and aunt. [Transcript 8 July p57].


  1. Instead, the approach of those in power at Lambeth lacked rigour, (David Pope) and focused on the result it wanted to achieve (the Senior Children’s Homes Officer Mr Thomas): to keep Carroll employed and as far as some were concerned, to allow him to foster the children in question, rather than on the evidence before it. Overall, this was a superficial, corrupt (by Thomas) and “clubby”, “we’re all in this together” approach to the investigation and disciplinary process. No independent advice was sought and no effective scrutiny of the evidence took place.  Mr Pope, who chaired the disciplinary process, did not even call for Carrol’s personnel file.  The result was a foregone conclusion: Lambeth failed to dismiss Carroll and chose instead to only impose a final warning.


  1. The result was that Carroll was not dismissed for another 5 years until 31 August 1991, during which time he was in a position to continue to sexually abuse children.


  1. All of these matters are evidence of a lack of imagination, poor judgment, a somewhat arrogant attitude and amount to a shocking dereliction of duty.


  1. The Inquiry is by now aware of the consequences of such attitudes and failures in childcare. Much remains as yet, unknown but CPs have given evidence of what was, in effect, over years, commercialised child abuse that included the taking of photographs and the filming of abuse (Leslie Paul among others). Further, the networks spread much further than London and the South East.


The North Wales Connection

  1. On 23 July 2020 Helen Kenward of CHILE confirmed in her oral evidence that Carroll was linked to other known paedophiles around the country, who were also involved in the residential care of children [transcript 23 July 2020 p95]. Therefore, it is unlikely to be a coincidence that some children were treated as chattels and sent to homes in North Wales for the purpose of sexually abusing them or at least in the knowledge that this is what would happen. Serious child sexual abuse was already taking place there, as is known from the Waterhouse Inquiry.


  1. Ms Kenward also said in evidence that: “Carroll was a charismatic person who could be either dominant and bullying or seductive and charming. He was well known in Lambeth, but he was also known on the residential scene, and he was a member of the Residential Care Association.  Now, that brought him into contact with a whole range of people, and I know, for instance, that people like Frank Beck were part of that organisation. Because of my previous experience in other investigations — Nottingham, Cleveland, and so on — I knew that that was a meeting place for many people, but also for paedophiles.” [transcript p95].


  1. Brothers LA-A109 and LA-A181 were taken on at least one trip to North Wales by John Carroll. LA-A181 was abused there and he suspects LA-A109 was too, although LA-A109 does not mention this [Thematic Gist Table F8; witness statement of LA-A181, INQ005683 paras 23 onwards].


  1. LA-A311 was sent to live in Ynys Fechan Hall in Gwynedd, a private children’s home in North Wales where he was subjected to excessive physical punishment/physical abuse; sub-standard food; poor supervision by staff, who drank alcohol and held parties; and used as in effect, unpaid slave labour under the guise of “work experience”. This was prioritised over very limited education from unqualified care home staff or associated of staff which took place only part time and consisted of copying things out from a blackboard


  1. LA-A311 witnessed his roommate being sexually abused in bed by a man in LA-A311’s presence and on another occasion LA-A311 was sexually abused by the same man [Thematic Gist Table E14, F14, H14, J14; witness statement INQ005591, paras 35-39].


  1. At the time Carroll was working, the oversight of placement of Lambeth children in private and voluntary accommodation was lamentably weak to non-existent. On 3 July 2020 transcript [transcript p84] Mr Osmond, the former Director of Social Services, was referred to paragraph 1 of LAM028400_3, a Placement Officer’s Report dated 17 November 1988 in which a Mr Byron said that:

Monitoring and control systems …” (of children being placed in private and voluntary accommodation)  “… simply did not exist. This state of affairs 3 did not result overnight but would appear to be the result of years of neglect and inefficiency.”


  1. Mr Osmond admitted he was not aware that there was ineffective monitoring of placements at of private or voluntary organisations but did not take responsibility for this and instead sought to place responsibility on Lambeth social workers (transcript pp85-86). Clearly, those in senior management roles at the Council, who should have been aware of the situation, were not. Nor did they at that time check that there was an effective system for monitoring in operation and Mr Osmond’s response to the questions about this demonstrate that not only was there a lack of oversight, but a lack of interest in such matters.


  1. Such failures had a direct effect on the CP’s we represent and undoubtedly on many others.
























Children on the Cusp of Going into Care

  1. The evidence before the Inquiry shows that children in Lambeth were at risk as a result of poor social work practice and poor management both before, during and after they were in care.


  1. In Counsel to the Inquiry Ms Langdale QC’s opening on 29 June 2020 she referred to a Social Services Inspectorate report, the inspection of Child Protection and Planning and Decision Making for Looked After Children in May to June 2000 (LAM029179), [transcript pp99-100].


  1. The overall impression was of a Children and Families Division struggling under considerable and relentless pressure. In many areas, basic work systems were functioning poorly or had collapsed. This led to inefficient, fragmented and inconsistent work practices. The SSI noted:

We were particularly concerned about potentially large numbers of children who had not properly been regarded as looked after. They had not been allocated a social worker, were not placed with approved carers and had none of the protection afforded by visiting, monitoring or statutory reviews. Urgent action was needed to trace these children and secure their safety.”

Furthermore, significant numbers of looked-after children and those on the Child Protection Register did not have social workers.


  1. In her evidence to the Inquiry on 21 July 2020, Annie Hudson, the now former Strategic Director of Children’s Services at Lambeth, acknowledged that children who were on the cusp of going into care and living with their families in high risk situations were not adequately protected by Lambeth.


  1. Children on the Child Protection Register were not allocated a social worker. Families that should have received intervention and support to see if it was possible to avoid children being taken into care, did not do so and as a result, children were left in potentially dangerous situations [transcript 21/07/2020 p4]. Such risks could have been exacerbated by because parents who presented a risk could have been encouraged by the lack of LA action to think that whatever they did, the LA would not interfere.  With no monitoring and no social work visits, children were exposed to unacceptably high risks.


  1. Instead, a crisis would occur and a child would be taken immediately into care through the court process or as a voluntary reception into care now pursuant to under section 20 of the Children Act, which provides for children to be received into LA care, with the parent or parents having agreed to delegate parental responsibility without the LA sharing parental responsibility with the parents. This is likely to have been upsetting and traumatic for the children concerned.


  1. Later in her evidence Ms Hudson was referred to LAM029179 (the SSI from May to June 2000) which raised concerns about potentially large numbers of “hidden” looked after children who had not been allocated a social worker and had been placed with friends or family on an informal basis and who were supported by payments under section 17 of the 1989 Act or boarding out payments under Regulation 11 of the Foster Placement Children Regulations. No checks were made on their carers, so that the poor social work practice of the 1980s and 1990s appeared to be continuing a decade later. Lambeth was therefore repeatedly in breach of the statutory duties it owed to children under Section 1(1) the Child Care Act 1980 (repealed) and Section 17 of the Children Act 1989, to safeguard and/or promote their welfare.


  1. Today, there is evidence that similar problems continue to arise with the (mis)use of section 20, denying the child a voice because, without public law proceedings having been issued, no statutory reviews take place, no Child’s Guardian is be appointed and decisions about a child’s future are delayed. If placed by local authorities under informal arrangements which have not been assessed children continue to be at risk because of a lack of social worker intervention and support.  The flowing cases provide some examples:


  1. Medway Council v M, T (by her Children’s Guardian) [2015] 10 WLUK 311, 13 October 2015 (judgment included with supplementary materials): 5 year old child placed in emergency foster care when her mother was detained in hospital with a serious mental order and there was no one else to care for her. The local authority failed to consider the mother’s capacity or the child’s legal status; It delayed involving the court (failing to issue proceedings for 2 years); did not explore permanence and had allowed the case to drift; it had neglected parental contact; it had been advised of the need to take legal proceedings but did not do so and therefore had no lawful basis on which to accommodate the daughter without an order under the 1989 Act.


  1. The local authority had displayed a “shocking” misunderstanding of the law and the limits on the exercise of its power, compounded by an arrogant and ignorant disregard for the advice provided by the looked after children review process. Damages was sought and paid for breaches of both the mother and child’s ECHR Article 6 and 8 rights to a fair trial and for a private and family life respectively.


  1. Kent CC v M [2016] EWFC 28: the local authority had breached the child’s Art.6 and 8 rights when it: failed to properly assess her for 3 years and 4 months; failed, for the same period, to implement a care plan that met her needs, including ensuring that there were sufficient procedures in place to give effect to the recommendations of the Looked After Reviews; failed to provide her with a proper opportunity to secure a suitable long-term placement and a settled and secure home life; failed to issue proceedings in a timely manner from March 2012 to November 2015, depriving her of the protection afforded by the 1989 Act and of access to the court. Care proceedings would have helped significantly to provide the stability and security that the child so clearly needed. She would have had the benefit of a Children’s Guardian and a legal representative to give her an effective voice regarding the local authority’s failures. The issue of proceedings would also have enabled the local authority to share parental responsibility with the child’s mother.  Harm had been caused to the child by the lack of security and stability any of her placements (other than her most recent one) were able to offer her. The evidence showed that she was acutely aware that her mother could remove her at any time. The delays by the local authority in taking the necessary steps that its own decisions provided for had had a negative effect on the child’s emotional health and development and contributed to multiple breakdowns of foster placements.


  1. Herefordshire Council v AB [2018] EWFC 10: the local authority failures were described as “egregious”. There had been several occasions when care proceedings could have been issued but were not, and where legal advice should have been sought and was not.  There was no clear explanation for many of these decisions and there had been “complete inertia” which was “inexplicable”. The teenage mother had been side-lined from her child’s life.  She had needed the greatest possible advice, support and consideration, which she had not been given (paragraph 54).


  1. The Supreme Court has recently found it necessary to set out the principles governing the use of Section 20 after another case of its misuse, this time in the London Borough of Hackney Williams & Anor v London Borough of Hackney [2018] UKSC 37.
  2. Worcestershire CC v AA (A Child) [2019] EWHC 1855 (Fam) is a further example that came after and cites The local authority had serially and seriously failed to meet the child’s needs over a very prolonged period of time. The case had caused the local authority to undertake a root and branch review of its practices and procedures for the benefit of the children and young people whom it would be looking after in the future.  The failure to:
  • provide the child with therapeutic support;
  • provide adequate or effective support to his foster carers;
  • provide a stable and clear plan for his care, especially to ensure a responsible person or body had effective parental responsibility for him;
  • institute public law proceedings in respect of him and to provide him with the protection of a judge-led process and the protection of a voice via a children’s guardian;

was egregious in the extreme.


  1. Although in living with committed and nurturing foster carers, the child had been left adrift in the care system. There was no consistent planning for him through a succession of 22 social workers. His future settled and stable care should have been arranged and approved many years ago. There was no excuse for that not being done. He was failed by the local authority. A separate claim had been made on the child’s behalf seeking damages for breaches of his human rights for which the local authority had admitted liability.


  1. It is acknowledged that there is high quality social work and management taking place, that there have been vast improvements in children’s services and that practitioners have to operate in accordance with local conditions and under financial constraints. Worryingly, all too often, children continue to be let down and to suffer harm as a result of poor social work, informal arrangements and the misuse of Section 20, exposing them to risks and leaving them to drift at the edges of the care system without a voice. The fact that it is often left to the courts to deal with the consequences of these problems, whether in individual care proceedings and/or in civil proceedings for personal injury or under the Human Rights Act 1998 is far from satisfactory.













Children in Care

  1. The Inquiry has heard extensive evidence about the huge disadvantages suffered by children in the care of Lambeth, including the CPs we represent. Their evidence will not be repeated here, a representative sample having been included in the thematic gist table and reference having been made to their experiences in the introduction.


  1. Core Participants have been invited to comment on the legal remedies available to children in care and in particular whether and how the voice of a child already admitted into care may be heard within legal proceedings in the event of the child’s disagreement with the corporate parent on an issue of real concern to the child.


  1. Core Participants have been referred by Solicitors to the Inquiry to the comments made by Baroness Stedman-Scott when she tabled an amendment to the Child and Families Bill, seeking to appeal restrictions to Section 8 order children in care:
  2. Section 8 orders such as contact, prohibited steps and specific issue orders enable children to prevent their parents taking actions that are against their best interests. If a parent attempts to prevent a child seeing a family member or tries to move the child away from their home, the child may, through their solicitor and if that legal representative considers there to be sufficient grounds, ask a court to make a Section 8 order. Though rarely exercised or indeed necessary, the right to do this is a crucial protection for children in difficult situations.” [Hansard HL, Children and Families Bill, Vol 748, col 142, 14 October 2013].[2]


  1. Ultimately the proposed amendment was withdrawn, possibly because Baroness Stedman-Scott was persuaded by Lord Nash, the Parliamentary Under-Secretary of State for Schools (Lord Nash) that to allow a child in care to apply for a Section 8 order would cut across the scheme of the Children Act and the local authorities’ duties towards and responsibilities for children.


  1. If care proceedings have not been finalised and the child is subject to an interim care order, the Children’s Guardian can voice any concerns that the child has, including those about the care plan and where he or she should live. In the event that the child’s views differ from her Children’s Guardian, as long as the child is competent to instruct a solicitor, that child may be represented by and instruct her own solicitor.


  1. Whether or not look final care order has been made it is clear that a child is prevented by section 9(1) one of the Children Act 1989 from applying for a prohibited steps or specific issue order. While this is rationalised as an avoidance of cutting across the local authorities’ responsibilities, a local authority is not fulfilling its responsibilities properly, such an apparent lacuna must raise concerns.


  1. There are potentially, other options for a child in care to raise issues of concern, but in a limited and indirect way.


  1. Section 9(3) of the 1989 Act provides that:

“A person who is, or was at any time within the last six months, a local authority foster parent of a child may not apply for leave to apply for a section 8 order with respect to the child unless—

  • he has the consent of the authority;
  • he is a relative of the child; or
  • the child has lived with him for at least one yearpreceding the application.


  1. A foster carer who fulfils one of the subsection 3 criteria can apply for leave to make a Section 8 order application, but this will only give voice to the child’s concerns if the individual foster carer is able and willing to take such a step. This will be difficult if for example, if the child’s interests or views conflict with those of the foster carer or if the local authority, which will continue to hold parental responsibility, has advised the foster carer against taking such a step, particularly if it takes the view that the nature an application conflicts with the care plan for the child.


  1. Older case law from the Family Division of the High Court suggests that a child can obtain a Section 8 order for contact with siblings because such an order would be an order “with respect to” the child’s siblings rather than in respect of the child in care and would not therefore fall foul of section 9(1): Re F (Contact: Child in Care) 1995 1 FLR 510, FD. In reality, a child in care seeking such an order is likely to face obstacles.  In the Re F case the application was made on behalf of the child, K, by the Guardian ad Litem (the correct nomenclature at that time) at final hearing of the care proceedings, relying on Section 34(2) of the Children Act 1989, which provides for an application for contact to be made by the local authority or by the child for contact between that child and any named person.   The siblings of K were not in care and the parents wanted nothing more to do with K and objected to contact.  They appealed the order successfully, the court finding that neither a person named in such an order (or the person who was living with and caring for them if the named person was a child) was obliged to have or permit the contact provided for.


  1. The exception to this would be if it was the local authority applying for a s.34(2) order; then, the court’s jurisdiction should only be used where the local authority was adopting an inappropriate stance in respect of contact between the child in care and another person. The compulsory effect of a s.34(2) order, providing for the contact which was to be allowed between the child in care and the named person, attached only to the local authority.


  1. The court also found that there was no need for a s.34(2) order requiring the local authority to permit contact between K and her siblings, as the local authority had a duty to promote contact. The court would not make an otiose order.


  1. Furthermore, whilst the child making such an application would be a party, she would not be the subject of the proceedings and so the welfare principle, requiring the court to consider the best interests of such a child, would not apply to the child applicant. Thus, if the court did not consider that contact with the applicant child, was in the subject child’s best interests, no order would be made.


The Inherent jurisdiction of the High Court

  1. As part of its general jurisdiction as a court of superior record and as a trustee of the Crown’s duty to protect all of its subjects, in certain circumstances, the inherent jurisdiction of the High Court may be used to supplement or fill gaps in statutory provisions where this is necessary in the interests of society but should not be exercised in a manner which cuts across the statutory scheme: the Family Court Practice commentary on Re B (A Child) (Habitual Residence: Inherent Jurisdiction) [2016] UKSC 4.


  1. The High Court is prohibited by Section 100(2)(c) of the 1989 Act from making a child who is the subject of a care order a ward of court (vesting custody and control of the child in the Court) however, the duty of the Court under its inherent jurisdiction is to ensure that the child who is the subject of proceedings is protected and taken care of. In these limited and generally more extreme circumstances the Court may in exercising its inherent jurisdiction make any order or determine any issue in respect of a child unless limited by case law or statute. Such proceedings should not be commenced unless it is clear that the issues concerning the child cannot be resolved under the Children Act 1989: Practice Direction 12D, paragraph 1.1.


  1. As well as all of the orders that can be made in family proceedings the court may make a wide range of injunctions for the protection of a child: PD12 para. 1.2. Whilst the circumstances in which it would be appropriate for an application for an injunction to be made in relation to or by a child in care are likely to be very limited, an example can be found in Coventry CC v O (Adoption) [2011] 2 FLR 936, CA when the Court of Appeal upheld, in principle, a decision to grant an injunction, pending the final hearing, restraining a local authority from removing children from a placement with foster carers who had given notice of their intention to adopt the children (although the appeal by the local authority against the granting of the injunction was allowed on another ground).


  1. This option for the child’s voice to be heard is potentially useful, but in practical terms is likely to be of limited application: an application for an injunction would risk cutting across the statutory scheme under the Children Act and unless the behaviour of the local authority was egregious and harmful, the prospects of obtaining an injunction are unlikely to be high.


Independent Reviewing Officers

  1. Once a final care order is made and the Child’s Guardian no longer has a role to play, the Independent Reviewing Officer (“IRO”), who will have been appointed as soon as the child became subject to an interim care order, will have a continuing duty to review and monitor the child’s case on an ongoing basis and to ensure that the child’s voice is heard.[3] This does not always happen. There has been criticism of IRO’s in the case law and by the judiciary on the basis that they have not always fulfilled their functions and have not had sufficient training to appreciate the importance of the proper legal order being in force, nor the potential importance of contact to children in long term foster care: A and S v Lancashire County Council [2012] EWHC 1689 (Fam); https://niromp.org/2017/05/26/in-case-you-missed-it-independent-reviewing-officers-a-better-basis-for-change/.


  1. IROs provide information to children in care about their role and responsibilities, including information about advocacy support, which is not solely for the purpose of complaints but should also ensure the child has a voice.[4]


  1. A serious case review in 2017 concerning the Croydon Safeguarding Children’s Board concluded that Over the years, a narrow focus on a handful of performance indicators has had a significant impact on the LAC (looked after children) Review process and resulted in diluting the core functions of the IRO in the life of the child. As a result, the potential for IROs to make a significant contribution to children’s care plans, and to service wide quality assurance and development, has not been sufficiently realised: Serious Case Review, “Claire”, Full Overview Report, Bridget Griffin, Croydon Safeguarding Children Board, 2017, pp60-64.


  1. Section 23ZB of the Children Act 1989 provides for local authorities to appoint Independent Visitors for a child where it would to be in the best interest of the child and where there has been infrequent communication between the child and their parent or the child has not been visited for a year.  Although an Independent Visitor is not a substitute for an advocate or an IRO, such a person can provide friendship, support and advice. Access to an independent person is something several of our Core Participants have recommended. Ideally such Visitors should be readily available to children given that IROs have not consistently been able to fulfil  their duties to children in care.


  1. At the time Baroness Stedman-Scott raised her concerns she also referred to the possibility of an application for judicial review, although there may be practical barriers to this due to the costs and complexities involved.


  1. A further possibility would be for the child to issue stand-alone proceedings under the Human Rights Act 1998 for breach of his or her Article 8 rights to a private and family life, subject to obtaining the assistance of a litigation friend (required for minors under the Civil Procedure Rules, in contrast to family proceedings, in which “Gillick competent” children can instruct a solicitor) and of course, subject to obtaining public funding.


  1. It is clear that children in care who wish to have a voice in legal proceedings face many difficulties.


  1. From the limited exploration of the issues set out above, it is submitted that children care face difficulties in being able to effectively voice their concerns in legal proceedings even if, when local authority is about to cease to looking after a child, the IRO must ensure that, having regard to the child’s age and understanding, the child has been informed of the steps he or she may take under the 1989 Act and in particular of the right to apply, with leave, for a Section 8 order and, where the child is in the care of the responsible authority, to apply for the discharge of the care order.[5]



Leaving Care


  1. The CPs who suffered childhood sexual abuse while in care faced difficulties after leaving the care system. Many were unsupported and left alone to manage day to day living arrangements, negotiating the benefits system; finding work; managing emotional and mental health problems as a result of their traumatic and/or neglectful experiences and managing substance misuse.


  1. Care leavers are now better supported, and there are support organisations to assist and support care leavers, but the support offered by local authorities is not necessarily always effective.


  1. In September 2017 Barnardo’s published Neglected Minds, a report which considered the mental health needs of care leavers and what could be done to better support them. The Report found that 46% of the Barnardo’s care leaver cases which were reviewed as part of the research involved young people who in the opinion of the personal adviser had mental health needs; 1 in 4 of the case files involved a young person who had faced a mental health crisis since leaving care; 65% of young people whom workers identified as having mental health needs were not currently receiving any statutory service.


  1. Adverse childhood experiences such as abuse, neglect, or witnessing domestic violence can all impact on a child’s developing brain and statistics show this results in much higher levels of mental health problems in this group than in the general population. 45% of looked after children (and 72% in residential care) have a mental health disorder – compared to 1 in 10 in the general population; and looked after children and care leavers are between four and five times more likely to attempt suicide in adulthood4. Despite these worrying statistics, changes specifically aimed at improving the mental health of looked after children have been slow to materialise.


  1. The report also found that despite the fact that the Government had issued statutory guidance aimed at promoting the health and well-being of looked-after children, evidence continues to suggest that assessment of the mental health needs of looked after children is patchy:
  2. https://www.barnardos.org.uk/sites/default/files/uploads/neglected-minds.pdf


  1. In a pilot study carried between 2017 and 2018 by Dr Claire Baker, Head of theBright Spots Programme at Coram Voice, she specialises in research focused on the experiences and outcomes for young people in and leaving care. found that some struggled financially; some felt lonely.  A third of care leavers did not feel their accommodation was right for them, yet official government statistics suggested that 84% were in suitable accommodation:



  1. Since this time the government has announced a further initiative: a Care Leaver Covenant Board, comprised of Secretaries of State from across relevant government departments who will meet three times a year to address the key barriers facing young care leavers. The Care Leaver Covenant, funded by the Department of Education, tackles the disadvantages that young people aged 16-25 face when leaving care and helps them to live independently as they adjust to independent life as adults: finding a suitable, safe place to live, supporting them to remain in education, employment or training, and helping them access appropriate healthcare. It will also look at how to support councils to employ adolescent mental health workers in every leaving care team in the country: https://www.gov.uk/government/news/vital-new-support-for-young-people-leaving-care


  1. What help will be offered to access appropriate health care and what is meant by looking at how to support councils to employ adolescent mental health workers in t clear.


  1. On 9 July 2020 Lord Herman Ouseley was asked about whether the restrictions on children set out in S9 should be removed and said:

You have to have some statutory recognition that if there is a clear belief that children who are in care are almost second-class citizens, in that they have no right of expressing themselves, that that right should have provided to them so that it can be, with advocacy, expressed in a way that reflects their feelings, their experiences, their worries and concerns, in a manner that then can be addressed by those who make decisions, and continue to make decisions, which may have an adverse impact continuing on the lives of those children.” [Transcript p48]


  1. In order for children to have better outcomes after being in care, they need to be able to rely on local authorities to fulfil their duties towards them to a high standard. Regrettably, this was not and is not always the case. We submit that the only way to ensure that local authorities meet the high standards of care that children in their care deserve, then such standards should be enforceable by an overarching body with the power to compel action and impose sanctions for non-compliance.
















  1. The criminal justice system is a very different to what it once was. Much has been done to improve the environment in which children give evidence and the multi-disciplinary and child-centred approach, including the suggestion that psychologists could conduct ABE interviews pioneered by the Lighthouse is very welcome, but for adult survivors, there continue to be real difficulties,  The system suffers from underfunding and the CPS statistics published on 30 August 2020 on rape prosecutions does not give cause for optimism that the Criminal Justice system is working well for victims/survivors of sexual.


  1. After the close of the evidence, on 6 August, the CPs were provided with a letter dated 24 July 2020 and accompanying documents, which had previously been sent to the Inquiry. In the letter the CWJ expressed concern that CPS Gregor McGill’s evidence to the Inquiry on 10 July 2020 in respect of the current CPS practice in the prosecution of sexual offences was so selective as to have provided a misleading picture when he said, among other remarks, that the CPS that the HMCPSI report in December 2019 contained:

an independent finding that our procedures and practices and how we approach these cases is much more successful than perhaps it was in the past.” (letter 24 July 2020, p1)


  1. Dame Vera Baird QC, Victims’ Commissioner for England and Wales wrote to Geoffrey Cox QC, Attorney General, MP, on 30 January 2020 setting out in details her concerns about the CPS approach and the HMCPSI review and stated that: “the simple fact is that the CPS are charging a much smaller proportion of those cases referred to them than previously was the case.” (Vera Baird QC’s letter, p6)


  1. On 14 November 2019 the Law Society Gazette published an article by Melanie Newman into a Gazette investigation into the CPS, which found that the CPS had a conviction rate ‘benchmark’ that had never been made public.  Women’s rights organisations brought a legal action against the CPS in the autumn of 2019, alleging that a covert change in its internal practice was partly responsible.  After an appeal (the legal action having initially failed), the application for judicial review is to proceed.


  1. Ms Newman noted that the CPS had previously denied any change in its approach to charging rape. But admitted to the Gazette that it imposed targets on staff between 2016 and 2018 that were ‘not appropriate’ and may have acted as a ‘perverse incentive’ on prosecutors, deterring them from charging less straightforward cases. Without wanting to state the obvious, historical cases of child abuse are not straightforward so are likely to have fallen foul of such target setting.


  1. The CPS stated that it had dropped all the conviction rate targets in April 2018, two years after their introduction and acknowledged that they were not an appropriate tool to measure its success in bringing the right cases to court – although the CPS’ inspectorate was still using them to measure the service’s performance in May 2019.


  1. Further proof that those who have suffered CSA face difficulties in the criminal justice system can be found in The London Rape Review (“the Review”), conducted by t[6]he mayor’s office for policing and crime (MOPAC) and the University of West London. This looked at 501 allegations of rape made across the city in April 2016, a time when the CPS’ questionable policy was in operation.


  1. The Review found that while 84% of allegations were classified as a crime by the police, in 58% of cases the victim withdrew the allegation. Only 6% of cases reached trial and 3% resulted in a conviction. The average length of time from the date of reporting to the trial outcome was 18 months.


  1. The review further found that a number of key factors exist in predicting whether a complainant will withdraw. The strongest predictors of victim withdrawal were procedural characteristics. For example, withdrawal was 6 times less likely in cases where the victim/survivor participated in a Video Recorded Interview, suggesting that such measures are having a positive effect in that they contribute significantly to rape complaints being carried forward towards a possible conviction.  Another factor highlighted by the Review, which is highly relevant to survivors of CSA in Lambeth, is that victim/survivor mental health, when considered as the sole factor, was a significant predictor of the police deciding to take no further action; however, when controlling for victim/survivor inconsistent accounts, it lost significance, suggesting to the authors of the Review that the relationship between victim/survivor mental health and the police taking no further action was due to inconsistency in testimony (Review p26).


  1. The extent to which, if at all, the Review considered or was in a position to consider whether inconsistency was linked to traumatic experiences is not known, but on behalf of the Core Participants who have suffered traumatic abuse as children, it is submitted that inconsistency and mental health problems as a result of trauma are not necessarily mutually exclusive. An inconsistent account well be consistent with, linked to or caused by a mental health difficulties or perhaps simply the difficulty in recalling and reliving extremely traumatic experiences.   Several CPs have described blocking or blanking out distressing memories: LA-A243 [Thematic Gist table F5]; LA-A323’s witness statement [INQ005688], para. 25; LA-A312 [Thematic Gist table I11].


  1. In giving evidence to this Inquiry on 1 July 2020 LA-A299 (who, after a course of bullying, was anally raped in the playground by an older care resident who appears to have been incited by a member of staff) said:
  2. There’s a lot that I’ve blocked out. There’s a lot that I don’t want to – I’ve never really wanted to remember anything about Shirley, to be honest with you. I have spent a lot of my life trying to push that out.” (P63 Transcript).


  1. Such reluctance is also likely to be a factor in complainant decisions to withdraw complaints. The Review found that victims/survivors’ reasons for withdrawal were complex and often interrelated. There were typically multiple reasons given for withdrawal, one the most common being the stress and trauma caused or exacerbated by the investigation, particularly because of having to talk in detail about the incident (Review pp13-14).


  1. Ultimately, while improvements have undoubtedly been made, victims/survivors of CSA continue to experience difficulties in the criminal justice system.


  1. Emma Harewood, who gave evidence on 28 July 2020, referred to The Children’s Commissioner published report in September 2015 and arising from Ms Harewood’s research, commissioned by NHS England into INQ005455_001 and _004; INQ005454_001 and _003. The Children’s Commissioner said in the introduction:

In England, it is estimated that only 1 in 8 victims of child sexual abuse are identified by the authorities. Children who disclose that they have been sexually abused face multiple interviews with social workers, the police and medical professionals in a variety of settings. Interviews are often the only source of evidence in sexual abuse cases, yet for many children the interviews led by the police do not enable 9 them to provide the best possible evidence. Repeat interviews can be confusing and cause children, particularly young children, to give inconsistent evidence which, in many cases, will lead to the perpetrator not being charged.  Children can be traumatised by having to give an account of their abuse to multiple professionals in multiple locations. They can also then face long waiting lists to access specialist therapeutic support….The current system is not child-centred and does not achieve the best results either for the children or the criminal justice system.”


  1. For all of these reasons, the movement towards a multi-disciplinary one stop approach such as the Children’s House, emulated by the Lighthouse, is welcome and it should be properly resourced, and made available on a nationwide basis.













  1. Victims/Survivors of child sexual abuse are able to bring a claims in the civil courts against a local authority:
  • in tort, on the basis of negligence and/or on the basis that it is vicariously liable for an assault/trespass to the person; or
  • a claim under the Human Rights Act 1998 for Article 8 breaches (see cases referred to in the Children in Care section).


  1. Each type of claim presents a number of difficulties: in summary the Limitation Act 1980 sections 11 and 14 provide for a limitation period of 3 years from the time that the cause of action accrues or the date on which the Claimant knew that he or she had suffered a significant injury. Section 33 of the 1980 Act provides the court with a discretion to allow an action to proceed notwithstanding it is time-barred within the time permitted by ss.11 and 14 of the Act. The discretion is wide and based on the balance of prejudice to the parties but includes all the circumstances of the case. The checklist at s.33(3) provides a structure for guidance to which the court must have regard:
    • the length of, and the reasons for, the delay on the part of the plaintiff;
    • the extent to which, having regard to the delay, the evidence adduced or likely to be adduced by the plaintiff or the defendant is or is likely to be less cogent than if the action had been brought within the time allowed by section 11…
    • the conduct of the defendant after the cause of action arose, including the extent (if any) to which he responded to requests reasonably made by the plaintiff for information or inspection…
    • the duration of any disability of the plaintiff arising after the date of the accrual of the cause of action;
    • the extent to which the plaintiff acted promptly and reasonably once he knew whether or not the act or omission of the defendant, to which the injury was attributable, might be capable at that time of giving rise to an action for damages;
    • the steps, if any, taken by the plaintiff to obtain medical, legal or other expert advice and the nature of any such advice he may have received.


  1. Defendants in such cases are entitled and do raise the statutory limitation defence in such cases so that Claimants alleging historical child sexual abuse in almost all cases are required to seek the court’s Section 33 discretion and have the burden of proving that there were good reason for the delay in bringing a claim. This can present difficulties if for example a Claimant’s is inconsistent in his or her account or if the alleged perpetrator is dead, allowing the Defendant to plead that it would be unable to mount a proper defence to the allegation and thus it would not be in the interests of justice for the case to proceed.  Section 33 cases can also be difficult if the damages to be obtained are relatively modest, as case law suggests that proportionality is a relevant factor to be considered as one of the circumstances of the case.


  1. CN v POOLE BOROUGH COUNCIL [2019] UKSC 25 clarified and re-stated the law on negligence as it applies to local authorities dealing with children. A claimant must prove that he or she was owed  a duty of care by the local authority.  Where his or her case is based on alleged omissions by the local authority, the claimant must prove that the local authority assumed responsibility for him or her.  For example, a local authority could be shown to have assumed responsibility for a child if it issues proceedings and obtains an interim care order and then fails egregiously to protect a child, causing damage.  On the facts of the CN case, the local authority was not found to have assumed a responsibility actionable in negligence.  It not applied for an interim care order.  The children had been assessed as children in need under the Children Act 1989 and a local authority investigation relating to one of the children had taken place under Section 47 and the child was made subject to a child protection plan; but this was insufficient to form the basis for a duty of care.


  1. While CN is a recent decision which is yet to be tested extensively in the courts, claimants who, like many children in Lambeth were “hidden” looked after children; that is, with no interim care order in place, a private or voluntary arrangement in place and/or the child had been left at home in an unsafe situation, are likely to meet a defence that the local authority had not assumed a duty of care and therefore that the claimant has no cause of action.



  1. Human rights Act claims by contrast, do not require negligence to be proved in this way, but with a 1 year time limit for bringing claims (which can be disapplied in certain circumstances) and a damages regime which does not lead to very high awards, the availability for such claims is relatively limited.


  1. Similarly, a Criminal Injuries Compensation claim has a time limit of 2 years, which causes problems for adults who suffered abuse as children and the perpetrator was not convicted.














  1. The CPs welcome the scheme as a positive step in their search for recognition and justice. This is the first local authority scheme of its kind in England.  To date no other English local authority has offered such a scheme.  Without it many victims/survivors would have no recourse to justice.  Damages payments overall are roughly comparable to those that could have been received in a court award of damages, sometimes higher.  It is also right to point out that in our submission there are some limitations to the scheme, of which Switalskis solicitors have extensive experience, at the most recent count representing approximately 26% of Applicants to the Scheme.


  1. The main issues of concern to our CPs are as follows.


Racial Abuse

  1. Mr Verdan QC, counsel to Lambeth Council, has acknowledged that Lambeth recognises that children from black and ethnic minority communities suffered disproportionately in Lambeth’s care. The Inquiry is by now aware that children from minority ethnic groups were subjected to racial abuse by not only other children, but those who had been entrusted with their care.


  1. The scheme recognises that racial abuse an aggravating factor: at para 2.12 it is stated that: “an award for Aggravated Damages seeks to compensate for distress and humiliation caused. This category of damages is awarded as compensation for an individual’s mental distress where the manner in which the abuse has been committed, or the motive for the abuse, has upset or outraged the individual. For example, issues of race or sexual orientation.”


  1. In practice aggravated damages for racial abuse are limited to a 10% uplift which is capped at £10,000. Whilst it is understood that the scheme must be financially viable for Lambeth, it should be recognised that the racial abuse suffered, which in many instances was horrific and linked to the sexual and/or physical abuse of children, caused damage that went far beyond causing upset or outrage.  Although victims/survivors can be compensated under the scheme for long terms psychiatric injury, the effects of racial abuse, which, for many of our CPS undermined their very identities, do not fit neatly into a psychiatric diagnosis.  The damage caused by racism is not necessarily psychiatric, but psychological and all pervasive.


  1. In the circumstances we submit that the cap of £10,000 does not offer sufficient compensation and that consideration should be given to increasing the cap.


  1. Scheme awards for aggravated damages are said to be assessed “in line with common law principles.”. Even if such payments are to be limited to aggravated damages , we submit that  the cap is too low.


  1. Some cases below provide examples of the sort of awards that we submit would be a more appropriate starting point. They involve sexual abuse and not racial abuse, but the individual features of malevolence, cruelty, contempt for those being abused and breach of trust were very much part of the experience for those who suffered both racial and sexual abuse.


  1. AT & others v Dulghieru [2009] EWHC 225 (QB) – a trafficking case involving trafficked women being forced into prostitution in Soho (their brutal treatment included beatings, intimidation and being forced in some cases into having sex with 30 or 40 men a day). General damages awards ranged from £82,000 (£113,535) to £125,000 (£173,000);  aggravated damages of between £30,000 (£41,500) and £35,000 (£48,460) were awarded because the defendants’ conduct was appalling, malevolent, and utterly contemptuous of the claimants’ rights.


  1. We submit that CPs, who were of course children at the time, children were subjected to sexual and racial abuse, which was similarly appalling, malevolent, and utterly contemptuous of the claimants’ rights. LA-A309 is one example of this but her case is not unique.



  1. RAR v GGC [2012] EWHC 2338 (QB): awarded £10,000 (£12,000) in aggravated damages after RAR had suffered “cruel and unusual” sexual abuse at the hands of her step-father between the ages of 7 and 12. This included threats to C, a vulnerable girl, to send her to a children’s home if she did not comply with his sexual demands, from which there was no escape as C was abused in her own home.   The taking of photographs of the claimant in compromising positions caused her additional humiliation and distress. The judge made clear in her judgment that this did not represent a ‘double recovery’ with the general damages awarded at £70,000 (£84,300).


  1. GLB v TH [2012] EWHC 3904 (QB). £67,500 (£79,800) was awarded in general damages for abuse C suffered at the hands of her grandfather between the ages of 11 and 16.  £15,000 (£17,880) was awarded for aggravated damages because the abuse represented an abuse of trust and in recognition of the emotional upheaval caused by the conflict of emotions experienced; the claimant’s grandfather was on the one had nice and kind, and on the other, her abuser. There was also a loss of pride and self-esteem caused by the abuse that was not compensated by way of the general damages award.




  1. A child who was placed in a Lambeth home prior to being in foster care and then suffered abuse at the foster placement has included in his or her award the consequences of damage in both locations.


  1. Damage caused to a child who was in foster care before being placed in a Lambeth children’s home is not included. We submit that while there may be a rationale Behind this stance linked to causation issues , given the egregious and repeated failures by Lambeth to care for its children over decades 1 cannot be confident that the placement of such children Was well thought out and did not cause them damage. In the circumstances we submit that the redress scheme ought to compensate for abuse caused in foster placement whether this was before or after a child was placed in a Lambeth children’s home.



The Melting Pot

  1. We understand that this residential facility was managed and funded by Lambeth but was not a Lambeth home and that the Shirley Oaks Survivors’ Association is asking for it to be included in the scheme. We support SOSA’s efforts in this regard.



North Wales

  1. We have referred to a number of CPs, for example, LA-A311 in the section dealing with Michael Carroll. The evidence before the Inquiry shows that ultimately, Lambeth was responsible for transferring any children out of the area to homes that were unregistered and where they were abused.  We submit that consideration should be given to compensating call participants who, as a result of poor decision making on Lambeth’s part, suffered abuse in North Wales.






Loss of Earnings and Education

  1. This bracket is limited to £25,000. In many cases, is equivalent to a year’s earnings. We submit that whilst it is necessary to be mindful that public funds are involved, this amount is too low.


  1. The Inquiry has heard evidence and received witness statements to the effect that many CPs barely received adequate or any education. Some were unable to read.  The effect on such applicants of such a poor experience of education is not easy to measure but is likely to have had lifelong consequences for their ability to work and earn.



  1. Any applicant who has a complex and/or high value loss of earnings claim is likely to fall outside the scheme and will then have a stark choice of having to stay within the scheme and accept a payment that does not adequately compensate their loss, or to take their chances in a civil claim which, in our experience, will be fought hard on behalf of the defendant, and no guarantee that the claimant will succeed in meeting a limitation defence.


  1. There is, we acknowledge, a support and loss of opportunity component in the scheme but we submit that this cannot possibly compensate for decades of difficulty faced by those who were left, as some were, barely literate.
  2. We therefore invite the Inquiry to consider making recommendations for the scheme to be revised accordingly so that loss of a CPs education is more suitably compensated.


Non-Financial Aspects of the Scheme

  1. This consists of counselling, and for Lambeth residents, advice about housing, benefits and education. Initially, the counselling offered was face to face in Woolwich, South East London and via telephone with the Oxleas Trust, with whom we understand Lambeth entered into a contractual agreement for the provision of counselling services.


  1. On behalf of our CPs we are grateful that, following a meeting attended by some CPs, their legal representatives and Lambeth Council at which Amy Clowrey of Switalskis Solicitors spoke, Lambeth to extend this arrangement and pay for face to face counselling for applicants who live outside Woolwich. There is a condition that they must show that they could not obtain counselling via their GP first.  We submit that this is unfair because of the differential treatment of those applicants who do not live in the Woolwich area, which can result of many months’ delay as they seek a referral and wait to be referred by a GP.  We invite Lambeth to provide for and fund face to face counselling to avoid such delays.





Social care records

  1. Under the schemeapplicants only receive redacted versions of their records.  This contributes to a feeling among many CPs that Lambeth has something to hide from them and fosters feelings of mistrust.  While we appreciate that Lambeth may have concerns about data protection, we submit that the approach to redaction of social care files should follow common law principles.  In accordance with Dunn v Durham CC [2012] EWCA Civ.1654 redaction should be limited to circumstances where Lambeth can show that this is strictly necessary.  Further, provision can be made for undertakings to be given that applicants and their legal advisers will not disclose the documents and that they will be used solely for the purpose of the application.  We invite the Inquiry to make recommendations accordingly.















  1. The Inquiry has heard evidence that although qualified social workers are subject to regulation, care workers remain unregulated. In his oral evidence Lord Patel of Social Care England, acknowledged that Social Work England lacks the power to regulate such a group.  It spears that the ability to do so lies between the Department of Health and Social Care and Department of Education [28 July 2020, transcript p63].  Lord Patel also said that he believed that around 30% of vulnerable adults who suffered abuse were abused by professional carers, so that there was an issue regarding who should regulate this.


  1. He also acknowledged that the data held on social workers was “very minimum, basic data” which would impact on this question [transcript p64]. We submit that it is essential that such workers, who are responsible for caring for the most vulnerable in society, are regulated.


  1. Councillor Edward Davie gave evidence to Inquiry that Elected Councillors have available to them but are not required to undertake training on Children’s Safeguarding and corporate parenting. They should be. Given what has happened at Lambeth, no person elected to a role which includes responsibilities for corporate parenting can ever be allowed to take on such a role without receiving proper training about their responsibilities, including the safeguarding of children.

Duty to Report Suspected Sexual Abuse

  1. There is inconsistency in this country regarding the duty to report child abuse. In England there is no statutory mandatory duty to report child sexual abuse.  In Wales there is a statutory duty on certain public bodies to inform the local authority if they have reasonable cause to suspect abuse and neglect: Section 130 of the Social Services and Well-being (Wales) Act 2014.  In England, certain regulated professionals such as doctors are required by their regulatory bodies to report abuse and government guidance Working Together to Safeguard Children 2018 provides for reporting of suspected abuse by those involved in working with children.


  1. By contrast, in both England and Wales there is a statutory obligation on all regulated health and social care professionals and teachers to report female genital mutilation on female children to the police: Section 74 of the Serious Crime Act 2015.


  1. We submit that these gaps and inconsistencies in the system leave children at continuing risk of sexual abuse and that there should be a statutory duty to report suspected and actual cases of the sexual abuse of children. For reasons that remain Inexplicable to the core participants we represent, many staff who were in a position to assess the risk of sexual abuse.  We acknowledge that in the present day those working with children are more aware of the risk of sexual abuse, but there are recent examples (such as the Rotherham abuse) where the existence of a statutory mandatory requirement to report sexual abuse could have made a real difference to the victims/survivors of child sexual abuse.



  1. Had there been a statutory obligation to report cases of sexual abuse during the time that children were being sexually abused in Lambeth, we submit that it is likely this would have assisted those working with children to focus on and fulfil their safeguarding responsibilities, thereby preventing further abuse. We therefore invite the Inquiry to recommend that those involved in working with children should be subject to statutory mandatory reporting requirements.


  1. The Core Participants we represent remain concerned that over many years, despite repeated Inquiries and inspections, Lambeth continued to fail the children in its care and remained unaccountable for its failures. Such failures are not confined to the past or to Lambeth Council, as can be seen from the case law referred to earlier in these submissions and as the Inquiry has seen, children continued for years to be exposed to the risk of sexual abuse.


  1. Currently there is no overarching local authority regulator or national safeguarding body that is able to compel action and impose financial sanctions on local authorities who are in breach of their statutory duties towards and causing harm to children. For example, the Local Government and Social Care Ombudsman can make recommendations as to a remedy but cannot impose one.


  1. We submit that the time has now come for such regulation. Without this, given the history of repeated failures to protect children on the part of Lambeth and other local authorities, there is a real risk that already disadvantaged children in care or who are on the cusp of going into care will continue to be at risk and worse, to suffer damage.












21 August 2020







[1] The Coroners Rules 1984 (repealed), Rule 56 required such documentation to be retained for 15 years.  Current practice appears to be similar but there is scope for some records to be archived.  Source: The Surrey Council website link to policy on Registration and Coroners: https://www.surreycc.gov.uk/__data/assets/pdf_file/0020/121385/RS16-Registration-Services-and-Coroners.pdf

[2]  https://bit.ly/2ohFiBp or https://hansard.parliament.uk/Lords/2013-10-14/debates/13101422000148/ChildrenAndFamiliesBill


[3] https://nairo.org.uk/about/what-is-an-iro/

[4] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/221761/young_20peoples_20guide_20to_20the_20independent_20reviewing_20officers_20handbook.pdf (See para.3.14)

[5] Care Planning, Placement and Care Review (England Regulations) 2010, regulation 45.

[6] .  (Frances Perraudin, The Guardian Newspaper, 31 July 2019). https://www.theguardian.com/law/2019/jul/31/only-3-of-rape-claims-london-result-convictions-study-says


Switalskis IICSA Lambeth Council summary week 4


27th July 2020 – 31st July 2020

Week 4

Brief overview of witness evidence

Day 18 – Wednesday 29th July 2020

Councillor Edward Davie – Elected member Lambeth Council and Cabinet Member for Children and Young People

Councillor Edward Davie has been an elected Member of Lambeth Council since May 2010 for Thornton Ward. He was designated as the statutory Lead Member for Children’s Services on 22 April 2020, when he was appointed Cabinet Member for Children and Young People. For the previous two years he was Cabinet Member for Health and Adult Social Care and for the seven years prior to that he chaired scrutiny committees including Health and Adult Social Care (2011-2014), Overview and Scrutiny (2014-2018) and Children’s Services Scrutiny (2016-2018).

Councillor Davie provides this statement on behalf of Lambeth Council in respect of the current role of Councillors in the governance and decision-making arrangements in the council in relation to children in the care of Lambeth (MORE DETAIL BELOW)

Dr Emily Phibbs – Clinical Psychologist

Dr Emily Phibbs is a Consultant Clinical Psychologist who has experience of working with survivors of abuse. The Inquiry has asked a number of questions to Dr Phibbs surrounding the impact of child sexual abuse. (MORE DETAIL BELOW)


The Inquiry heard from LA-A61, a survivor of abuse.

Thursday 30th July


Day 19 – Friday 31st July 2020

Core Participant Closing Submissions


Day 18 – Wednesday 29th July 2020

Councillor Edward Davie – Elected member Lambeth Council and Cabinet Member forChildren and Young People

Councillor Davie begins his statement by apologising on behalf of all current Lambeth councillors, to everyone who has been failed by Lambeth Council during the period covered by this inquiry. When a child becomes the legal responsibility of a local authority, they are obviously extremely vulnerable, and it is the legal and moral duty of that local authority to protect and nurture them. He confirms that as the evidence to this inquiry has made clear, Lambeth Council failed many children over decades leading to great harm to them and their families. Childhood trauma of the nature described by brave witnesses to this inquiry has lifetime consequences and has caused terrible damage.

Within his statement he discusses many points such as; governance and decision making, Corporate Parenting and Members Enquiries. In section 2 of his statement he discusses Statutory Responsibility for Children’s Services, The role of the statutory Director of Children’s Services (‘DCS’) and how it has professional responsibility for the leadership, strategy and effectiveness of local authority children’s services and is responsible for securing the provision of services which address the needs of all children and young people, including the most disadvantaged and vulnerable, and their families and carers. In discharging these responsibilities, the DCS works closely with other local partners to improve the outcomes and well-being of children and young people. The DCS is responsible for the performance of local authority functions relating to the education and social care of children and young people. The DCS is responsible for ensuring that effective systems are in place for discharging these functions, including where a local authority has commissioned any services from another provider rather than delivering them itself. Because the role of DCS is politically restricted, it cannot be held by an elected Member. He discusses the Lead Member for Children’s Services and the Working Together policy.

Councillor Davie discusses the Overview & Scrutiny and Assurance of Children’s

Services. He confirms that The Overview & Scrutiny Committees are not decision-making bodies but are designed to hold the Council’s executive (Cabinet) to account. Scrutiny provides backbench (non-Cabinet) councillor with the opportunity to question Cabinet members, senior officers and other statutory partners on their proposals and hold them to account for their decisions and for the delivery of anticipated outcomes.

The Children’s Services Scrutiny Sub-Committee is a scrutiny sub-committee of the Overview & Scrutiny Committee. The purpose of the Children’s Services Sub-Committee is to scrutinise the provision, planning and management of children and young people’s services including children’s social care; safeguarding children, children in care; Special Education Needs and education inclusion; troubled families and the Youth Offending Service; education, learning and schools; youth services; early years; education capital estate; and youth and play services.

In section 5 of his statement he Corporate Parenting Board and confirms that that its responsibility is to monitor and review the quality and effectiveness of all services, delivered by the Council, partner agencies and commissioned services, taking into account the needs of children looked after and care leavers. The Corporate Parenting Board provides oversight to ensure that children looked after and care leavers are effectively supported to reach their potential through the provision of high-quality parenting, education and opportunities to develop their talents and skills and effective support for their transition to adulthood

In section 6 of his statement Councillor Davie discusses the Lambeth Fostering Panel is a statutory panel responsible for making recommendations in respect of fostering matters. Specifically, the function of the Panel is to consider: applications for approval and recommend persons suitability to act as a foster carer, the first annual review of newly approved foster carers, any subsequent foster carer’s reviews referred to it by the fostering service, recommend whether foster carers remain suitable, advise on and monitor the effectiveness of the procedures for undertaking reviews, provide advice on other matters or cases referred to it, to dual approve prospective adopters as foster carers and vice versa to enable permanency, whether a foster carer is suitable to care for a child long term. He confirms that The Panel is not a decision-making body; having considered each case presented, it then makes recommendations to the council’s decision maker. This is currently the Assistant Director for Corporate Parenting who will make the final decision on the matter having regard to the recommendation of the Panel.

He confirms that with respect to cases presented for approval of permanence plans for children to be placed with long term foster carers many documents would be provided to the members in advance of the Panel meeting, some of these include; Childs Permanence Report (known as the CPR) — a detailed profile of the child’s needs completed by the child’s allocated social worker, matching report setting out the rationale and basis for recommending the child be placed long-term with the identified foster carers and; a Support Plan setting out the council’s proposals to support the placement including social work and financial support.

Councillor Davie discusses the training and allowances for Councillors. He confirms after each borough-wide election newly appointed councillors are invited to attend an induction programme where information is provided about specific responsibilities and Committees. There is also an ongoing programme of Member development which continues through the term they are elected. Training is offered for Councillors sitting on the Corporate Parent Board. This provides members with information about their roles and responsibilities as a corporate parent to children who are looked after by Lambeth.

As a Councillor he has attended corporate parenting, mental health, governance and finance training.

In section 8 he discusses relevant partnerships with other organisations and the role councillors play with these organisations.

Councillor Davie concludes his statement by saying that he is relatively new to his respective role and he are currently reviewing a range of procedures and approaches including those related to the safeguarding of looked after children. He intends to make a series of further improvements starting with setting priorities at the Corporate Parenting away-day scheduled for 29 July 2020.

He states that whilst a range of training is offered to newly elected councillors at the

start of the municipal year he wants to ensure that more councillors participate in corporate parenting and safeguarding training by exploring how to make these sessions

He states that they also intend to increase the opportunities for children to make their voices heard and influence decision-making. To support this, Lambeth Council is developing a bid to become a UNICEF Child Friendly Borough in which the human rights and voice of children is paramount. High performing authorities such as Leeds City Council have adopted this model successfully and we intend to learn from them and UNICEF as this approach is developed.

Finally he states that Lambeth Council is committed to doing whatever is required to ensure that Lambeth Council learns from the outcomes of this inquiry. It will implement the recommendations it makes in addition to the current work that it is undertaking to improve safeguarding and wider outcomes of all Lambeth’s children, but most particularly of those they are directly responsible for children who are looked after or who are their care leavers

Dr Emily Phibbs – Clinical Psychologist

Dr Emily Phibbs is a Consultant Clinical Psychologist who has experience of working with survivors of abuse. The Inquiry has asked a number of questions to Dr Phibbs surrounding the impact of child sexual abuse.

Dr Phibbs is asked about the challenges faced by children who suffer from complex needs and/or communication difficulties when reporting abuse and particularly those children in residential care. In response to this Dr Phibbs discusses the ways in which the difficulties faced by children who have suffered abuse are heightened for those children who suffer with complex needs/ communication difficulties. She discusses how an additional difficulty that these children face is the inability of adults to facilitate communication with the child. She explores the importance of adults being willing to learn to communicate with such children. She discusses how children’s needs differ depending on their specific disability. For example, intellectual disabilities, physical disabilities, mental ill-health and trauma.

Dr Phibbs is then asked to comment upon how the reporting of disclosures of sexual abuse by children with complex needs and/or communication difficulties differs from those children who do not suffer such difficulties. It is Dr Phibbs view that it seems highly likely that the reporting of disclosure of abuse is impacted by a high number of these children being unable to communicate in conventional ways which has not been understood by the adults around them. She also discusses how changes in the child’s behaviour (such as aggressive or difficult behaviour) can cause difficulties as the adult may not understand the reasons why the child is behaving in this way and a behavioural response may be given by the adult which places the child in double jeopardy. She discusses how children with additional needs my re-enact aspects of sexual abuse and how the wrong response from an adult can be a further bar to a child being able to communicate their lived experiences.

Dr Phibbs is then asked to comment upon an article she co-authored called “Opening Doors; best practice in therapy when a child might be showing or telling that they are at risk” (Marchant, Fuller and Phibbs 2017). Phibbs explains how this document sets out ways in which children can be safely support to provide further information around possible abuse and barriers that can occur when children makes or seems to make a disclosure or allegation of abuse. She is subsequently asked by the Inquiry to provide best practice advice. Dr Phibbs outlines the range of advice available in order to support children with complex needs when raising concerns about possible abuse.

Dr Phibbs has been asked by the Inquiry to comment upon whether the language used by an adult can impact the accuracy of a child’s account of child sexual abuse. Dr Phibbs discusses the current guidance in place for interviewing children and the importance of carefully questioning children. She gives examples of best practice. Dr Phibbs discusses, in details, the Achieving Best Evidence guidance. This is the guidance that the police use when conducting police interviews.

Dr Phibbs is asked about the importance of understanding a child’s psychological or development condition and the impact that may have on communication skills prior to any interview being undertaken. In response to this question Dr Phibbs discusses the role of police officers and how they cannot be expected to fully appreciate the multiple aspects of child development and psychological that may impact a child witness. It is her view that police officers ought to be able to recognise when they need assistance due to a child’s inability to communicate from other professionals. She discusses how guidance is available for this and the tools, and other resources, available to assess a child’s ability to communicate.  Dr Phibbs goes on to discuss the professional support that the police have access to such as a National Vulnerable Witness Advisor.

Following on from this Dr Phibbs provides details of best practice for preparing to interview a child with complex communication needs and where sexual abuse is suspected and, in particular the use of registered intermediaries and how this works in practice.

Dr Phibbs is also asked what steps can be taken to obtain the best evidence from a child. In this section of her statement Dr Phibbs concentrates on the support available to children post-interview such as when they are giving evidence at court. She refers to the Youth Justice and Criminal Evidene Act 1999 and the special measures used such as, for example, the removal of wigs by judges and barristers and the uses of screens so that the witness cannot be seen by the defendants. She also discusses the use of intermediaries, pre-recorded evidence, evidence by video- link and the guidance available to the courts and advocates for dealing with vulnerable witnesses.

In Part 2 of her statement Dr Phibbs is asked about the abuse of children at Ivy House and Monkton Street which were Lambeth homes for children with complex needs. Dr Phibbs deals with the abuse and communication issues of specific children known to the Inquiry as LA A26 and LA A49.

Dr Phibbs goes on to discuss the a form that a police officer is required to complete following a disclosure of abuse, MG02 Form. She discusses how her understanding is that the form may be the first part of the documentation of a child’s need for special measures within the Criminal Justice system and assists the police with planning. She discusses how the police would need to make enquiries if it is clear at that stage that a child has communication difficulties and how an intermediary may be necessary.

Dr Phibbs is asked whether this ‘assessment prior to interview’ raises any concerns in practice.  It is her view that there is a danger that the information gained for the specific purpose of filling in a form may be privileged over the broader requirement to fully engage with an assessment of a child witness through gaining as much information as possible from those that know a child’s communication well. Dr Phibbs also discusses the implications of undertaking an assessment prior to an interview. She discusses how the police officer undertaking the ABE interviewer may not always be the person who undertook the assessment and so may not know the full information about the child. She is unsure whether these forms are always completed prior to children giving video evidence.

Within her statement Dr Phibbs reiterates the integral role that intermediaries play in supporting vulnerable child witnesses.


















Switalskis IICSA summary week 3



Week 3 – 20th July 2020 – 24th July 2020

Brief overview of witness evidence 23rd – 24th July

Day 14 – Thursday 23rd July

Commander Alex Murray – MPS

Commander Alex Murray has been a servicing police officer for 23 years and has performed roles in most ranks within the police service.

His statement deals with specific matters raised by the Inquiry which are; the development of MPS policies and procedures in responding to allegations of child sexual abuse and child sexual exploitation; and the current approach taken by the MPS to allegations of child sexual abuse and child exploitation.

James Bowler – Ministry of Justice  


Helen Kenward – Children in Lambeth Children’s Home Enquiry (CHILE)


Lord Paul Boateng


Day 15 – Friday 24th July 202

Stephen Bubb – Vice Chair, Social Services Committee, Lambeth Council

Mr Stephen Bubb was elected a Councillor for Clapham Old Town in Lambeth in May 1982. In 1983 he became the Vice-Chair of Social Services and subsequently Chief Whip.

In his statement Mr Bubb provides details of the way of the subcommittee and the way that it operated. He discusses the training and the Role of Councillors, the Brixton Riots and the consequences. He discusses the decision making and conflict on matters such as secure accommodation, fostering and adoption during the period he was employed by Lambeth.

Chris Hussell – Former Social Worker for Lambeth Council.

Chris Hussell was a social worker, and subsequently a Team Leader, in Lambeth in the early 1970’s. He left Lambeth in 1984 to take up another role.

Within his statement he discusses the culture of Lambeth Council and specific events that he was involved in during the period he was employed by Lambeth.

Joan Twelves – Former Lambeth Counsellor (leader of the Council)

Joan Twelves was an elected member of Lambeth Council from 1986 to 1994. She was the leader of the council between 1989 to 1991. She was medically retired in 1994

She discusses her experience in these roles.

Stephen Whaley – Councillor in Lambeth Council 1986-1994 

Stephen Whaley was a Councillor and Chair of Social Services Committee. We have already provided you with a summary of his witness statement which discusses, in detail, the poor state of the Council as a whole and the implications that this had upon the protection of children.

Detailed Summary of Evidence  

Commander Alex Murray – MPS

Summary of the witness evidence provided by Commander Alex Murray.

Commander Alex Murray has prepared this statement to deal with a number of matters related to specific investigations carried out by the Metropolitan Police Service.

Commander Alex Murray has been a servicing police officer for 23 years and has performed roles in most ranks within the police service. His current role is the lead of Central Specialist Crime Operational Command Unit, two of its functions are 1) vulnerability (including Child Sexual Exploitation and Operation Winter Key) and 2) Online Child Sexual Abuse and Exploitation.

His statement deals with specific matters raised by the Inquiry which are; the development of MPS policies and procedures in responding to allegations of child sexual abuse and child sexual exploitation; and the current approach taken by the MPS to allegations of child sexual abuse and child exploitation.

First Commander Alex Murray confirms that the exact remit of; and introduces Operation Winter Key Investigation in that it is to ‘investigate criminal allegations of non-recent child sexual abuse referred to the MPS through IICSA/Operation Hydrant or by other reports or referrals to the MPS where a the allege abuse took place before 2012’;


  1. By people of prominence in public life,
  2. In the context of educational or religious organisations, where it would appear that there is repeated institutional failings.
  3. Within Local Authority premises or within voluntary organisations, where it would appear that there is repeated institutional failings.
  4. Within national and private service organisation (such as the BBC), where it would appear that there is repeated institutional failings or
  5. As otherwise agreed by the Gold Commander.


Operation Winter Key has also taken the responsibility for investigating complaints and allegations of police misconduct arising from MPS investigations of, or responses to non-recent child sexual abuse falling within the above criteria. Operation Winter Key refers any such cases of alleged misconduct to the IOPC.

Commander Alex Murray makes this statement in his capacity as the Commander with responsibility for Operation Winter Key

He discusses the general development of policy and practice between 1963 and 2016.

He confirms that based on the information available which suggests that specialist child abuse teams only began operating within with MPS in 1988. Information suggests that child abuse sexual abuse offences were dealt with by the CID (Criminal Investigation Department) between 1963 and 1988.

He confirms that the approach to the investigation of child sexual abuse allegations changed in 1988 when the CPT (Child Protection Teams) were introduced to the MPS. The aim of the new CPT was to investigation allegations or suspicions of children abuse with the investigations to be conducted within a ‘multi-disciplinary approach (i.e. jointly with social workers from the relevant Social Services Department or with representatives from other agencies).

He discusses the current approach to Child Sexual Abuse and Child Sexual Exploitation from 2016 to present.

He provides details regarding the PNC (Police National Computer), PND (Police National Database), the CRIS (Crime Reporting Information System); ViSOR (Violent and Sex Offenders Register), the DBS (Disclosure and Barring Service).

He then goes on to discuss the current approaches to information-sharing and the process available to police officers.

He discusses the training of officers investigating Child Sexual Abuse and Child Sexual Exploitation in that since 2005 all new police officer recruits have received training of child protection and safeguarding and that since 2015 new police officer recruits have received training on the following; safeguarding children, which includes training on their responsibilities under the Children Act 2004; child sexual exploitation and missing persons.

This training aims to enable new police officers joining the MPS to; take appropriate and proportionate action when they identify a safeguarding issues; to recognise child sexual exploitation; to respond effectively to reports of the same and to effectively investigate and report cases where a person has gone missing. He discusses the specialist training which is now also provided to officers, this is subject to continuous review and improvement.

James Bowler – Ministry of Justice  

Helen Kenward – Children in Lambeth Children’s Home Enquiry (CHILE)

Lord Paul Boateng

Stephen Bubb – Vice Chair, Social Services Committee, Lambeth Council

Summary of the witness evidence provided by Stephen Bubb

Mr Stephen Bubb was elected a Councillor for Clapham Old Town in Lambeth in May 1982. In 1983 he became the Vice-Chair of Social Services and subsequently Chief Whip. However along with 32 other colleagues he was disqualified in April 1986 for refusing to implement major cuts to their budgets.

Mr Bubb provides his personal and professional background.

Within his statement he discussed the Committee System in Lambeth which as the Vice-Chair of Social Services, he sat on all sub committees, included the cases subcommittee. He confirms that he was not involved in setting up the subcommittee as this was already established when he came into post.

He confirms that the subcommittee of social services examined individual cases focusing on the statutory duties of the council for children and young people in care, fostering and adoption, the cases of the subcommittee received recommendations from officers or from the adoption panel.

He confirms that at the time local councils had more powers and duties in relation to the legislation concerning children, but that over time these council social service powers have gradually been reduced. The cases subcommittee was there to consider cases in more detail such as secure accommodation, fostering and adoption than would have been possible in the main social services committee.

In his statement Mr Bubb provides details of the way of the subcommittee and the way that it operated. He discusses the training and the Role of Councillors, the Brixton Riots and the consequences. He discusses the decision making and conflict on matters such as secure accommodation, fostering and adoption.

Mr Bubb confirms that he did not know Michael Carroll or his wife. He believes that he was not made aware that Mr Carroll had a conviction for child sexual abuse nor did he know that they had made an application to foster children.

Chris Hussell – Former Social Worker for Lambeth Council.

Summary of the witness evidence provided by Chris Hussell.

Chris Hussell was a social worker, and subsequently a Team Leader, in Lambeth in the early 1970’s. He left Lambeth in 1984 to take up another role.

He discusses the culture at the council which he describes as ‘liberal/progressive and innovative’ and he talks of how the staff were ‘open minded and non-judgemental’. He explains that it was not until the mid-1980’s that they (likely to be referring to social services/ workers) became aware of paedophilia and that he became aware of the ‘devious and manipulative nature of paedophiles and the need to adopt a more sceptical approach’. He discusses how prior to this he took people at face value.

He does not recall any investigations during the time he was employed. He discusses difficulties in the relationship that Lambeth social care had with the police in that here was a strong difference in culture.

He then goes on to discuss events that he was specifically involved in which relates to the alleged abuser LA-F36, who was dismissed from his position in 1982. The child, then an adult, involved later took his own life. Prior to this they had made a statement to police in 1999. Chris Hussell states that he was no aware of any allegations until he was interviewed by police in 1999.

Chris Hussell discusses how in hindsight it could be considered that they were ‘naïve and too trusting’.

Joan Twelves – Former Lambeth Counsellor (leader of the Council)

Summary of the witness evidence provided by Joan Twelves

Joan Twelves was an elected member of Lambeth Council from 1986 to 1994. She was the leader of the council between 1989 to 1991. She was medically retired in 1994.

Within her statement she discusses the difficulties being faced by the Labour party in the mid-1980s and how many councillors were disqualified from Lambeth due to issues surrounding rate-capping. She describes how 37 of the 40 councillors elected were brand new which caused difficulties as the calibre of experience was mixed.

She discusses how her own interests, experience and expertise were focussed on housing, women’s rights and employment issues rather than social services.

She describes it as a miracle that the elected members of the council were able to survive the turmoil and that the government didn’t intervene. She describes political upheaval.

Joan Twelves discusses how the overall dysfunctional corporate management combined with the elected members collective inexperience may have allowed unacceptable occurrences and practices to go unnoticed and unpunished.

She then goes on to discuss her experience as leader of the council during the years 1989-91. She describes trying to heal many rifts which had developed over the previous three years. She describes shaking up and strengthening corporate management and how she introduced a new regime of prudent financial management. She provides evidence of her progress such as comments from the District Auditor who describes ‘real progress’.

Twelves discusses the effectiveness of Councillors and how some were more effective than others, conflict between Councillors and Officials and industrial action in children’s homes between 1983 and 1984, the ‘same race’ policy  Carroll and the Appleby Report.

She closes her statement acknowledging that not everything she did was done perfectly and she apologises for any mistakes she may have made. She acknowledges that the Council could  have improved about the manner in which they served.

She states ‘it is of great regret to me that I was unable to effect those lasting improvements which I had sought to create.

Stephen Whaley – Councillor in Lambeth Council 1986-1994

Summary of the witness evidence provided by Stephen Whaley:

Mr Whaley provides a statement discussing his role as a Councillor of Lambeth and subsequently as Chair of Social Services Committee. He was a Councillor between 1986 and 1994.

He described how most Council’s at the time were not employed as Councillors and therefore undertook duties in their spare time whereas today the Lambeth Council Leaders and those Cabinet Members are given salaries to enable them to work full-time.

He discusses in detail how there was effectively open warfare in the Council’s Management Team during the time that he was a Councillor. He discusses the culture at the time being difficult due to the political situation and how trade unions had a great deal of influence. He describes major issues facing the Council including the state of the Council’s finances. He describes how the Council’s finances were in an appalling state which led to decisions to close social services and that it had always been expensive.

He notes there are a number child protection issues that he had concerns and he goes onto detail specific instances relating to possible sexual abuse of children. He discusses how he was involved in the setup of the Clough inquiry which investigated events surrounding Michael John Carroll and how he in particular always wondered why Carroll had not been sacked in 1986 and believes the decision not to do so was wrong.

He discusses how when he was the Chair of Social Services he believed he had a reasonable professional working relationship with David Pope. He feels that with hindsight David Pope was selective about the information he provided to Mr Whaley. He notes that when the Clough Report was published David Pope’s employment was not questioned. He believes that this may have been because there was a state of paralysis with there having been three Chief Executive’s within three months.

He describes the major institutional conditions at that time plus the events at Monkton Street and Ivy House.

He goes on to discuss how the many reports recommended change and that Council Officers failed to follow through important recommendations in relation to the protection of children against child sexual abuse. He discusses how there was cross party concern that the commissioning of reports was not achieving any real changes and recommendations.

He also discusses the employment of unqualified social workers.

Ultimately his view is that the Council was in meltdown which impacted its ability to protect children in care homes and foster care homes.


Switalskis IICSA summary week 2


Week 2


Brief overview of Witness Evidence 06-10 July

Day 6 – 06 July

The Inquiry heard from 3 survivors of abuse.

Day 7 – 07 July

Val Suebsaeng (nee Rogers) – Social Worker 1976-1984

A summary of Val Suebsaeng’s witness statement is below:

Val Suebsaeng was a social worker for Lambeth between 1976 and 1984. In 1984 she became a team manager until she left Lambeth Council in 1989.

Her witness statement discusses the culture of the Council and indicates that there was a lot of change throughout the period that she worked for Lambeth. Developments tended to be when new policy was brought into force.

Val Suebsaeng recalls how councillors became more closely involved in individual cases in the late 1980s and how this led to conflict between the councillors and the officers.

She discusses how in the 1980s a Permanency Policy was put in place to try and ensure children were returned to their own families or placed in adoptive families as efficiently as possible.

Val Suebsaeng discusses her knowledge of Michael John Carroll and how she came to be informed of his conviction. She states she was not aware of this conviction until 10 years after she had left Lambeth and he asked her for a reference. She describes how he minimised his conviction and described it as horseplay, as did senior members of the Council. She provided a reference.

She discusses the conversations that she subsequently had with senior members of the Council in relation to Michael John Carroll and the decision made, by senior members of the Council, to give Michael John Carroll a final warning which enabled him to remain at his post as officer in charge of Angell Road Children’s Home.

Val Suebsaeng voluntarily made contact with the police in 2014 and provided a statement regarding her knowledge of Michael John Carroll.


Clive Walsh – Probation officer and local authority social services senior manager; Assistant Director with Southwark Social Services (1978-1985)

A summary of Clive Walsh’s statement is below:

Clive Walsh discusses Clive Walsh worked for Southwark social services department and in around 1987 or thereabouts he received a request from Lambeth to approve Michael John Carroll and his wife as foster carers. His statement discusses how due to the schedule 1 offence he deemed it inappropriate for Mr Carroll and his wife to be approved as foster carers and rejected and denied his request. Within his witness statement he notes that the managers themselves and Lambeth were wholly supportive and approving of Carroll as existing members of their own staff.

He discusses how it was explained to him that Carroll’s wife was not aware of his conviction and he wanted to avoid the embarrassment of her finding out which is why he had not disclosed the conviction.

He notes that Lambeth did not volunteer that Mr Carroll was a schedule one offender was making the request for Southwark to approve him as a foster parent.

Within this statement he refers to a statement that he provided to the police dated the eighth in 2014. In preparing this review I have also reviewed the statement which, apart from that mentioned above, also refers to a meeting between Southwark social services and Lambeth social services in which a politician Janet Boateng also attended and put pressure on Clive Walsh and Southwark to reverse their decision to deny John Carroll as a foster carer.

He also notes that he had a couple of calls from somebody that referred to themselves as Paul Boateng, who would have been Janet Boateng’s husband, and who also worked in politics.

He said that those of the clear impression given was that Mr Carroll had friends in positions of influence and that included Janet Boateng.

He states that during this unusual meeting, which took place at 7:30 PM and was not minuted, it was clear that Lambeth were concerned that another local authority had deemed it inappropriate for Carroll to be a foster carer and the implications that this would have upon their decision to continue to employ him as an officer in charge of Angell Road. It is his view that there must be another reason, other than stupidity, from managerial failure to accept the responsibility and the opportunity to safeguard children in their residential care settings by removing John Carroll from post when his nondisclosure of a schedule 1 offence came to light.


Richard Clough – General Secretary to the Social Care Association (wrote the Clough report)

A summary of Richard Cough’s report is below:

Richard Clough was commissioned to prepare the Clough Report (1993). This statement covers his findings.

Richard Clough was approached in February 1993, as the General Secretary to the Social Care Association, by the London Borough of Lambeth to undertake an independent inquiry into the circumstances of the employment of Mr John Carroll by Lambeth Council and the subsequent application by Mr and Mrs Carroll to foster children in the care of Lambeth Council. He was nominated to undertake this inquiry by the Department of Health. The Terms of Reference (i.e. what the inquiry would look into) were set by Lambeth. The inquiry that he undertook did not relate to allegations of child sexual abuse.

He describes the process of preparing the report and how it was completed in May 1993.

His report discusses Carroll’s conviction and how it should have been disclosed to Lambeth Council when he applied to be the Deputy Office in charge of a Lambeth Council children’s home in 1978 and again when he applied for the post of Officer in Charge of the Children’s home in 1990.  Richard Clough also discusses an anonymous letter which was received by the Senior Care Home Officer of Lambeth Council in November 1994 alleging wrongdoing by Carroll. It was unclear to Richard Clough as to whether Senior Officials took any action about this despite a memo being sent to the Senior Assistant Director of Social Services.

Richard Clough then goes onto discuss the Carroll’s application to foster children (to Croydon in 1986) and how this led to knowledge of his convictions. Carroll was then disciplined in 1986 and received a final written warning. It is Richard Clough’s view that the Lambeth Social Services did not eliminate the risk to children when they had a justifiable opportunity to do so. He believes that the decision not to terminate Carroll’s employment was the root cause of later decisions and actions/ non-actions.

He further discusses Carroll’s further application to foster children in 1987 at a time when Lambeth were aware of his conviction and how Wandsworth were asked to carry out the assessment and allegations that pressure was put on Wandsworth to approve the assessment report as satisfactory, particularly by Jack Smith who was the Chair of the Foster Panel. Wandsworth rejected the application.

Senior Officers of Lambeth Council, including David Pope, then sought to formalise an ‘aunt and uncle’ relationship between the Carroll’s and the 2 boys that they had attempted to foster.

He then goes on to discuss matters leading to Carroll’s dismissal in the 1990’s. Matters which related to unauthorised purchases, falsified overtime claim and other matters.

Richard Clough acknowledges that the recommendations within the report that he prepared ought to have been clearer and that he should have emphasised the importance of ensuring that Warner report recommendations were adopted.

Richard Clough states that he did not become aware of any matters of child sexual abuse in Lambeth when preparing the report and if he had he would have halted the inquiry and brought these matters to the attention of the relevant authorities

He was not aware of Lambeth’s internal investigation into Carroll in 1994 until papers were provided to him as part of this Inquiry.

Lady Janet Boateng – Former Chair of Social Services Committee of Lambeth Council 1982-1986

A summary of Lady Janet Boateng’s statement is below:

Lady Janet Boateng initially worked a volunteer youth worker in Lambeth and Wandsworth in the early 1970’s and then went on to work as a residential social worker in 1977-1978 and as a Deputy House Mother in one of the homes run by London of Borough of Lambeth.

She became very active in the movement for civil rights and racial justice. She sought to address the problem of black underrepresentation at every level of government in the public services and society. She saw how racial injustice impacted upon the lives of young children and their parents.  BAME young people and their families were more likely to be living in poverty, unemployed underachieving or excluded from school and over represented in custodial or institutions. BAME communities lacked a voice and all too often when concerns were raised they were either not heard or not acted on. Lady Janet Boateng wanted to be part of movement to change this and as a consequence became a councillor in Lambeth in 1982.

During her employment she was concerned about the experience of children in residential settings the disproportionate number of BAME children in Children’s homes. The quality of care they received and difficulties in in finding suitable placements for fostering and adoption.  She therefore set up a rota of visits which gave all members of the Social Services Committee the opportunity to visit and familiarise themselves with the establishments.

She recalls a heated meeting involving herself, the Deputy Chair, Stephen Bubb and senior Lambeth Officials including the Director Robin Osmond. This was in relation to her request following a meeting of the Case Sub Committee where an allegation of sexual abuse of a child in the care of Lambeth came to light against an employee of Southwark Council in a secure home. She wanted to meet to discuss the welfare of one of their wards. She recalls the attitude of the Chair of Southwark was extremely defensive and unhelpful, she felt threatened and intimidated. She requested that the Chair pursue this matter and make sure this was dealt with properly. She believes that an employee at that home was convicted of sexual abuse.

She refers to the initial investigation being below an acceptable standard. She does not know if the initial investigation was tainted by corruption, but does confirm that it lacked insight and sensitivity to the parents’ concerns, this again shows that when members of the BAME community raised concerns they were not listened to or acted on.

In her view the second management meeting that the disciplinary proceedings were entirely justified and the fact that the outcome of the proceedings in not upholding the disciplinary complaint was unsatisfactory and a matter of grave concern.

She had seen the consequences of ignoring the significance of ethnic identity and culture on children in residential and institutional settings and in placements. The availability of appropriate food and hair care products and knowledge as how to give a child a sense of positivity with a regard to appearance  were overlooked in placements at the time and staff were often ignorant of these matters as well as being ill equipped to cope with a child’s needs. Others were in denial as to the significance of these matters. The placement of BAME children in rural settings with families from different ethnic backgrounds without support often left them ill-equipped to deal with racism and racial disadvantage.

After a national confrontation between Labour led Local Authorities and Conservative central government which became known as the Rate Capping Rebellion, she was part of the 32 members who declined to set a central government cap rates as this would mean cuts of £113 million from already stretched budgets including that of social services. She was therefore disqualified from office in 1986 and had no further involvement with Lambeth council.

Dame Heather Rabbatts (DBE) – Former Chief Executive of Lambeth Council 1995 – 2000 (witness statement awaited)

Day 8 – 08 July

David Pope – Director of Social Services (appointed 1988-1995).

Summary of the witness statement of David Pope:

David Pope began working at the London Borough of Lambeth in 1975 as Social Work Team Leader. He continued to work for Lambeth until in 1988 he was appointed as a Director of Social Services. He left Lambeth in 1995 after the Appleby Report was published. He agreed to accept voluntary redundancy. This was based on a projected overspend on the adult social care budget and the need for a change in leadership.

The statement discusses and the culture within the Council, which he describes as radical, in light of the political changes in the early 1980s and that it was highly stressful and continually difficulty situation attempting to change service and delivery. He discusses the long-standing and ongoing problems in providing services of high quality. This is despite the hard work of staff

and effort of staff involved. He describes how Lambeth was one of the most deprived boroughs and there were issues recruiting and re-training qualified and un-qualified staff. There were financial issues, budgetary constraints, media criticism and other issues which led to issues. He goes on to discuss the overview of management and how the committee structure worked. He discusses training recruitment and retention.

He states he was not aware of John Michael Carroll’s conviction for sexual abuse prior to Carroll’s disciplinary proceedings. He discusses how the fact that Carroll had failed to disclose his offence during his period of employment with Lambeth, while serious, was not the purpose of the investigation. The primary focus was to see whether his previous conviction had any bearing on the safety of children in their care. Ultimately it was concluded that the investigation and the information presented to the panel corroborated what Carroll had said. It was therefore decided that he would be given a final written warning.

He also discusses Angell Road and Carroll’s application to foster.

He then discusses schedule 1 offences generally and states that Lambeth did not have a specific policy in relation to the employment of schedule 1 offenders in 1992. Local authorities at the time would take offences into account and not use them as an automatic disqualifier.

He then goes on to discuss various reports which looked into abuse in Lambeth and particularly a report regarding South Vale (Zephyrine Report). He indicates that with hindsight it may have been that had the inquiry spoke to children then evidence in relation to Les Paul may have come to light sooner. He goes on to discuss the Barratt Report and the Appleby Report which ultimately led to him taking voluntary redundancy.

Clare Whelan – Councillor on Social Services Committee

Summary of the witness statement of Claire Whelan OBE:

Claire Whelan was a Councillor for Lambeth between May 1998 and 2014. She has held various other posts but during her time as a Councillor for Lambeth she was immediately appointed the Conservative Spokesperson for Social Services. When she was appointed she had major concerns about child sexual abuse and the running of the children’s homes. This followed the report from the manager of the Council’s children’s homes, Robert Morton, who prepared the Morton Report.

Following this repot she requested an immediate inquiry into the allegations made in this report. This did not happen. She continued to have an interest in the children’s homes in Lambeth and notes that it was her long-standing view that, given Lambeth’s records, they should not be running children’s homes at all.

She then discusses specific children’s homes such as South Vale and her concerns.

She discusses how she put a report together in relation to the Melting Pot, which was not a Lambeth run home although funded by Lambeth, and how she took all of her papers to be the Social Services Inspectorate in 1991 seeking an inquiry. In 1992 there were further allegations about sexual abuse in Lambeth homes and that this came to Councillors attention via the press rather than Council Officers which was inappropriate.

Later, in 1991 the Social Services Inspectorate carried out an inspection of child protection services at Lambeth as part of a rolling programme but they were not specifically looking at the management of Lambeth children’s homes or the abuse of the children at the hands of professional carers. That being said the report found major concerns of Lambeth social services and it noted that there was delay in investigation, conferencing and programming. She notes that the Inspectorate also criticised Lambeth’s policy of removing the requirement to have professional social work qualifications to achieve the recruitment of black staff. She notes how the Council’s process to improve discrimination policies had unintended negative consequences and ultimately the care and safety of children at risk should have been given top priority.

She goes on to discuss Stockwell Park children’s home and incidents that occurred at Monkton Street and Ivy House, Angell Road the various reports that were commissioned to look into the situation in Lambeth children’s homes.

She discusses the culture of Lambeth and describes in detail how it was dysfunctional.

It is notable that throughout this witness statement, Claire Whelan provides a number of exhibits to her statement which highlights that she was trying to push Lambeth to take the issues of child protection seriously. There are a number of communications between Claire Whelan and senior members of the Council and she discusses how she received a number of people coming to her as whistle-blowers. She notes on at least three occasions she handed over information to law enforcement investigations.

Overall Claire Whelan’s statement provides strong evidence that she tried to raise the issue of child sexual abuse and the protection of children in Lambeth throughout her time as a Lambeth Councillor.

Anna Tapsell – Employee of Lambeth Social Services (1978-1989); member of Lambeth Council (1990 – 1998)

Summary of Anna Tapsell’s 1st statement is below:

Anna Tapsell initially joined Lambeth as an Assistant Carer in 1978. She continued her employment with Lambeth as well as being actively involved with trade union and the Labour Party until 1989 when she retired on medical grounds. She was then persuaded to stand to be elected to the Lambeth Council in 1990 and she was successful. She sat on various committees and ultimately became the Chair of the Social Services Committee in around 1993.

She discusses how when she became a Councillor she became aware of Michael John Carroll’s schedule 1 offence in around 1982. She questioned David Pope, the Director of Lambeth Social Services, about this and indicates that he downplayed the incident as horseplay. She described how she was on the Appeal Committee to hear John Carroll’s appeal against his dismissal in 1991 for fraud offences and to her it seemed there was a pattern of behaviour that was not a good practice of childcare.

Anna Tapsell discusses how thereafter David Pope told her that she was to prepare a sensitive piece of work for the children of Angell Road. This was to see if the children had any problems as a result of being at Angell Road. She was also to approach the staff. Despite her chasing progress reports it appears this work was never completed.

She confirms she approached the Social Services Inspectorate and asked them to force Lambeth to undertake an independent inquiry to establish why Carroll had continued his employment in child care after Lambeth became aware of his conviction. She was unsuccessful with this as they felt it was not appropriate. She also approached the Metropolitan police.

As she was not getting anywhere she leaked the story to the press. After the report appeared in the newspaper the Minister of Health and Social Services ordered an inquiry.

She also discusses how she spoke to other people including Elizabeth Appleby (who prepared the Appleby Report) and told the Chief Executive of Lambeth Council about her concerns.

According to Anna Tapsell, David Pope made further disclosures to her in around 1993 about another girl who alleged that Carroll had sexually abused her. She told him the allegation needed to be thoroughly investigated.

Anna Tapsell then covers her knowledge of Carroll’s adoption application and notes how Lambeth were compromised because of the earlier decision which they had made (not to sack him) which declared Carroll a fit person to care for the most vulnerable children.

She discusses how a social worker was threatened with disciplinary proceedings when she refused to place any other children with Carroll.

She then goes on to discuss concerns that other people raised in relation to John Carroll.

Anna Tapsell then goes on to provide a further statement which provides further clarification as to the above and looking more closely at the committee system and the political atmosphere. She goes on to state ‘the bureaucratic gap between town hall based, high status officers and those responsible for the care of children in particular is unjustified and dangerous’.

She further discusses Janet Boateng and, what she describes as, ‘entirely inappropriate’ interference in individual cases and additional information regarding her knowledge of Michael John Carroll, various reports, the Paedophile Information Exchange and police investigations including into the production of child pornography.

She also touches on her knowledge of Steven Forrest against whom allegations of child sexual abuse have been made.

Day 9 – 09 July

Lord Herman Ouseley, Former Assistant Chief Executive, Lambeth Council

A summary of Lord Herman Ouseley’s statement is below:

Lord Herman Ouseley held a variety of posts over his career but notable to this Inquiry he was the Assistant Chief Executive of Lambeth between 1984 and 1986 (for 18 months) and the Chief Executive of Lambeth between 1990 and 1993.

Lord Herman Ouseley indicates that on both occasions he left Lambeth as he felt unable progress was not being made. He also notes political and management turmoil across the Council in the 1980’s. He is unable to provide much information regarding issues relation to child protection and child abuse as he had little involvement with the social services directorate. He indicates he had no knowledge of Michael John Carroll during 1984-86 and between 1990-93 matters relating to Carroll passed by him. He spent most of his later years of employment dealing with issues of corruption.

Lord Herman Ousely discusses the difficult financial situation Lambeth found itself in which had direct impact on directorates such as Social Services and how decisions were often driven by directorate interests and “protectionism”. He gives examples of this. He discusses his frustrations about the number of reports about cases and system failures and how recommendations for action were being led and implemented, or not and how there was a culture of initiating inquiries and investigations into serious complaints rather than prioritising the implementation of best management practices.

Finally, he outlines the harassment/ personal attacks that he faced such as threatening calls in the middle of the night, smashed windscreens and slashed tyres.

David Staples – United Grand Lodge of England (Freemasons)

David Staples is the Chief Executive Officer and Grand Secretary of the United Grand Lodge of England. He provides an overview of how the Freemasons operates on an international, national and local level.

He discusses Freemasonry in Lambeth and particularly how there is no record of Freemason meetings taking place at a place called “Town Hall” or “Lambeth Town Hall”.

The Inquiry provided a list of names to the Grand Lodge who are persons of interest to the Inquiry. David Staples describes how he was not able to identify any persons on this list as a Freemason. Further searches found that 1 person, who was employed by Lambeth, may be a Freemason and they resigned from his Lodge in 1988.

David Staples also discusses the outcome of the Harris and the Appleby Reports.

Dr Nigel Goldie – several senior roles in Lambeth Council (1990 – 1999), appointed Assistant Director of Corporate Strategy & Quality

Gillian Delahunty

Day 10 – 10 July

Dr Clive Driscoll – Former Detective Inspector with the Metropolitan Police Service (MPS)

Richard Gargini – Former Commander with the Metropolitan Police Service (MPS)

Crown Prosecution Service – Gregor McGill





























Switalskis IICSA evidence summary week 1


Brief overview of Witness Evidence 29 – 03 July


01 July – The Inquiry heard from 4 survivors of abuse.


02 July 2020 – Annie Hudson, Outgoing Strategic Director of Lambeth Children’s Services (summary here):

Review of the First Witness Statement of Annie Hudson

Strategic Director for Children’s Services




Ms Hudson explains her role as the Strategic Director for Children’s Services in that she has statutory responsibility for the Council’s services for children in care. She has held this position for 4 years since May 2016.  She states that Lambeth Council recognises that it failed children who were in care in Lambeth Care in the past and that the consequences of children abuse and neglect are profound and life altering for individuals. She highlights the fact that a number of internal and external investigations were set up for the purpose of examining particular service failures. These clearly indicated that there was a continuing failure to ensure that children were protected and it is clear that the Council did not respond robustly and systematically to address the underlying risk factors and identified causes.

Annie Hudson apologises unreservedly on behalf of Lambeth Council to all of the former children in the care of the Council who were failed so badly by the Lambeth Council.

She confirms that the Council was entrusted with the care of the most vulnerable children and those who experienced harm and abuse whilst in care of the council were failed so badly by Lambeth, there were systematic failures to safeguard children in Lambeth’s care and these vulnerable children were placed in harm’s way.

She acknowledges the courage that survivors have shown in coming forward and sharing their experiences. She mentions that fact that not all survivors were believed in the past and confirms that the Council have taken a number of steps in order to address this failure and to acknowledge the experiences of those in its care.

Lambeth Council have accepted responsibility for the abuse and neglect that occurred at Shirley Oaks and other Children’s Homes managed by the Council. Lambeth Council hopes that the steps taken demonstrate its unequivocal commitment to acknowledge and seek to address past failings.

She recognises the importance of this Inquiry in examining the nature and extent of past failing and in identifying any lessons that might be learned and in highlighting what can be done to ensure children are protected from such harm in the future.

There are many exhibits referred to in Ms Hudson’s statement and these are all available to Core Participants should they wish to view them

Summary of Sections in the Witness Statement

The statement considers the arrangements and culture of Lambeth Council (section 4). This includes an explanation of the Council Committees that were responsible for Lambeth’s children’s homes between 1965, when Lambeth Council was created, and 1995, when the last mainstream children’s home closed. It also describes the decision making structures in place over this period for managing Lambeth’s children’s homes. Lambeth recognises that its political and corporate culture during the period it managed children’s homes was at times chaotic and problematic, and acknowledges with deep regret the poor and inconsistent quality of governance of Lambeth’s children’s homes over this period The Council acknowledges that there were significant failures of leadership and governance at both political and officer level during this period and accepts that the prevalent culture at times was not conducive to promoting the welfare and safety of the children in its care. Although many of the problems Lambeth encountered were shared by other local authorities, even by the standards of the time, the culture in some of Lambeth’s children’s homes was harsh, uncaring, and hostile which created an environment where the risks to children were likely to have been increased.

A short introduction is then provided to each of the children’s homes to be considered in the case studies: Shirley Oaks; South Vale Assessment Centre; Angell Road; Ivy House and Monkton Street children’s homes (section 5).

This is followed by a summary of the employment and prosecution history of convicted perpetrators, acknowledging that management failings almost certainly contributed towards creating an environment in which dangerous and dysfunctional cultures could and did develop, with serious consequences for the Council’s ability to safeguard and protect children in its care (section 6).

Section 7 of the statement sets out the omissions and mistakes that were endemic to Lambeth’s approach to internal visits and inspections of its children’s homes. By March 1993, when the Social Services Inspectorate (SSI) inspected three Lambeth children’s homes, the required Member and officer visits were not being undertaken regularly. To compound this, Lambeth’s own Inspection Unit failed to inspect the Council’s children’s homes, placing the Council in breach of its statutory responsibilities. The Council accepts that the level of oversight provided by elected Members and senior managers in relation to internal inspections and visits to children’s homes was inadequate.

In Section 8 of the statement she discusses Lambeth’s approach to equal opportunities, particularly in relation to race, and the consequent impact upon service delivery, recognising a paradox at the heart of Lambeth’s approach to such issues. Despite being ahead of other local authorities in its commitment to try to combat inherent racism within society in the 1970s and early 1980s, by the late 1980s and early 1990s Lambeth’s progressive equal opportunities policies and procedures did not result in improved practice within children’s homes, particularly in relation to meeting the needs of black children and their families.

In her statement Ms Hudson then goes on to address the recruitment, vetting and development of staff working in Lambeth’s children’s homes, accepting that Lambeth’s failings in relation to consistently carrying out the necessary checks, and inconsistencies in following its own recruitment procedures, would have increased the risks to children in its care. The high turnover of senior managers led to informal ‘acting up’ to senior roles, creating instability which exacerbated Lambeth’s recruitment difficulties. In the late 1980s and early 1990s Lambeth’s policy of waiving qualification requirements for field social workers, although ensuring a workforce that better reflected a diverse local community, resulted in a proportion of the unqualified workforce that did not necessarily have the skills required to identify and respond to signs of child sexual abuse. External inspections by the SSI in the early 1990s also highlighted a lack of professional supervision of field and residential social work staff, compounding the overall poor quality of practice. The Council recognises that there were failures in the arrangements in place for recruitment, vetting, training and supervision of staff during the time when Lambeth operated its own children’s homes.

In Section 11 Ms Hudson summarises the history of Lambeth’s Fostering Service, including a recognition that by the late 1970s Lambeth had proportionately fewer children in foster care than other local authorities. It also describes the significant failure of the Fostering Service to carry out pre-approval checks of foster carers in the 1980s and 1990s, and summarises available information about allegations against foster carers. It is acknowledged that there were significant failures in the Fostering Service.

The statement also covers what the Council has been able to discover about any deaths of, or serious injuries to, children in its care placed in children’s homes (section 12). Before considering the internally commissioned investigations and inquiries, the statement acknowledges Lambeth’s inability to put into practice the learning from the various national inquiries and reports relating to children in care published between 1987 and 2000 (section 13).

Lambeth commissioned at least eight separate internal inquiries between 1985 and 2000. The first of these, Ivy House, consisted of two management investigations and a formal inquiry into allegations of child sexual abuse in relation to a child who received respite care at Ivy House in 1985 (section 15). The next report was the Investigation into Allegation of Child Sexual Abuse’ which looked into allegations of child sexual abuse at Monkton Street children’s home in 1987 (section 16). The ‘Report of the Enquiry into South Vale Assessment Centre,’ otherwise known as the Zephyrine Report, followed in January 1990. This Report investigated the operation and management of South Vale, including allegations of racism, sexism, poor childcare practice and inadequate management. The Report made a number of recommendations, including the temporary closure of South Vale (section 17).

‘An Independent Inquiry Commissioned by the London Borough of Lambeth’, referred to as the Clough Report was published in 1993. This Report considered issues surrounding the employment of a convicted offender and the management of the care of two boys he had applied to foster. Lambeth’s conclusion from reading this Report is that staff interests were prioritised over children’s needs. (Section 20)

The ‘Investigation into Alleged Breaches of the Council Equal Opportunities Policy in the Housing Directorate’, known as the Harris Report, including allegations about pornographic material being circulated among Housing officers and elsewhere. The Report, published in 1993, demonstrated an oppressive culture within the Housing Directorate, including failure to address serious allegations of harassment, particularly against women and black staff. This Report sheds light on the dysfunction and wider culture in Lambeth at the relevant time. (Section 23)

This was followed by the ‘Inquiry Report of Miss Elizabeth Appleby QC’, known as the Appleby Report, published in 1995, which exposed the dysfunctions which existed within Lambeth Council during the 1980s and early 1990s. The Appleby Report reveals a catalogue of systemic structural, cultural, financial and organisational failings, which partly explain why Lambeth Council was incapable for a lengthy period of time of making improvements, and provides evidence of a prevailing culture which protected staff to the detriment of service delivery. Appleby referred to Lambeth at that time as, “an appalling financial and administrative mess with non-existent or incompetent management” (Section 24)

The final report discussed in this section is the ‘Events and Circumstances Associated with Changes to Services at a Home Providing Residential Respite Care for Children with Disabilities’, known as the Evans Report (2000), which investigated events at Chestnut Road respite home for children with disabilities. The Evans Report highlighted the failure of Lambeth’s own Inspection Unit to inspect Chestnut Road children’s home, and raised serious concerns about the perceived conflict between the necessity to protect the needs of children and the employment rights of staff.

The reports generated by these investigations and inquiries demonstrate that Lambeth was determined to explore the reasons underlying service failure but despite the numerous useful recommendations, there is little evidence to demonstrate that these recommendations were consistently implemented. It is therefore unclear what Lambeth learned from these eight reports as the Council appears to have been unable to put in place, and sustain, the changes required to keep children safe.


The Lambeth of 2019 is a very different place to that of the 1970s, or even the 1990s. Child care practice has moved on considerably over this time, both nationally and in Lambeth. Since 2015 the Council has been on a steady improvement journey; the Lambeth of today is fully committed to learning the lessons of the past and doing everything in its power to reduce the risk of child sexual abuse to all children, including as corporate parent to children in the care of the council (section 34).


The review of the documents discussed in this statement has led the Council to conclude that the institutional failings within it can be categorised into four overarching themes. These are:

Firstly, the lack of leadership and failure of governance at both political and officer levels, compounded by the political legacy, financial pressures and the rapid turnover of senior staff as evidenced in the Appleby, Harris and the Barratt reports.

The second theme is the overall poor quality of practice, both within Social Services for children and more broadly across the Council, in such areas as Personnel Management/Human Resources. This is illustrated by the South Vale Report, the Barratt Report, and others, as well as examples of failures to discipline staff properly.

The third theme is that of the inadequate recruitment and vetting practices adopted by Lambeth over the years when the Council operated its own children’s homes, as documented in the Clough Report among others.

The final theme is the Council’s inability to implement the recommendations from investigations, inquiries and inspections, leading to failure to effect any meaningful change.

Lambeth Council apologises for these historical failings, recognising that the problems of leadership and governance, and consequent poor quality of practice that characterised this period in its history, had lasting consequences for many of the children In its care.


02 July 2020 – Dr Anne Worthington, Former Social Worker in Lambeth Council

Dr Anne Worthington discusses the difficulties facing social service departments in the 1980’s and particularly criticises the police who she states, with hindsight, were ill equipped to deal with allegations of child sexual abuse and particularly children who suffered from learning difficulties. She discusses incidents at Monkton Street and Ivy House.

03 July 2020 – Dr Josephine Kwhali, Former Day Care Officer and Assistant Director for Children and Young People for Lambeth Council.

Dr Josephine Kwhali discusses her employment as a black woman in Lambeth in the 1980’s and the difficulties she and others faced. She discusses incidents at Monkton Street and Ivy House. She also discusses the council’s employment of Michael John Carroll and criticises the police and the council for not being aware of his conviction for sexual assault and criticises the council for their attitude towards his conviction when they became aware, which she states was minimised.

03 July 2020 – Milius Palayiwa, Senior Officer in London Borough of Lambeth 1984 -1993.

In 1986/87 Milius Palayiwa was the Chair of the committee which prepared the Interim Report which reviewed the policies, procedures and practices in place at the time. It is often referred to as the Theaker Report. This report was never published. Milius Palayiwa criticises Lambeth council for this and notes that the police and/or the Social Services Inspectorate could have intervened and did not do so.

03 July 2020 – Robin Osmond, Director of Social Services, Lambeth Council (1977-1988).

This statement has not yet been published. As soon as it has been published a summary will be provided to you.

03 July 2020 – Phyllis Dunipace – Labour Councillor 1986-1990; Chair of Social Services Committee 1986 – 1988; Deputy Leader of the Council 1989-1990; Advisory teacher in Education Dept 1994-1997.

Phyllis Dunipace discusses events which took place between 1986 and 1990 when she was a Councillor. She discusses the difficulties facing social service departments in the 1980’s and the concerns that Councillors had about the quality of social work at the time. She also discusses incidents that took place at Monkton Street, Ivy House, Angell Road and her knowledge of Michael John Carroll.




On 2nd July 2020 he Inquiry heard from Dr Anne Worthington, Former Social Worker in Lambeth Council.

A summary of Dr Anne Worthington’s witness statement, dated 15 May 2020, is below:

Dr Worthington’s statement discusses her involvement in events associated with Ivy house and Monkton Street. She indicates that the Inquiry specifically asked her about events between 1985 and 1987.

The statement discusses how, in Dr Worthington’s view, the council and the police responded to allegations of abuse. She did not have the impression that the allegations were minimised or dismissed. Dr Worthington states that she had no concerns or knowledge about possible inappropriate involvement in ‘political figures or freemasons; about ‘paedophile rings’ or the distribution of pornography; about bullying or harassment or about corruption generally either during her employment with Lambeth social services or subsequently. She states with hindsight that in those days the police were ill equipped to deal with such an allegation by a person with learning disabilities.

She describes how the social services team were similar to any other local authority at the time and in that the culture was relatively hierarchical. She describes how there was a tendency for those needing support from the council to be seen as objects of concern rather than citizens treated as valued customers. She describes how social workers, like herself, were relatively junior and their role was to advocate for, and be on the side of, those they supported. She acknowledges that time has moved on since then. Dr Worthington describes how in the 1980s most council employees were white and that this was not addressed at an institutional level. This is despite the population of Lambeth being very ethnically diverse. She describes a significant amount of racism. She described how the power dynamics between men and women were less balanced than today. How those with severe learning difficulties and problems communicating were less understood and how council staff would not have come across profound learning difficulties in challenging behaviours that were common at Ivy house and Monkton Street. She does not doesn’t recall any specific training in being the recipient of allegations about the sexual abuse of children with disabilities.

She goes on to discuss the management inquiry’s at both Ivy House and Monkton house which arose following allegations of child abuse, along with disciplinary proceedings, but is able to provide much information about these topics due to her limited involvement.

Day 5 – 03 July

The Inquiry will hear from Dr Josephine Kwhali, Former Day Care Officer and Assistant Director for Children and Young People for Lambeth Council.

A summary of Dr Josephine Kwhali’s witness statement is below:

Dr Josephine Kwhali started work for Lambeth social services in 1983. She gives an overview of her experience as an employee of Lambeth. She discusses how she was one of the new black staff members recruited following the publication of the Scarman Report in November 1981 into the causes of the ‘Brixton Riots’ earlier that year. She indicates she therefore felt she faced challenges due to her race. She sensed the attitude of the ‘old guard, new guard’. She describes the period being a difficult one politically and recalls 31 Councillors being expelled and a large group of new and largely inexperienced councillors elected in their place. Social workers and their managers devoted considerable time to hearing evidence at the inquiry into the death of Tyra Henry and responding to the report findings and subsequent press interest. She describes therefore competing pressures. She describes feeling ill equipped and unsupported to meet demands. She decided to leave Lambeth and take a break from the profession.

The statement discusses how in the 1980s, which is when she first into practice, child sexual abuse by staff members was relatively unheard of and how child abuse did not feature in social work qualifying courses.

She describes how there was a hierarchy within the Council and an environment where decisions by those in power would not have been challenged your questioned. She talks about the unease she felt and about her concerns which included unqualified staff, entrenched attitudes, lack of training opportunities and limited accountability. She describes the 80’s as being a ‘sea of change’ within social services with more issues being exposed and changes being made.

Dr Josephine Kwhali discusses the allegation of sexual abuse that happened in Ivy house and describes how the initial inquiry was inadequate which led to a second inquiry. She was asked to join the panel during the second inquiry she describes how the second panel 100% believed that the young person had been abused within Ivy House but this was not the outcome of the disciplinary proceedings.

Dr Josephine Kwhali goes on to discuss issues surrounding Angell Road and Michael John Carroll, noting that she was not aware that he had a schedule 1 conviction.

She questions why Carroll’s schedule 1 offence was not identified by the police at his appointment and why reporting systems were so poor as to allow schedule 1 offender to secure work in childcare initially.  She discusses how, when senior members of Lambeth Council became aware of Carroll’s conviction it was played down as a minor and historical offence.

The Inquiry heard from Milius Palayiwa, Senior Officer in London Borough of Lambeth

1984 -1993.

A summary of Milius Palayiwa’s witness statement is below:

This witness statement discusses the set up of ‘An Independent Inquiry: To Review the Procedures for Dealing with Allegations of Child Sexual Abuse in Establishments run by the London Borough of Lambeth’ (The Independent Inquiry). This report, which was unpublished, is often referred to as the Theaker report.

In describes how the independent inquiry was set up in 1986 by the Chief Executive following the Ivy house case. Millius Palayiwa was the Chair of this Inquiry.

Describes how in the first instance the inquiry limited itself to reviewing policies, procedures and practices in place at the time. The result the a production of an Interim Report that dealt solely on reviewing the procedures for dealing with allegations of child sexual abuse and establishments run by the London Borough of Lambeth.

The witness statement discusses that there was a failure to adopt and implement the recommendations of the report and how this was regrettable a missed great opportunity. He outlines his understanding of why the report was withdrawn which was essentially objections from other committee members. He has recently come to understand that a conflict of interest was raised. He states that both the police and the Social Services Inspectorate in 1987 could have asked and put pressure on the London Borough of Lambeth to release the report and ask for an explanation for the non-release of the same.

The Inquiry heard from Robin Osmond, Director of Social Services, Lambeth Council (1977-1988).


The Inquiry heard from Phyllis Dunipace – Labour Councillor 1986-1990; Chair of Social Services Committee 1986 – 1988; Deputy Leader of the Council 1989-1990; Advisory teacher in Education Dept 1994-1997.

A summary of Phyllis Dunipace’s witness statement is below:

She explains her role as Councillor in Lambeth Council and events which took place between 1986 and 1990. She discusses how there were a number of issues at that time but particularly the Council was struggling to deal with race issues following the ‘Brixton Riots’ in 1981 and 1985 and the murder of Tyra Henry, who died as a child in the care of Lambeth on 01 September 1984.

Phyllis Dunipace discusses how Councillors were concerned about the quality of social work practice and were keen to promote fostering and adoption rather than Looked after Children being in children’s homes. She describes poor systems and processes and how Lambeth, as a Local Authority, had a poor reputation which meant that it was difficult to recruit and train staff with appropriate level of qualifications. She was in favour of recruiting unqualified staff and giving them limited roles with supervision and training. She wanted there to be better training of staff so that allegations of child sexual abuse would be handled appropriately.

The witness statement covers abuse which took place at Monkton Street, Ivy House and Angell Road.

In relation to Monkton Street she describes how she has been asked about her recollection of investigations that Lambeth carried out relating to abuse at Monkton Street. She recalls being concerned about the physical examination of the children by the police surgeon which could be construed as a form of abuse of young people with severe learning difficulties. She recalls how the police and the council did not have a strong partnership at that time.

In relation to Ivy House she notes that the investigation had to be carried out twice as there was great concern within the community about the outcome.

She goes on to discuss Angell Road and her knowledge of Micheal Caroll. Phyllis Dunipace states that she had no knowledge of his convictions and his failure to disclose his conviction but acknowledges that social services should have known about his conviction.

































Switalskis IICSA Final submissions to the Lambeth Inquiry



  1. We represent 27 CPs; some of whom will be giving evidence, although the evidence of those not called to give live evidence is equally important. Many have only relatively recently been able to speak in detail about what happened to them.  Many are still coming to terms with what happened to them.
  2. They are relieved that Lambeth Council has accepted responsibility for its failings and for neglecting children in its care and has offered compensatory payment through the redress scheme.  They appreciate the efforts of  SOSA which helped to bring this about and are grateful to other supportive bodies too.

The CPs’ View

  1. CPs welcome this Inquiry and understand its nature and scope: upon institutional responses to allegations of sexual abuse. They have waited a long time for an opportunity to find out why terrible things happened to them.  They wish to contribute.  At the same time some are concerns:
  2. Some worry that the individual wrongs they suffered but which were repeated across decades, will not be put right: wrongs that included social workers who must have seen that something was very wrong with some of the children and failed to act, to the perpetration of appalling abuse and degradation, by identified and unidentified abusers.


  1. Some are concerned that the exact numbers and identities of those who perpetrated abuse and the nature and extent of any activities – including how organised they were, might never be fully known but, it is important to shine a light on to what happened, and to be unsparing in doing so and the Core Participants we represent wish to contribute to that and are willing to place their trust in this Inquiry.


  1. Context is important: the late 20th century saw many changes in child- care legislation; child protection and the investigation of crimes against children and that in Lambeth itself, there was political and financial upheaval and mismanagement and, at times, chaos. What they need to know is how it was and why it was that the abuse was able to happen, over decades, when between 1985 and 2003 no less than 20 investigations, Inquires and Inspection Reports were produced relating to children, their care and abuse.
  2. It is also important to recognise that when Lambeth took over responsibility for the children’s homes it inherited from the London County Council when it was created in 1965, children living in them were already being neglected, badly treated and sexually abused. There can be no doubt that paedophiles were operating in the children’s homes and that some, such as Leslie Paul, were doing so not only for their own gratification, but for commercial gain.
  3. As this Inquiry has heard, there have been deaths. One of those was only a baby, aged 11 months who was placed in an inappropriate harness and as a result, asphyxiated.
  4. Why was it, our Core Participants ask, that insufficient attention seems to have been given to the situation in the children’s homes when Lambeth took over, at a time when it was reasonable to expect that there would be, at the very least, a level pf professional curiosity about the circumstances in which children were living?


  1. Some of the experiences of our CPs were shared by other CPs and some common themes emerge from the experiences of those we represent:

Removal from vulnerable children from family homes was confusing, frightening and traumatic. 

(LA-A299) Aged only 8 he taken into care when left in care of older siblings by a parent who had made a temporary trip abroad for family reasons.

After a night elsewhere he was taken to Shirley Oaks Children’s Home and ended up staying there for just over a year.  No effort appears to have been made to find alternative carers for him from within the extended family.

Once in care, whether in a children’s home or in foster care, with a few exceptions, they experienced:

  • isolation;
  • disregard for culture and religion
  • cruel treatment;
  • exposure to abuse from strangers, from those whose job it was to care for and protect them and even from other children: the complete opposite of the care they needed.

(LA-A321) placed in care at Daisy Cottage, at Shirley Oaks at about age 9 in about 1960.  His mother had died.  No one asked him if he was alright.  The House parents were cold and unfriendly; they would always come and go.

LA-A323.  In early 70’s she was at Shirley Oaks (Musk House).  As a very young child (under 5) she was repeatedly hit by adults around head and legs. She was repeatedly told by the house mother she was nothing, wanted by nobody, was bad and a bastard child, unloved and unwanted. No love was shown.

LA-A299, a Muslim child, had to eat pork.  LA-A299 sexually assaulted by a Dr under the pretext of a standard examination.    He was also bullied by older boys and nothing was done.

He had had a nice SW, but another one took over who was not interested and barely talked to him, failing to notice how he was becoming withdrawn.

LA-A327 was told by staff at Cumberlow Lodge (1970s) that her parents didn’t love me and that was the reason I was there.

Paedophiles such as Michael John Carroll were manipulative and sophisticated.  He sexually abused LA-A181.  At one stage LA-A181 went home under a care order and the abuse it continued, as Carroll had befriended and “groomed” his father by doing favours for him.  Carroll was later convicted in 1999 of indecent assault but at that earlier stage there was no escape for LA-A181.

Children from BAME backgrounds suffered racial abuse.  Sometimes the abuse was both racist and sexual.  Before going on to sexually abuse her,  the man who ran Lavender House, part of Shirley Oaks, told LA-A309 that most children of mixed parentage ended up in care and that races were not supposed to mix.  Efforts were made to dissuade her from attending a mass at Christmas by a staff member who said the bible forbid mixed relationships – so she couldn’t even take comfort in God.

Later his language changed to refer to her as “exotic”, informed, I suggest, by stereotypes about black women and girls as overly sexual.  Some were targets for the worst kinds of sexual depravity.

The idea of culturally appropriate placements was introduced in Lambeth in late 1986.  One of the CPs we represent, LA-A304, of mixed ethnic heritage, had suffered sexual abuse in one care home before being placed with a white family.  She where she was happy and felt well looked after.  After she left there, once the same race policy had begun to be implemented, she was moved to another city, she believed by Lambeth, and told she “had to be placed with a black family” where she was bullied, beaten, not fed properly and told she was “possessed”.   While the aims were laudable, and may have been successful in some cases, this was not always so.  In this case, the policy seems to have been prioritised over what the child needed, suggesting a rather simplistic approach to children’s cultural needs.

Another theme: while convictions have been achieved, much of the time children were too frightened to complain; if they did, there was either no response at all and they were ignored, there was a bare acknowledgment or they were dismissed as liars and complaints were not followed up.

When LA-A307 was about 9, in the early 1960s, in the sick bay at Shirley Oaks, he awoke to see a man by the bed masturbating,  When he told the matron or nurse the next day he it was dismissed as a bad dream.  It happened again, only this time he was assaulted.  He complained and was told to “stop this nonsense.

LA-A299 sexually assaulted by a Dr under the pretext of a standard examination and bullied by older boys.  When he complained about the Dr, he was told he wouldn’t have to see him alone again, but the Dr continued to work there.  The bullying from older boys worsened and progressed to a serious sexual assault.  LA-299 was unable to tell anyone.

I was scared, felt dirty and felt as though it was my fault.”  He felt he had no one to turn to.


LA-A300 was abused by Leslie Paul.  In the late 1980s she agreed to be interviewed by Lambeth Council about Paul.  She told them what had happened and believed that

She was being listened to, but a few weeks later she was written to and warned that she would be taken to Court for slander if I ever repeated the allegations again.  She was not listened to or believed and received no support.


On another occasion the Council went to her home to interview

Her about her time in care and abuse.  She discussed this with them but never heard anything back afterwards.  This left her feeling as if she was part of a tick box exercise.


LA-A327 was suffered sexual abuse from boys at Calais Street CH.  During one such

occasion when she was aged 14 or 15 A staff member walked in when one was in bed with her but his only reaction was to tell the boy to get out and nothing was done.


While at South Vale in the mid-1970s when she was aged 12, LA-A309 witnessed

another child being sexually assaulted.  When she reported it to staff she was told

not to mention it again, “we are dealing with it.”  She didn’t hear any more about it.

Later, after complaining about sexual by LA-F33, she was interviewed in the same room as the man she alleged had sexually abused her.


Failure to provide proper education is another theme. 

Children’s education was neglected and time was lost, especially for those who struggled with literacy.

Support for leaving care

When they left the care system many had no or very little practical or psychological support on leaving.  Some survivors left homeless; others were left in sub-standard and unsafe accommodation with no guidance of how to live independently or budget.  More than one took an overdose in a suicide attempt rather than face bleak reality.  In effect, they were left to fend for themselves.

It is hardly surprising that some turned to alcohol or drugs to help them cope, to block out what had happened.

Questions on behalf of the CPs

  1. And it is these sorts of experiences that they ask you to keep in mind:
  2. Whether there has been a Conspiracy of silence; whether there was a large-scale, organised network of paedophiles; the conditions under which children suffered appalling, degrading and caused long term harm to them and their families were already in place:
  • why were paedophiles able to continue as they did and to flourish?
  • why were those who were supposed to protect children so apparently indifferent to them?
  1. The CP’s are hoping for some clear answers.
  2. Many wonder if they were ignored; disbelieved and treated with indifference and worse, because of who they were, once they became the responsibility of the state as children in care who came from families who faced a number of difficulties:
  • who lacked resources;
  • who came from were abusive or neglectful backgrounds;
  • who were working class;
  • who were from a black or minority ethnic background;
  • or who were simply unfortunate enough to end up in care.


  1. They want to know how anyone can be confident that with this history and these experiences, things will be different in future?
  2. This is not a problem confined to Lambeth. There are recent examples in which the institutional response to complaints of abuse has been inadequate, for example, in Rotherham.
  3. Michael John Carroll, a schedule 1 offender (that is a person whose offence is listed in schedule 1 the CYPA 1933 as a warning that any such offender could cause a particular risk to children) was able to obtain a job with Lambeth, work to manager level and was able with his wife, to apply to foster children. Even when his offending was discovered by another LA, he was left in post for some    Was this:
  • a failure to appreciate the significance of the previous conviction for indecent assault on a male under 16.
  • wilful blindness and neglect when it came to children in care?
  • was there a willingness to play down the significance of clear evidence he was a risk to children? If so why? Was it simple arrogance? Or more?
  1. The experience of many of the CPs we represent has been that that if they dared to complain, the starting point, the assumption seems to have been that any allegation they made was untrue. As if they were less worthy of being believed than other people.It is no exaggeration to say that although the late 20th Century has seen a raft of legal and social reforms in relation to children, what happened to these children has parallels in the 18th and 19th centuries when we had slavery and child labour: Children were penned or contained, rather than properly homed; Kept in ignorance, rather than properly educated Abused and neglected rather than nurtured and cared for; ignored rather than listened to.  Treated as less then human.  It is a scandal and a source of shame that this could have happened.


  1. That the state’s ability in the form of the LB Lambeth to care for its most vulnerable citizens has been found grievously wanting is not in issue, but to prevent this happening again, our CP’s feel that a different approach is required and hope that once Inquiry has heard the evidence; and once some of them have been able to tell their stories you will reflect, consider and take this opportunity to make strong recommendations for the changes that are clearly required.






Lemn Sissay – An Inspiration

Lemn Sissay – an inspiration.

Imagine a child taken illegally from its mother in the late 1960s. This child was given to white devout Christian parents and told he is theirs. The child grows up in this family, is charming and extremely likeable. Like all early teenagers the child breaks a few minor rules – taking biscuits without asking – nothing major. Without warning the Christian parents decide this black child doesn’t fit into their family and is told to leave. The child is forced to leave the only family he has known, the only neighbourhood, friends and school he has known. The child is not found a loving, nurturing foster family but is sent to a series of residential children’s home where the rules are strict and the unwritten rules of bullying and racism from other children and staff alike have to be endured. Imagine how this child would feel faced with assaults, racism and neglect on top of having been torn away from his family. As if this were not enough, whilst in care this child discovers his name was changed by the council.

Would you fight back ? Would you have ended up in trouble ? Would you have seen your life chances as narrowed ? Would you have given up ? I would.

Lemn Sissay didn’t. He somehow found super-human levels of tolerance. He didn’t get into trouble with the law. He “kept his nose clean” and emerged from this ordeal to fashion himself into a writer, poet, performer and broadcaster.

Where did he find his tolerance ? Was it from his religious upbringing ? Was it a desire to rise above personal insults ? Is it from his philosophical take on life ? I’m not sure but he has some mercurial element that made him impervious to stuff that would knock us mere mortals off course.

Lemn has devoted a large part of his substantial creative talents and career to finding out more of his story and trying to make sense of it. Some if his notable publications are his Child of the State TED talk; his desert Island Discs of October 2015; his poetry, his plays; his memoirs My Name is Why; and The Report (Lemn listening for the first time to his psychological report on stage in front of a packed house at the Royal Court Theatre). He is a thoughtful advocate for the rights of children in care. He has set up the Gold from the Stone Foundation to provide Christmas dinners for care leavers. I recommend you search out all these inspiring works.

I had the privilege of helping Lemn explore the legal process. By 2015 he had plucked up the courage to get hold of his social care records from Wigan Council. He has published some of them in his memoirs My Name is Why. Lemn asked me if there was anything he could do. We poured over the records and discovered how, right from the start, the council had taken him from his Mother illegally. Lemn himself set up a unique meeting at Manchester Town Hall attended by the leader of Wigan Council, The head of Children’s services and the Chief Executive. Lemn wanted acknowledgement from the council that :-

  • It was wrong for the council to prevent him from being returned to his Mother when she repeatedly requested this in 1967;
  • That it was wrong for the social worker and foster parents to change his name;
  • That is was wrong for the Council to enter this illegal arrangement with the foster parents, that he was insufficiently supervised; that the issue of race was treated insensitively and that he was treated badly by the foster parents;
  • That it was inappropriate for Mr Sissay to have been placed at Woodend assessment centre;
  • That it was wrong to have provided him with no finances when he was forced to leave care at the age of 18.

Lemn not only got the meeting but was given unreserved acknowledgements and apologies on all these five requests. I hadn’t previously attended such a meeting with high level council personnel present. Rebuttals, blanking and defensive positions are the usual response when I ask for such meetings or apologies from councils.

Lemn took the meeting with dignity and some relief. We chatted about next steps and decided we should press on with seeking financial redress.

Lemn’s career has been successful. He has been well known for many years but has worked very, very hard at his craft. The opportunities open to his Mother’s later children were closed to him. He had been unable to progress through decent education due to the appalling treatment he had to endure from Wigan Council’s social workers. This meant Lemn lost opportunities and its right that he was compensated.

In 2017 I started the legal proceedings for him and on 17th April 2018 after a marathon 10 hour negotiation in London involving solicitors, barristers, and Wigan Council officials we agreed terms. It has been a privilege to work for Lemn. It is a privilege to work for all disadvantaged children. We all deserve to be treated with respect and dignity. Lemn got neither as a child.

I particularly like the line from Lemn when he says : “Children in care should be treated so well that middle class parents are queueing up to get their child in.”

David Greenwood (Solicitor privileged to work for Lemn and other care leavers).

IICSA Roman Catholic final hearing Closing comments of David Greenwood


IICSA Roman Catholic Investigation

Oral Closing for Core Participants represented by Switalskis Solicitors

The Catholic Church has proved itself incapable of self-governance in the protection of children in its care. We emphasize the impediments to self-governance presented by:

      1. Catholic teaching; Divine Law; Canon Law;
      2. Its hierarchical structure and reliance on one man at the head of each diocese as decision maker;
      3. Its culture of brotherhood, deference and forgiveness;
      4. Its unincorporated status.

We recommend, in summary:

The adoption into law of Mandatory Reporting as advocated by the organisation Mandate Now.

The creation of a new statutory body with powers to police and enforce basic standards of child protection. We envisage a body similar to the Health and Safety Executive.

A review of the powers of the Charity Commission and a body to take control of the gaps in legislation which are not filled by Ofsted, ISI, the DfE and the Charities Commission in relation to suspicions of abuse in schools. The lack of a safeguarding regulator or powers for these bodies on safeguarding was demonstrated by failures at Ealing Abbey and Downside.

The extension of ‘position of trust’ offences which we will expand upon in our written submission.




We agree with Adrian Child when he said to you on 13/12/17 [Transcript page 137]:

“..I don’t see any value in tinkering around the edges and saying, “Here you are. Here is a third opportunity [post-Nolan, post-Cumberlege]. Go away and sort this out yourself….there needs to be accountability and some kind of mandatory enforcement.”

That was almost two years ago.

During the currency of this Inquiry we saw Peter Houghton, Chair of the Safeguarding Commission in Westminster, comment about A711 in May 2017: “we need to keep playing the good practice card if we are to contain this person’s manipulative behaviour” [INQ004695_001]. That is at best, hypocritical. At worst, it reveals a deep cynicism towards complainants and safeguarding in general.

Take the troubling evidence of Vincent Nichols as an example. Mr Altman identified that in one breath he is announcing publicly, positive measures, whilst at the same time completely ignoring an intelligent woman with a legitimate request for help. If that is the attitude and practice of the leader of the Catholic Church, a man at the heart of Nolan, Cumberlege and well trained in safeguarding, what hope can we place in anyone else in the Church?

This Inquiry has only had the time and capability to expose a small fraction of the duplicitous behaviour of the Catholic Church. What would be unearthed if the men in black were genuinely penitent and handed over their scandals to the Inquiry?

Catholic Organisations have run out of excuses. The time has long gone when those I represent were prepared to give them a chance to get it right. We have seen a painful catalogue of abuse and cover up facilitated by their internal rules, self protection and bonds of brotherhood.

We hear again that more time is needed for the safe spaces support project , more time for Cumberlege, to wait for the General Decree, and more time for the Ian Elliott review. Even Mr Spears told us “There is normal time then there’s church time”. With the lack of audits between 2015 to 2018 it seems that time was standing still for Catholic safeguarding.

Had the Bishops and heads of religious come together at any time in the last 10 years and demonstrated a commitment to safeguarding by handing over accused clergy to the police, kicking them out of their church, casting aside canon law secrecy and showing they had achieved the recommendations of Nolan and Cumberlege in every diocese and Religious community we may have given them a chance.

The church’s processes, training and attitudes needed radical change. But the church is not radical. It is deeply conservative. It is not fit to be in charge of developing and enforcing its own safeguarding policies.

We heard from a number of witnesses that the Seal of the confessional cannot be broken and out-ranks canon law. Rome will never order the breaking of the seal of the confession where reports of child sex abuse are admitted. It has been recorded in evidence to the Australian Royal Commission that some Catholic priests would rather be imprisoned than break the sanctity of the confessional.  The Catholic Church’s absolutist position on the confessional highlights the particular danger of this institution to children in its care. They accept this violates the paramountcy principle. At the same time, they are prepared, according to Vincent Nicholls, to die for it. Even the Anglican Church is prepared to accept mandatory reporting with no exception for the confessional.

Both Eileen Shearer of COPCA and Jane Dziadulewicz [Ja-Dully-Vitch], the Clifton safeguarding adviser, made it clear they were frustrated that guidance by the Catholic Safeguarding Advisory Service was simply that: advisory only. Common themes emerged from the evidence of the senior social worker, Mr Molesworth, the director of COPCA, Mrs Shearer, and the Clifton Safeguarding Adviser. Each cited barriers to achieving good Safeguarding within the EBC Abbeys and schools as being:

    • CSAS lack of power to enforce the guidance;
    • Abbots exploiting this lack of sanctions by obfuscating on disclosure and access;
    • Clergy were reluctant to allow outsiders in. Mr Molesworth described Ampleforth monks as “secretive and resentful” of his presence;
    • They found too much emphasis on forgiveness.
    • Each asked the panel to implement Mandatory Reporting and for a body to be established to hold churches to account.

It is frankly insulting to those harmed by clergy for Gordon Read, the canon lawyer, to suggest that breaches of the CSAS guidance (even if it is elevated to canon law status with the General Decree) will result in a meaningful sanction for a Bishop. The only sanction he could point to was:

For the Papal Nuncio to speak to a Bishop or possibly that the Bishop would be contacted by the CDF.

This is hardly a sanction at all. Diocesan safeguarding co-ordinators will remain powerless. Their Bishop will still overrule them. We know from Jane Bertelsen that some Bishops are still hostile to CSAS and its rules from outside.

This is an organisation that trusts only to its own. It prefers those who have demonstrated blind loyalty and views inimical to child safety like Jane Jones in Birmingham and Peter Houghton in Westminster. It will try to sideline internal critics such as Messrs Haywood, Child and Sullivan. Dissent is not encouraged. Whistle-blowers are not tolerated.

I hesitate to spend time picking apart the many rules and contradictions which even the Chair of the NCSC was obviously struggling to interpret and instead refer you to the evidence of Edina Carmi who expertly established that there are mostly bad and a few good examples among the cases she audited. It was however worrying to note the trends she identified include a) a lack of support to victims b) poor record keeping c) a reluctance to carry out investigations, and d) conflicts created by clergy being appointed Diocesan Safeguarding co-ordinators.

In contrast, Ms Carmi showed us that perpetrators receive plenty of support with accommodation, legal costs, treatment, testimonials and an open-ended commitment.

Indeed the wide variation in standards from the appalling to the good demonstrates there is no ‘One Church’ policy, no minimum standard. Service levels are reliant on the vagaries of powerful individuals

As we said in opening. We need ‘one nation’ policies applicable to all institutions that care for children.

It is worth reminding ourselves of the relevant recommendations made in 2014 by the United Nations Committee on the Rights of the Child. This is a body interested in establishing minimum standards of child safeguarding :-


  1. The Holy See should ensure that clergy against whom allegations have been proven should be immediately suspended from duty or dismissed
  2. To take effective measures to ensure that where a credible allegation is made the police should be immediately informed.
  3. Rather than obstructing the police and civil authorities the Holy See should co-operate with the police in their investigations and should not continue to hide evidence from the police.
  4. The Holy See should ensure that a fair and adequate system of compensation is implemented to compensate victims of clergy abuse.


On every one of these measures the Church still firmly opposes progress. To date the only positive step taken in the UK on these stipulations is to agree the general decree which in theory obliges church officials to co-operate with the police. The lack of substantial sanction means that the Bishops whom Sister Jane Bertelsen believes are opposed to the outside imposition of rules will be able to ignore it. The Church has taken no steps to introduce a compensation scheme. Suspensions are rare and dismissals even rarer. Laicisation takes years.

Whilst the Catholic Church in the UK espouses good practice and has set up detailed guidance for its Bishops, in truth these can be ignored without real sanction. Without state level enforcement of mandatory reporting Bishops will continue to have the final say on whether allegations should be reported to the police.

The implication of all this is that so long as the Catholic Church is engaged in the care and education of children, it poses an unacceptable risk to children. We reserved our position at the outset of this Inquiry but since hearing of the dangers of the confessional, the powerlessness of the Diocesan Safeguarding Co-ordinators, the lack of sanctions for priests, the reluctance to report to police and LADOs, the failure of the church in the international sphere to take steps to sanction errant priests, we are firmly of the view that faith-based education is not conducive to the safety of children and that schools should be removed from Church control and governance.

By any measure the Catholic Church is not fit to be entrusted with our children. But the Catholic church is not alone. There are many other organisations in the same category whose disinterest in the safety of children in their care has been ignored for too long by legislators. Self-regulation in safeguarding is a failed experiment and we need strong legislation to enforce basic standards and to impose meaningful sanctions for breach. A minister at Cabinet level to develop and enforce children’s rights would be a step in the right direction.

We invite the panel to consider the creation of a new statutory body to police and enforce minimum national standards of child-safeguarding. We envisage such a body having similar powers to the Health & Safety Executive. The Health & Safety Executive operates for the safety of workers. Children are an even more vulnerable group. The absence of a powerful statutory body dedicated to their protection is a serious defect.

The introduction of compulsory incorporation will establish a system of accountability and will deal with unincorporated organisations such as churches.

Such a body will:

  1.           Establish a register of relevant Institutions that look after children.
  2.           It will be an offence to look after children without being on the register.
  3.           To be on the register institutions have to introduce a corporate structure.
  4.           “regulated” institutions will be forced to adhere to minimum safeguarding.
  5.             The body will have the power to prosecute regulated organisations for breach of this guidance (similar to HSE prosecutions). Fines will be imposed.
  6.             All corporate complaints will be captured by Mandatory Reporting legislation.
  7.           The body will gather information from complainants, regulated institutions and third parties. It will have the power to compel disclosure of material.
  8.           It will liaise with and assist civil authorities such as the police and social services. It would ensure the police and other statutory organisations are taking appropriate action within reasonable timescales. It will have the power to compel the police to investigate and refer cases to the CPS.
  9.             It will have the power to make an award of compensation via new redress scheme. It will decide the support to be offered to the complainant. It will investigate the complaint using the balance of probabilities as the standard of proof. There will be no statute of limitations. A scheme will be established to provide adequate compensation for victims of child sex abuse which takes into account the effect on quality of life and a series of other relevant factors (as opposed to the rigid CICA system).
  10.             Complainants will be allowed to take advice from lawyers and a contribution towards legal costs will be awarded.
  11.           The cost of the body’s work will be assisted by a levy on the institutions. The cost of awards of support, reparations and legal costs in each individual case will be recouped by the state direct from the organisation which was vicariously liable for the perpetrator.
  12.             It will provide to Government regular reports on its progress and, inter alia, the extent to which its activity is promoting the UK’s obligations under the UN convention on the Rights of the Child.

We have exhausted all attempts at self-regulation. It has failed. Attitude and practice has not improved, even during the currency of this Inquiry.

Our recommendations are ones of necessity, to redress the power-imbalance between children and large institutions that would seek, for their own purposes, to care for them. It is the role of the state to protect the weak and the vulnerable. Nobody else can or will.

The burden is now upon the Catholic Church to demonstrate to you why we are mistaken. This, now, is their last opportunity, through their leading counsel Ms Gallafent QC, to address you in public on this matter. We anticipate that, on past form, they will say little or nothing of substance.

David Greenwood

William Chapman

Joshua Yetman

8th November 2019

Roman Catholic Final Hearing Notes of David Greenwood

IICSA Roman Catholic investigation final hearing


Notes of David Greenwood



28th of October 2019


Brian Altman, counsel to the inquiry mentions the Bullivant report which analysed 726 complaints from survivors of child sex abuse in the Catholic Church. There were more boys than girls and reports peaked in 2010. It is common for survivors to delay reporting and that the abuse by the Catholic Church represents the grossest breach of trust and has a very human impact. A 20 feels nauseous when she recalls her abuse. She has attempted suicide. A 62 feels the impact is lifelong. He has persistent anxiety has lost sleep and has nightmares. Graham Wilmer found the abuse was compounded by poor responses and has had alcohol problems. Mr Altman recollects the abuse and cover-ups of the Birmingham investigation and the Benedictine investigations where complaints were not referred to the police or local authority and cover-ups were facilitated.


Representatives include Brian Altman, Jackie Carey and Mr Saad, all counsel to the Inquiry. Slater and Gordon, David Greenwood of Switalskis, Mrs Gallagher, Alan Collins, Howe and co, the catholic council and secretary of state for education.


The first week of the enquiry will deal with contemporaneous safeguarding regimes whether responses have improved. The role of insurers will be examined, reviews of recent safeguarding files and whether they are compliant with CSAS policies. The issue of Mandatory reporting and the seal of the confessional together with relationships between Rome and dioceses will be examined.


The structure of the church has been criticised insofar as safeguarding is concerned as each diocese cannot be controlled by the Cardinal and only has to follow rules set by Rome. Each bishop is responsible for safeguarding in his diocese.


Religious orders are groups of consecrated men and women who abide by canon law but outsiders have no power over their leaders (named provincials). Some orders have only one member, some have over 100. Most orders deploy diocesan safeguarding coordinators to work with them on safeguarding and six do not.


In 2001 the Nolan review was intended to bring about significant changes including one single set of policies based on the paramountcy principle, and a new organisation of structures at parish and diocesan level (parish child protection representatives and Diocesan safeguarding coordinators), and including national child protection unit, COPCA, CSAS, CRB checks, and reports to police and social services immediately.


The Cumberlege review five years later in 2007 recommended that COPCA then renamed as CSAS reports to the bishops conference and coordinates training, advice and providing updates on safeguarding.


Has the Catholic Church adopted a ‘one church’ approach? How far has it pursued the Paramountcy principal?


Cumberlege recognised in 2007 that CSAS cannot give orders to bishops. For that a decree from the Pope is required. A general decree was passed in June 2019 but is still to come into force 12 years after it was recommended by Cumberlege.


We will hear that Danny Sullivan, the former chair of national Catholic safeguarding committee felt he was not respected and not funded. A lay member of NCSC, Stephen Spear will tell us safeguarding responses were poor and that the church did not monitor them. The current chair of CSAS, Collette Limbrick will say that CSAS tries to ensure the one church approach.


One problem is that by in house safeguarding coordinators are accountable and employed by the bishops. They are taxed with reporting to the police and the LADO.


We will hear from Edina Carmi who has looked at the two most recent files from each diocese and order.


We will hear that limitation has been used as a defence, that Scotland has removed limitation as a defence in child protection shown cases.


We will hear that the Charity commission is mainly interested in protecting the reputation and assets of charities.


Will hear that trainee priests have to be sifted and the unsuitable trainees prevented from advancing.


Will hear criticism that Rome and the papal Nuncio has refused to provide answers to questions regarding what it knew about Lawrence Soper’s disappearance in 2011, despite IICSA having followed all appropriate channels to the foreign office.


We’ll hear about how long it takes to lsicise individuals suspected and convicted of child sex abuse offences.


The congregation of the doctrine of the Faith deals with discipline and canonical crimes and IlCSA will have questions for various witnesses but the CDF itself has refused to answer questions.


We’ll hear from complainants about errors, mishandling of complaints and malevolent attitudes in the last two years.


Opening statements of core participants


Richard scorer suggest that the panel should have deep scepticism about the churches protestations that it is doing better. He says there is cultural resistance to positive approaches on safeguarding. He says there are systemic flaws in that church is run by small groups of individuals with bonds of mutual loyalty and those take precedence over safeguarding. He says that Jonathan West, an Ealing campaigne,r has analysed Catholic Church safeguarding policies and found them to be full of holes. He says that only external oversight can protects children in the future.


William Chapman (for Switalskis Core Participants)


His central recommendation is that there needs to be an independent statutory body to enforce national minimum standards of safeguarding for organisations which look after children. He says that the evidence has come from the enquiries into Ampleforth and Downside, Birmingham and Ealing Abbey. Those investigations demonstrate the scale and extent of abuse and comes from the panels earlier findings.


The Roman Catholic Church poses a high risk of harm to children in its care. It is too reliant on individual powerful men in the church making decisions. Some weak like Abbott Shipperley, some unwilling like Abbott Wright at Ampleforth and some are paedophiles such as Soper in Ealing.


In the Birmingham enquiry the panel found that rather than assisting the police, the Vicar General attempted to help Samuel Penny out of the jurisdiction and ensure that Robinson was financially supported for years whilst he was in the United States. Abuse could have been stopped much earlier in various settings of the Catholic Church but the plight of victims was ignored and abusers were allowed to continue their crimes.


If IICSA had not looked into Birmingham, it is doubtful that the diocese would have recognised there was a problem. The Downside the Abbotts and headmaster tried to pave the way for the return of abusive monks.


Victims have been vindicated but they doubt whether IICSA will be anything more than a gravy train for lawyers unless an independent statutory body is set up to enforce minimum standards safeguarding. The current patchwork has failed. Neither the police, CPS, Charity commission, ISI, Department for education have had safeguarding as their chief role. The structure of the Catholic Church means it is unable to change itself. There have been many failures of leadership. It would be a mistake for the state to try to amend the churches by tinkering with structures and only setting standards from outside will do.


Mrs Gallagher QC criticises failures of the Catholic Church. She says it has demonised and marginalise survivors and continues to do so.


David Enright says it is hard to see how the Roman Catholic church can change due to its structural inability. Some of his clients met with Archbishop Longley from Birmingham positively by contrast some clients have been treated appallingly by the Combini order.


Alan Collins criticises the structure of the Catholic Church.


Mr Brody’s client wants mandatory reporting, fines for organisations and convictions for individuals who fail to report allegations of abuse.


Miss Gallafent for the Catholic Council gives a roundup of what the different parts of the church are working on and details various minor improvements.


29th of October 2019.


Evidence of A711.


She describes how a priest, F500 at a primary school groomed and then sexually abused her in the 1980s then followed her to university and raped her. She went into a religious vocation had psychotherapy. She complained to her local diocese but was transferred to the Westminster archdiocese as her original safeguarding coordinator was off work ill. She thought Westminster Archdiocese would be hot on safeguarding but soon realised that nothing could be further from the truth.


She realised that the one church principle was not in play as there was so much variance between different dioceses that she had worked with. She felt it has been a battle throughout her complaints and disclosures. By June 2017 she was exhausted. She did get written apology from the abuser, F500 but felt it was a sham and written by a lawyer.


The abuser had a risk assessment done by Joe Sullivan. A 711 was denied access to the risk assessment. There was no feedback to her on the risk assessment because of advice from the lawyer, Kathy Perrin who advised Westminster not to share the details.


Eventually there was then independent assessment done by Karen Abrahams (INQ004720) which upheld all of her complaints and in particular criticised decision making was being done by the insurer rather than diocese.


She criticised letters of apology as being insincere and drafed by a lawyer. Another apology from a Friar at the original Priory was more acceptable.


She felt that the safeguarding officers at Westminster Archdiocese were unsympathetic, tied up in their own processes and weren’t even clear about what their own process was. There were repeated changes of staff at Westminster. She eventually made a subject access request and found that she had been referred to internally as being ‘needy, this woman is deeply manipulative, and we need to keep playing the good practice card if we are to keep a lid on her manipulative behaviour’. She concludes that Westminster are not fit to be engaged in safeguarding.


She was so frustrated with the process that she asked for a meeting with Vincent Nichols who refused to meet her. Eventually she reported his refusal to a newspaper and he eventually met her on 12 April 2019. She suspects his motivation was that he was responding to the derogatory remarks that have been made against and the press article. She had met with the head of the order to check that the abuser would not have future ministry. He could not give that assurance .she asked ‘so rapist could be saying Mass? She was told that this was the case. She eventually spoke to the police and they told her that the abuser had admitted everything she had described.


On reflection she believes the one church approach can work but safeguarding in the Catholic Church needs to be administered by the independent body. CSAS does not even understand its own guidelines.


Mr McGuinness (evidence read).


Mr McGuiness reported sexual abuse at St Peter claver college, Mirfield to 3 senior members of the Comboni fathers order but was ignored each time. He was eventually expelled the age of 15. Since then he has written 20 letters to the order they declined to respond and in 2012 he joined a group action was eventually offered £40,000 under threat of having limitation raised at court. No admissions were made on liability and there was no apology. He does not believed the Comboni/ Verona order should be allowed to have anything to do with children.


Mark Murray (sworn). Man in his 50s – born in 1955.


He was inspired by a priest who visited his school to become a priest and missionary and moved from Liverpool to Mirfield in 1969 at age 14 stayed there until 1974. He complained that he was sexually abused by father Romano who also abused others at the college. He did not report it at the time. At age 18 he became a missionary brother in the order.


The abuse re-visited him when he did it counselling course in 1995 and he decided he had to do something about it and instructed a solicitor in 1997. The solicitor was unsuccessful in a case against the order. The case was withdrawn. He wrote to the Superior general in the Verona to explain the father Romano was in poor mental health. This superior general offered only priors.


Mr Murray was so determined to see and confront father Romano that he went to Verona himself, carrying a secret camera and videoing and recording the meeting he had in a chapel at the role of fathers headquarters in Verona. Father Romano apologised to him but when other staff heard about the conversation the Verona fathers tried to sue Mr Murray for trespass.


Mr Murray does not trust the Verona fathers and feels that the impact of their response has been worse than the abuse itself. He wants safeguarding taken out of the hands of Catholics together. The reason for this is that he feels that their primary aim is to protect their institutions, image, money, missionary appeals. It is far removed from any Christian meaning. He also believes that Catholics have so many factions that there are many different ways that they respond to safeguarding concerns. He believes it needs some uniform external agency to police safeguarding in the Catholic Church.


30th of October 2019.




A49 was a pupil seminarian at Mirfield St Peter Claver college from September 1963. He was sexually abused by F339 who masturbated him two or three times a week in total for 200 times. He was touched in the showers by another priest F338. A49 complained to the spiritual director and was told to go to see the rector, father Fraser. F338 was then sent abroad to work for the Comboni fathers where he worked in a secondary school and had access to children. He died in his nineties in the 1980s and was given a glowing reference/send off.


One of A49’s classmates was David Glenday, the current provincial of the order, who refuses to acknowledge that abuse happened despite being part of it at the time. Glendale was at least a pupil contemporaneous with A49 and must know something about it. A49 thinks safeguarding should be taken out of the church’s control.


Thomas James Kirby (man in 60s. Smartly dressed).


Became a pupil at Mirfield in September 1960. His family paid for his education there. He was abused by F339. Masturbation about 100 times. He eventually sued them via the group but didn’t get satisfaction. He feels that dioeses and orders don’t have the power to change or willingness to change. The Catholics hope that IICSAt will go away that this will all die down.


Angela McGrory (woman in 40s wearing a smart address)


Former safeguarding coordinator of Portsmouth. She moved to Brighton Roman Catholic diocese recently. The female survivor, A710 complained about abuse by a senior cleric. The complaint was sent personally to the congregation of the doctrine of the Faith of February 2011. There followed a negative media report. A710 was not the leak. Miss McGrory’s Bishop asked her to draft a letter to be published and was not published. Eventually they decided to ask Cardinal Vincent Nichols take up the case. She feels the church did not look after the complainant as well as it should have done. Vincent Nichols was asked to make a statement in writing a letter but internal politics stopped the process.


Philip Egan (Roman Catholic Bishop of Portsmouth). He was a distant, red-faced man in his 60s wearing a black suit, black shirt and dog collar.


He professed to have been frustrated with the process and on 9th of May 2019 contacted Vincent Nichols. Vincent Nichols eventually agreed to meet A710. Mr Egan was sensitive to criticism from Miss McGrory at his handling of the case. Mr Egan’s behaviour was more concerned with the church’s reputation and management moved at a glacial pace. He does not recall that the incident was reported to the charities commission. Overall he was a fairly reluctant witness and possibly out of his depth on safeguarding issues.


Alexis Jay asked whether anyone in the diocese asked about the reason for the leak and he confirmed that nobody had investigated that aspect. Alexis pushes him and he replies that he was more concerned with the care A710.


Druscilla Sharpling suggested that it appears the leak was aimed at discrediting A710. Mr Egan feels it was more likely to be an attempt to discredit the abuser. He admits he did not read all the press coverage. (His answer here shows how sensitive the Roman Catholic church is to criticism – thinking of itself first).


Mrs Sharpling asks why it took so long to issue a statement. Mr Egan repeated that he was more concerned to care for A710 by negotiating a letter from Vincent Nichols. Druscilla Sharpling ask whether the leak was investigated and his response that it was not. Alexis J asks how would a leak from the Vatican be investigated. It would have to be initiated by the chairman of the bishops conference (Vincent Nichols).


31st of October 2019.


Danny Sullivan (man in 60s wearing blazer and open necked shirt and glasses).


Something in the church the bishops and religious leaders. It comes from history and traditions of the Catholic Church. Children particularly feel unable to challenge priests.


He felt the Cumberlege report was too detailed that there was no need for 76 recommendations. I should have been a core of recommendations fewer in number.


The aim of the NCSC was to promote the one church approach. He wanted to have this CSAS audits independently assessed and wanted the NSPCC to do a thematic audit.


Bishops are responsible only to the Pope. Some bishops felt that imposing rules from the outside meant that they were losing autonomy. He experienced the tension between trustees of the diocese or religious order’S moral duty and advice from lawyers. There were some arguments about funding of CSAS. Mr Sullivan felt that the church’s biggest priority was its reputation. He has lots of grumbles about individual bishops closing down funding, closing down criticism and restricting apologies. He is critical of all responses in the Combini father’s case and confirms that the number of cases of false allegations is insignificant so all cases should be dealt with well.


Numerous press articles criticising the Combini and the head of their order. He recalled a time when Adrian Child made redundant for working too closely with Mr Sullivan. Danny then resigned. There was an inquiry which vindicated Adrian Child and Danny Sullivan.


Penicillin arrange for some way members to be on the NCSC they resigned because the Bishop of Portsmouth pursued the JGE case on vicarious liability.


Denisov commissioned the Bullivant report which confirmed the size of the problem in the last 10 years (50 priests were convicted of child sex abuse). O’Sullivan wrote articles in the Catholic Herald and daily Telegraph in 2013 agreeing with mandatory reporting.


He believes that there should be external monitoring of safeguarding. The church is to show humility and recognise that it is not really to be trusted with safeguarding.


Stephen Spear – man in 60s. Studious. White hair and red tie.


Mr Spear says the NCSC is not strategic and is reactive. The Safe spaces project only has two years funding confirmed.


After the IICSAr report on Ampleforth and Downside the NCSC recommended that CSAS guidance is given the status of canon law but this has not yet happened.


NCSC gets £64,000 per year. The pace of change is very slow. Safe spaces has taken five years so far. There is no overall (running total) data on numbers of abusive priests.


He feels that the church hides behind its organisational structures and all this has to be solved in Rome.


Chris Pearson (Man in 60s wearing a suit. An un-inspiring monosyllabic gentleman. Gives closded answers no detailed response or opinion).


He has been the independent chair of the NCSC has been from 2000. He wants to set up the safe so survivors advisory panel (SAP).


There is a debate on going on last review of safeguarding and he will put proposals to the bishops conference. It is felt that the NCSC is independent despite there being members of the house of Bishops, and conference of religious on the committee. He doesn’t detect deference and he likes members to use Christian names.




He admitted that the church will not put forward drafts of proposals for redress and wil act if it is imposed on them. He agrees that the church should drive policy forward as opposed to the insurers driving it forward.


There have been no CSAS audits between 2015 and 2018. His excuse is that this is the time of review of the guidance. He agrees there is a lack of clarity in CSAS procedures and guidelines. He is unable to interpret his own guidance for example deciding whether threshold has been met to report or should report.


David Marshall (Manin his 50s wearing a suit – friendly manner with spectacles)


Mr Marshall is the chair of the survivors advisory panel (SAP). He is a former police officer in the paedophile unit. The remit of is the provision of advice, offering knowledge, positive contributions and informing the NCSC’s work and advice on communication strategy. There are professionals and survivors on the panel. The SAP is a critical friend to the NCSC and is now doing some on the ground training. The SAP advised Vincent Nichols before he went to Rome for the child protection conference in January 2019 he feels that the church has apologise a lot but a lot of members of the panel are still very critical of the church. He is grateful to Vincent Nichols for visiting on two occasions.


1st of November 2019.


Sheila Hollins (woman in 60s dressed in black and wearing glasses)


Sheila Hollins is an independent peer and psychiatrist. She was on the pontifical Council for the protection of minors (PCPM) this was set up by Rome after a number of scandals had eight founding members and now has 17 members. Most members are European not all English-speaking. It meets twice a year. It has working groups on healing and care, training and education, guidelines, spiritual and legal it decided to submit guidance that all countries should adhere to on safeguarding to the congregation of the doctrine of faith. It has not heard back from them. Any guidelines are not mandatory. There is no sanction if bishops don’t follow them. The Pope is limited in what he can do to force bishops to follow the guidance as he can only laicise a Bishop if he is convicted of an offence. But he has only moral authority. Emotional empathy of leaders is important. She is reviewing the site and considering its relationship with PCPM. She was involved in training bishops in the Spain conference in May 2019 34 Bishops 4 members of SAP and 2 survivors attended. She is concerned for Bishops to have therapy too. In response to questions from Driscilla sharpling on the value of listening and empathy Mrs Hollins confirmed that both were valuable.


Collette Limbrick (woman in 50s with classes and brown hair).


Collett Limbrick is the director of CSAS. CSAS is at the forefront of driving improvement in safeguarding in the Catholic Church. It is an advisory service. It revises policy and procedures and offers advice to diocesan and safeguarding coordinators. She feels that CSAS is not independent from the Bishops conference as it is paid for by the bishops conference and controlled by it. Although she does make the point that the bishops conference does not influence its day-to-day work.


If she spots that if a diocesan safeguarding coordinator is not following procedures there’s nothing that she can do to enforce the procedures. She can only report that person to their Bishop.


She agrees that audits of dioceses could be more substantial as they are limited to 2 issues each audit.


Collett Limerick (woman in 50s, glasses and brown hair).


She is the director of CSS. Since house is at the forefront of driving improvement in safeguarding in the Catholic Church. It is an advisory service to anyone in the Catholic Church and devises policy and procedures. It explained updates and changes to guidelines. She believes that insurers inform policy would not do not drive it. She does not believe CSS is independent from the Bishops conference as it is funded by them. If there is an allegation made against Bishop, C Sass may complain to another dieses but otherwise has no power. If CSS is not happy with a diocesan safeguarding coordinator’s handling of the case it cannot compel them to relinquish the case.


Since us performs thousands of DPS checks each year. Schools do their own. She has helped the Archdiocese of Birmingham put its house in order. Since last looks at only some aspects when doing audits and is considering whether or not to widen these parameters out in future. She agrees that some biasing commissions are not fully compliant with her procedures.


4 November 2019.


Susan Hayward.


She is a member of the NCSC. She is an independent member. She is not connected with the church. Whilst on the NCSC she saw deference at work. She felt that the NCSC does not communicate well internally. The diocesan commissions view the NCSC with suspicion. She recalls a recommendation from the NCSC chair being ignored by the Bishop. She sees decisions being made within dioceses due to fear of litigation.


When liaising with the diocese of Westminster in 2010 she discovered that individuals within that commission were not speaking to each other and she recalls saying at meetings that the Westminster Archdiocese is unsafe due to the lack of communication. Westminster appointed a chair of the commission without following the CSAS rules. An audit planned by Sue in 2011 was put on hold because Westminster diocese was not ready and subsequently failed the audit. She and Adrian Child delivered the findings of the audit to Westminster and suggested that a further independent audit be carried out by the NSPCC. This further audit never happened. She felt that Westminster was not making progress. There was dysfunction in the safeguarding office and needed re-ordering. A number of cases were not satisfactorily resolved. Vincent Nichols was fully aware of the position. She believes that the Archdiocese of Westminster is unsafe for children. She believes there is no point in the NCSC or commission protocols if they are not adhered to which they were not in some cases in Westminster.


She contrasts this with Southwark diocese which she liaised with for the NCSC. Some have good communication and most of the Cumberlege recommendations have been introduced in Southwark.


Sister Jane Burtelsen (sworn – woman in 60s. Glasses, short hair, pale blazer).


She is a sister in the divine motherhood order. She is on the conference of religious in the safeguarding group, was on COPCA, was vice-chair of the NCSC 2011 two 2014. She is now on the PCPM set up by the Pope in 2013. And has limited capacity to influence the church. It’s only authority comes from its moral authority. She believes its status needs to be enhanced in Rome. Recognises that the church had a long way to go. She fears the church has been reluctant to follow the Nolan recommendations because they felt they were an imposition from outside. She has found that many countries around the world have developed their own guidelines so it is very difficult to bring them into line. In 2014 the NCSC put together a book of conduct for priests. The conference of religious adopted it but the Bishops conference withdrew from the project. This had been a Cumberlege recommendation. She was opposed to the move of CSAS from Birmingham to a building owned by the church in London. She thought that it compromised its independence.


Kathy Perrin (woman in 40s, dark hair).


She works for the catholic insurance service. She worked for solicitors opposing claims against the Catholic Church prior to moving to CIS. CIS covers 20 of the 22 dioceses. At Birmingham and Hexham and Newcastle do not CIS. 20 religious orders are also covered.


She has produced a spreadsheet dealing with all claims she has dealt with. 435 entries most against dioceses. Only 48 against orders.


She finds that sometimes difficulties in working out whether there is a record of insurance. 19 dioceses have retrospective cover. Now CIS now works with the Zurich insurance. Zurich tells organisations not to pay out claims and to leave it to their insurers otherwise the indemnity will be withdrawn. She has never experienced a diocese walk away from the insurance indemnity and take its own decision on payment of compensation to claimant. Dioceses also have to protect their charitable funds so can’t just decide on ethical grounds to make payments. She deals with 6 to12 cases per year where apologies are requested. Insurers do not contribute to the cost of counselling but allow dioceses to pay for them so long as it is without prejudice. Insurers do delegate instructions to solicitors but dioceses are becoming more and more interested in taking control and taking decisions


She’s looking into new guidelines on claims handling such as the EIG guidance. On apology she thinks any apology should be done in consultation with the insurers.


On the limitation defence, dioceses wishes are taken into account but the insurer is in control. She believes there is an obligation to raise the limitation defence and analysis of evidence “can there be a fair trial?” If the Catholic Church decided that it would not plead limitation, insurers would then have to decide whether or not to indemnify dioceses.


Gordon Reid (catholic priest, black outfit, dog collar).


Ordained 43 years. Canon lawyer. Sits as a canon law judge. Never judged a child abuse case.


Divine law comes from the Bible, canon law binds Catholics everywhere and personal law binds only orders members.


He describes labyrinthine set of acronyms which exist to run the Catholic Church CISCYSISL, CSAS, NCSC, SAP, SST etc.


He describes the grave crimes against children and the motto proprio of 2001 from Pope John Paul II. The reorganisation of these laws is needed and is in the pending tray. A recent motto proprio from Francis confirms that minors are now anyone under 18. The recent motto pproprio requires reports to Bishop only and only for the Bishop to cooperate with local statutory authorities and follow local reporting requirements (this does not mean mandatory reporting).


There is a time limit of 20 years from the date of the offence to the church being able to deal with it. Provided that a case has a ‘semblance of truth’ it can be considered by the Bishop or the CDF. The Bishop will write to the CDF and await a decision on how to deal with the case. Secrecy is enforced there are approximately 12 people in the CDF dealing with these cases. The CDF can decide either a judicial process or an administrative process for the Bishop to decide. The standard of proof is is ‘ moral certitude’. The worst is disciplinary action is laicisation.


If a bishop did not abide by the rules papal Nuncio would speak to the Bishop.


The general decree to make CSAS procedures canon law has five stages. One is that it is suggested at the Bishop’s conference. Two it gets approval from the Holy See. Three the text is then made and voted on and if passed by a two thirds majority moves onto the next stage. For assent from the Holy See. Five the Holy See publishes and the Bishops conference will then send it out. Once this procedure is in place if a Bishop failed to follow it, the nuncio can report to Rome. Initially the Holy See will speak to the Bishop and can either leave him in office or remove from office. (This law will have little practical effect).


On the seal of the confessional, even the Pope can’t change this rule. This witness came up with a convoluted procedure to try to get round the sacramental seal which is actually impractical.


5 November 2019


Edina Carmi (woman in 50s, blonde curly hair).


Mrs Carmi prepared a report on dioceses and religious handling of cases and procedures. She is an experienced social worker and consultant. She had reviewed CSAS policies and 36 files from dioceses (two the most recent from each). This is a desktop audit only.


On the structure and accessibility of CSAS policy, she found it extremely difficult to identify the correct part of the policy she was searching for. There were no paragraph numbers or hyperlinking. It is hard to work out who does what and when. Policy and guidance are mixed up there is inconsistency on when the LADO has to be notified. It is not obvious who should make reports. It is not obvious what should be done when the abuser it is dead. The “quick guide” is good. It should explain that where the crime has taken place that police may ask for the diocesan safeguarding coordinator’s notes.


On file audits it was not generally clear where police have been notified or the rationale for decisions.


The form CM1 is a very good form to use but was not used often in either religious orders or the dioceses. Religious orders record-keeping was very poor. Jesuit records were very good however.


She found it was hard to work out risk assessment framework and was critical. In 6 of 14 cases where risk assessment should have been considered, there was no evidence of risk assessment taking place or even being considered. One example was abuse by female nun of female pupil. A risk assessment was done by an independent independent consultant. The safeguarding panel rejected the need for a psychological assessment on the nun. Eventually a decision was taken not to do a risk assessment but it was hard work out why the decision had been taken. The initial report was held back from the survivor, data protection being cited.


She is unable to reconcile the paramouncy principle with the seal of the confessional.


She contrasted the amount of support provided for perpetrators such as emotional welfare, accommodation for practical needs, legal representation, testimonials and an ongoing commitment, with the lack of support provided to survivors.


Overall she does not feel the there is any compassion or support provided to survivors generally. In 20 of the 34 cases from dioceses no support was offered when it should have been. The church should think more about what it can offer.


One example was the diocese of Liverpool and father Simpson and his abuse of altar boys. The diocesan safeguarding coordinator was a male member of clergy. He didn’t want Simpson suspended after arrest despite advice from the police. Police threatened to make it a bail condition that he not act as a priest. Records were of good quality but there was no risk assessment at all. The diocesan safeguarding adviser, being a member of clergy and basically a colleague of Simpson was supportive throughout. A safeguarding agreement was eventually put in place.


She is critical of diocesan safeguarding coordinators being members of clergy as they have potential and sometimes actual conflicts of interest.


On the CSAS policy, overall she believes that there is the embryo of a good policy that needs for review, extra parts adding and re-integrating.


Paul Andrew Smith (Man in his 50s, black suit.dog collar, glasses).


Parish priest a member of the carthusian missionaries based in Middlesex. He’s been there since 1980 and ordained in 1990. He has been the leader of the conference of religious between 2006 and 2009 is now the head of the conference of religious currently. He and his staff worked out of spreadsheet or congregations. There are 240 congregations members of the congregation and 90 other organisations which are not aligned to them.


The congregation of religious has no powers over the religious orders and no authority over them. It does not involve itself in safeguarding issues. It confirms that the apostolic Nuncio usually comes to the conference of religious its AGM. He has little contact with Cardinal Nichols. He is content that the conference of religious have done as much as they can on the one church approach. It has adopted a common set of policies (the CSAS policies). Only 40 orders are insured through the catholic insurance society. Others find their own insurance or are self insured. Orders want to make payments but insurers prevent this. There is no sanction for non-compliance.


He recalls a young girl aged 14 speaking to him in a confessional in Guatemala complaining of sexual abuse. He encouraged her to tell her parents. There was no support mechanism existing in the country there and then.


6th of November 2019.


Vincent Nichols (sworn – man in 70s, black suit and dog collar).


Archbishop of Birmingham and 1999 to 2014 and Cardinal from 2014 and also Archbishop of Westminster. He has made six statements.


He stresses that he is not the head of the conference bishops but only has oversight of its work. Each bishop is accountable to Rome and if there is a serious breach by Bishop he can be reported to Rome.


The Pope called a meeting in February 2019 in Rome to discuss the child sex abuse issue in the Catholic Church because there was a crisis in the church and worldwide. There were 200 representatives from countries and areas worldwide he thought different areas were looking at the problem from different perspectives – the US from a legal perspective, Europe from a social worker perspective and Africa from a family culture perspective. In the Far East it was rooted in poverty. He says there is a problem with exploitation generally in society. It was decided that the church should have high standards. It was decided that the church should motivate individuals in parishes to raise standards. Vincent Nichols was questioned about a document provided to him by the chair of the survivors advisory panel and he did not seem to have a full grasp of the document despite saying that he took its messages and the document itself to the meeting February 2019 in Rome.


Vincent Nichols thinks the UK does reasonably well in safeguarding. A video of Vincent Nichols was played as part of the proceedings with him commenting on his ‘awakening’ at the meeting in Rome. He listened between 2000 to 2009 to 17 survivors and learned of the corrosive impact of child sexual abuse but felt that the survivors he listened to in February 2019 caused him to have an awakening. Mr Altman’s line of questioning to suggest that he was the best insincere with his 2019 video speech and at worst not telling the truth.


Vincent Nichols agreed that his handling of the press situation in Birmingham in 2001 to 2003 was not good.


He confirmed that he is willing to consider more resources for safeguarding. He agrees that he has to split his time between his role as the Archbishop of Westminster and the presence of Bishops conference and that of Cardinal.


The review of the shape of safeguarding the Catholic Church to be undertaken by Ian Elliott was discussed he is asked to come up with alternative models or to reaffirm the current model. Vincent Nichols confirms that he is open to suggestions for improvement. He is adamant that he would have done this even if IICSAl was not taking place.


It was pointed out that the Pope’s motto proprio of seventh of May 2019 only requires bishops to report suspicions within the church and not to external civil authorities.


The general decree which could take some time to be confirmed by Rome makes this CSAS guidelines have the status of canon law. Cumberlege had made this a recommendation to put in place by 2008. Vincent Nichols responded by saying that we wanted our policies and procedures to have matured enough to be converted into hard legislation which is difficult to change. Vincent Nichols does not accept that children could have been harmed in the 12 years delay that it is taken from 2007 to introduce the general decree (which is still not place).


There was criticism of the apostolic Nuncio failing to pass documentation to IICSA also attend its to give evidence.


There was criticism that the laicisation of Robinson, convicted in Birmingham in 2010 did not take place until 2018.


There was criticism that the booklet for guidance for priests on expected moral behaviour was not agreed by the bishops conference despite it having been implemented by the conference of religious.


On apologies, Vincent Nichols says he understands it is good to make apologies to make them easier when claimants come forward. He says for some people it’s helpful for some it isn’t.


He believes dioceses should only use limitation where the perpetrator is deceased, not convicted and no further allegations made and a fair trial is no longer possible. He believe it’s it is fact specific in every case. Vincent Nichols says he would be prepared to lose an insurance indemnity if he wants to make an apology. There are still some question as to who drives policy – is it the insurers or as the church?.


Vincent Nichols was questioned about A711, the woman abused as a child by a priest in the servite order who was treated badly by the Archdiocese of Westminster. Vincent Nichols agreed that he regretted not having responded to her and offered the explanation that he felt that she had high needs. He eventually did apologise to her in person and the letter this was after six emails to him without a response and actively telling his secretary not to respond. Vincent Nichols says he was not aware that the chair of the Westminster safeguarding commission, Peter Houghton, had written that A711 was deeply manipulative and making passive aggressive threats and that “if it comes we need to keep playing the good practice card if we are to contain this person is manipulative behaviour”. This is all taking place in 2017. Matters were made worse when A711 was not shown a copy of the Karen Abraham’s report which was a review of her complaints and action to be taken against the priest. He tried to excuse his behaviour by saying that the dioceses treats people wo were complaining about the process differently to people who are complaining about the abuse itself. Vincent Nichols agrees that communication had broken down and he accepts his part and responsibility in that.


During the same month that A711 was being treated so badly, he told the public that the church was to review all its aspects of complaints and that it is it was making progress.


7th of November 2019.


Vincent Nichols (continued). Vincent Nichols accepts that A711 was not responded to well. He accepted that the Karen Abrahams reports had pointed out serious deficiencies in the Westminster safeguarding team’s communications with the survivor.


On A710 (survivor who was sexually abused by Cardinal Murphy O’Connor). Vincent Nichols opened by stating that no police action was taken against Cardinal Murphy O’Connor arising from his defence of Father Michael Hill (the police priest at Gatwick airport). Vincent Nichols immediately lept to the Cardinal’s defence.


This lady had made complaints which was passed from the diocese of Portsmouth where it had taken place to the diocese of Westminster. Soon after this there was a leak of the information to European newspapers, attacking her suggesting that the allegations were false. Vincent Nichols agreed that the leak was probably connected with the the Vigano affair. A news article suggested that the leak was high up in the church in England.


The case was discussed in May 2009 at Valadolid and it was agreed that Vincent Nichols would meet A710. It was eventually decided by Bishop Daley that he would make a statement himself. Vincent Nichols denied he wanted to avoid making a statement as he did not want to bring attention to the Pope’s decision to stop the allegations against Cardinal Murphy O’Connor being investigated. Vincent Nichols professes concern only with A710s welfare. He did not accept that he let A710 down.


On the confessional Vincent Nicholls believes the church will not accept any breach of the seal of the confessional even if it means dying for it. He denies having received any reports of abuse in the confessional. He thanks IICSA for its work and offers unreserved apology to those abused not treated well.


Statements are then read by Mr Saad. The statements of Paul Farrar and Brian Coyle are read dealing with candidates for the ordination and how they are assessed and character defects weeded out.


Eighth of November 2019.


Closing statements were made by Ian O’Connell, David Greenwood, Angela Patrick, Chris Jacobs, Alan Collins, Mr Brodie and Ms Gallafent. Alexis Jay concluded the hearing at 1245. The report will be published in late summer 2020.


Roman Catholic Investigation final hearing Opening Commentsfor Switalskis



RC-A31, RC-A32, Sue Cox, RC-A33, C18, RC-A37


  • Chair, Panel. You have now reported on:


  1. Ampleforth & Downside;
  2. Diocese of Birmingham;
  3. Ealing Abbey.
  • You made findings. Those findings are no longer merely submissions. Those findings will, naturally, inform your final recommendations.


    1. Extent: The abuse you considered spanned nearly a century right up until the near present.
      1. In relation to Birmingham you said ‘Since the mid 1930s, there have been over 130 allegations of child sexual abuse made against no fewer than 78 individuals associated with the Archdiocese……16 criminal cases involved no fewer than 53 victims ’.
      2. In relation to Ampleforth and Downside you said ‘It is difficult to describe the appalling sexual abuse inflicted over decades on children aged as young as seven at Ampleforth School and 11 at Downside School’.
      3. In relation to Ealing you said, ‘Child sexual abuse at St Benedict’s School was extensive. Since 2003 two monks (Laurence Soper and David Pearce) and two lay teachers (John Maestri and Stephen Skelton) have been convicted of multiple offences involving the sexual abuse of over 20 children between at least the 1970s and 2008. In 2016 another teacher, the deputy head Peter Allot, was convicted of offences relating to the possession of indecent images of children.”
      4. In relation to all these institutions you said that the true scale of the abuse was likely to be considerably higher.
      5. This Inquiry is concerned with events in England & Wales. But we know from the Scottish Inquiry and the Australian Royal Commission alone that the pattern of abuse in Catholic institutions has been repeated internationally.
      6. The perpetrators have included some of the most senior figures in the Catholic Church: In England, an Abbot, Laurance Soper and a Headmaster, David Pearce. In Australia, a Cardinal, George Pell.


  1. Cover-up: You found that this abuse has been facilitated, encouraged and covered-up by the Catholic Church.



      1. You said about Ealing Abbey, “The abuse was facilitated for decades because of a culture of cover-up and denial”.
      2. You described how the atmosphere at Ealing was ‘like the mafia’, where staff chose not to risk their jobs by reporting abuse they knew or suspected was taking place.



      1. By their own admission, the Archdiocese accepted: “This Inquiry has heard more than sufficient evidence to be satisfied that during the second half of the last century, the Archdiocese was responsible for a number of institutional failings which on occasions permitted the sexual abuse of children to continue when it might otherwise have been stopped.”
      2. You said, “Rather than make progress by facilitating an investigation and assisting any potential victims, Monsignor Daniel Leonard, the Vicar General in charge of investigating such allegations attempted to make arrangements for [Samuel] Penney to leave the UK and evade arrest.”
      3. You said, that James Robinson was financially supported by the Catholic Church for years as a fugitive from justice in the United States.
      4. You said, “The sexual abuse by Penney and Robinson could have been stopped much earlier if the Archdiocese had not been driven by a determination to protect the reputation of the Church. In doing so, it sealed the fate of many victims whose trust was placed in these abusers. The plight of the victim was ignored or swept under the carpet, allowing the perpetrators to carry on abusing for many years.”
      5. You said, “Had this inquiry not focussed upon the Archdiocese of Birmingham, it is doubtful whether the Archdiocese would have itself recognised that these problems needed to be resolved.”

Ampleforth & Downside


      1. In relation to Ampleforth and Downside you said that “many perpetrators did not hide their sexual interests from boys…Both Ampleforth and Downside prioritised the monks and their own reputation over the protection of children.”
      2. Yet ‘Downside, in particular, tried to pave the way for the return of abusive monks such as Nicholas White’,
      3. We heard the extraordinary lengths to which some monks went to conceal potential abuse. The headmaster of Downside, Dom  Leo Davis – personally – took barrow loads of historic files to the edge of the estate and made a bonfire of them.
      4. The former Abbot, Dom Aidan Bellenger, described in a letter written a recently as 2016 (and which Downside tried to hide), ‘a heart of darkness in the community’ in relation to child abuse. He said child abuse was something which was tolerated by all his predecessors as Abbot.
      5. The Abbot President himself, Dom Yeo – post-Nolan, post-Cumberledge -  turned a blind eye to Father Anselm Hurt’s history of abuse and welcomed him back to the priesthood in a new Abbey in Ireland.

Papal Nuncio


      1. It is extraordinary that, in the face of those findings, the Papal Nuncio refuses to give an account to this Inquiry of what he and the Vatican knew about Laurence Soper’s own flight from justice to Kosovo. Here was an opportunity to show the Inquiry that in recent years the Catholic Church had extended itself to do the right thing to bring this evil man to justice. That the Papal Nuncio has refused that opportunity invites the heaviest, contrary, inference.
  1. In making those findings, you have confirmed what the bravest victims of catholic clerical abuse have been saying for years. Not only were they abused, but they were re-abused by a culture of denial and cover-up. No apology. No repentance. Compensation, if ever, heavily discounted after every technical legal objection had been exhausted.
  2. I have summarised the findings you have made to give some encouragement to the victims of clerical abuse I represent. They have been vindicated. Many doubted, and continue to doubt, that this Inquiry will achieve anything beyond what one has described as a ‘gravy train’ for lawyers and professionals. Will their courage in confronting past abuse prevent further abuse?



  1. We have one central recommendation: the creation of an independent national statutory body to protect children from child abuse, akin to the Health & Safety Executive. It is a recommendation we have made from the start of this Investigation. It is a recommendation we made at the conclusion of the Anglican Investigation. It is a recommendation supported by Howe & Co and the victims of abuse that they represent.  If such a recommendation was justified in the Anglican Investigation, it is even more justified in this Investigation.
  2. Our first submission is that the current patchwork of statutory oversight has failed, and is always likely to fail. Ealing was the clearest example. You identified:
    1. Failures by the Metropolitan Police into complaints against Pearce and Soper in 2002.
    2. Failures by Crown Prosecution Service for failing to prosecute either Pearce or Soper in 2004.
    3. Failures by the Charity Commission for simply accepting Ealing Abbey assurances that appropriate steps were being taken during a statutory inquiry at the very time Pearce was committing further acts of abuse.
    4. Failure of Independent Schools Inspectorate for wrongly concluding that child protection policy was compliant with statutory guidance and that an independent review into Pearce’s offending had been conducted and its advice fully implemented. The ISI was wrong on both counts. It took a member of the public to correct its report which had to be withdrawn and reissued.
  3. None of these institutions’ chief role is promoting child safety. The police and prosecution services are, by their nature, reactive. They respond to, investigate and prosecute crimes. They do not police child safety standards. The Charity Commission’s primary purpose is to police and protect charitable trusts. The Independent Schools Inspectorate is chiefly concerned with maintaining minimum standards of education in independent schools. Even the most egregious and open abuse at Ealing Abbey was not dealt with properly, let alone prevented by the rigorous enforcement of minimum child safety standards.
  4. Our second submission is that the Catholic Church itself will struggle by the nature of its structure to impose a ‘One Church’ policy on child abuse. It is an international organisation where Bishops and heads of the Religious enjoy a high degree of autonomy. We have seen how even post-Nolan and post-Cumberlege, the Abbot President Yeo simply ignored even the basic precepts of those reports to welcome a known abuser back into the Church. When you wrote ‘Much now will depend on the leadership of the Abbot President’ that is correct, but it requires an act of faith in one man that is simply not justified by past experience. Abbot Shipperlee resigned in the face of his failures. Abbot Soper, of course, was an abuser himself. Failures of leadership abound in the Catholic Church and in the Anglican Church. You rightly criticised Archbishop Carey’s leadership in the Anglican Investigation.
  5. It would be a mistake for the state to try to reform the byzantine structures of the Catholic Church with a long-list of piecemeal changes they could and should make. That is not the state’s role. The role of the state is to set and enforce minimum standards for any institution that wishes to care for and educate children. It is for the Catholic church to meet those standards  – if it can – without special pleading or some implied bargain that child abuse is a price worth paying for the benefits of the Catholic church’s care of children. If the Church cannot meet those standards, its involvement with children must end. If that poses an existential threat to the Catholic Church in England & Wales, so be it.
  6. It is with that chief recommendation in mind that we invite you to hear the final two weeks’ of evidence in this strand of the Investigation.



23 OCTOBER 2019