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Ditch the preconceptions

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Now that press hysteria surrounding the Baby P case has passed, it should be possible to look at the tragic case in Haringey in a more measured and rational way.

At the time, we wondered why such events seemed to keep happening. Were the people involved in the failings in such cases particularly incompetent, and the rest of us so much better? Maybe not.

It has long been recognised by psychologists that we see what we want to see. Human beings, when thinking about a forthcoming event or situation, develop a set of preconceptions about what they expect that event to be like. It helps them make sense of what otherwise would be a continuous set of new experiences.

People gather information during the event and afterwards which supports their preconceived view. Crucially they seem to reject information or evidence which inconveniently contradicts this.

When a police officer arrests someone on suspicion of a crime, they run the risk of looking for evidence which links the person to the crime rather than continuing to try and solve it. Some of the major miscarriages of justice have hinged upon this.

Doctors are also prone to this phenomenon. Indeed when young medical students are in training it is something their tutors are encouraged to look out for. A collection of symptoms may point to one diagnosis, but the good physician keeps an open mind to other possible causes as well.

Regulatory bodies such as Ofsted , the Audit Commission and the Healthcare Commission are not immune from this habit of thinking, How many times have we felt that an inspection team has written their report before their arrival?

The Sharon Matthews case in Dewsbury shows that it is possible for the whole country to be duped - including some of the very journalists who wrote the condemnatory stories about those involved in failing to protect Baby P .

So given that this is a feature of how people think and form their views about situations, what should we be doing about it?

Well, the first and probably the most important thing is to face up to it. My organisation is running some training for healthcare professionals in the new year as we boost the capacity of our child protection services.

We will be raising this issue of people seeing what they expect to see as a feature of work for which we need to be alert. We will be encouraging joint visits between health visitors and social workers to guard against having only one individual’s view of the situation.

But, additionally, we will talk about the importance of supervising the staff visiting the family.

The supervisor, like the medical tutor or the moderation process in regulation, needs to be alert to the dangers of how front-line staff work. They should challenge conceptions rigorously and ask staff to evidence them always from their knowledge of the situation.

Most importantly they should not allow information which does not support this view to go unaddressed.

This is particularly important as it can provide vital clues to where the earlier assessment of the situation might have to be revised.

This type of work with staff is very difficult. There will be a natural tendency to want to support - and therefore agree with - the front-line worker’s view of the case. But by acknowledging the problem, it is possible, I believe, to safeguard against it.

I came across an example of how this can be done in a visit I made to a GP practice six months ago. There was a sign in reception which read: ‘Dr X is a newly qualified physician. He is still in training. If you have any concerns about his work please speak to his supervisor Dr Y.’

Very exposing, but ultimately safeguarding for both patient and doctor.

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