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Thursday, February 05, 2015 

The numbers game and demanding something must be done.

Many of us have a problem with getting our heads round numbers.  The chief point of protest from those in Rotherham to Louise Casey's inspection team, sent in after Alexis Jay's report into child sexual exploitation in the town, was the 1,400 victims figure.  As I pointed out at the time, Jay had reached this number by not so much as an estimate but an outright guess, as the documentation was so lacking.  Her team had also read only 66 case files as part of random sample.

Casey in her report writes "those denying the figures could not point to any more authoritative figure" (page 22), precisely because of the lack of documentation or the changing counting methods, or indeed different things being counted in the documentation.  In other words, no one has the slightest idea just how many children have been sexually exploited in Rotherham, but it's a high one and Jay's figure is probably a conservative estimate, or rather guess.  When you consider that again Casey is counting not just those definitively groomed by Pakistani heritage gangs, but who may have been abused by members of their own family, it puts further doubt on her own conclusion.

This is not to deny the accuracy of Casey's other conclusion, that behind the questioning of the figure, by the councillors at least, was the denial of the very real problem of CSE.  Alexis Jay's report otherwise was excellent, and if anything Casey's work distracts from it.  When however you have a number that is focused on above everything else, as happened with the excess deaths figure leaked to the press concerning the Mid-Staffs care scandal, a figure that didn't appear in the final report precisely because it was felt to be confusing, it does invite questioning and disbelief.

Which brings us to another example of what happens when the very best of intentions, the demand something must be done, leads to poor decision making.  Back in February last year the Guardian and other newspapers began a campaign against the continued practice of female genital mutilation.  As worthy causes go, there isn't a much higher one: there is no reason whatsoever why so much as a single girl living in this country should be cut in such a way, nor should it ever be tolerated, regardless of any cultural sensitivity.  It's a crime, and its chief aim is to prevent women from experiencing pleasure during sex for the purposes of "control".

Alongside the urgently needed awareness campaign was however the bandied about figure of 65,000 girls being at risk, and much emphasis was also placed on how there had not been a single prosecution in the 29 years of legislation being on the statute book.  The reasons why there hadn't been any were fairly obvious: it's not something many victims are going to confess to until they start having serious relationships, or become pregnant. It's also nearly always organised by the victim's relatives, if not with the active permission of the parents, with all that entails for investigations if suspicions are reported to teachers or the police.  Failing careful monitoring of those most at risk, which carries with it the potential for accusations of profiling, misunderstandings and racism, it's always going to be difficult in the extreme to bring charges.

We can't then know exactly why the head of the CPS, Alison Saunders, decided to go ahead with the prosecution of Dr Dhanuson Dharmasena for committing FGM.  Was she under pressure to do something because of the campaign?  We do know that the prosecution was announced three days before she was due to appear before the Home Affairs Select Committee, where the failure to prosecute anyone over FGM would undoubtedly been questioned.

Nonetheless, even on the basic facts of the case it ought to have been clear that Dharmasena had acted in the interests of his patient, even if he erred in precisely the procedure he carried out.  Dharmasena's patient, who did not want the doctor to be prosecuted, had undergone either type 1 or type 2 FGM as a child.  Hospital policy was she should have been seen by the antenatal team earlier in her pregnancy when the damage caused by the FGM could have been repaired.  For whatever reason, this hadn't occurred.  Dharmasena himself had not encountered FGM previously, nor undergone training on it.  After making a number of cuts to the patient in order for the baby to be delivered, it was born safely.  The bleeding however didn't stop, and on the spur of the moment he put in a single continuous suture in a figure of eight.  Hospital policy was the damage should not have been repaired in such a way, and was considered to be in effect reinfibulation, or carrying out the FGM again.  An investigation by the hospital after Dharmasena himself raised concerns over his actions recommended further training and a "period of a reflection".  It was also, fatefully, referred to the Metropolitan police.

Almost as soon as the prosecution was announced doctors responded anxiously, saying there was a world of difference between a repair being made during delivery of a baby and actual FGM.  Calls for it to be dropped were however ignored, and the judge during the trial also rejected 3 separate attempts by the defence for the case to be thrown out.  Even so, it took the jury little more than 30 minutes to decide Dharmasena was not guilty.

On the face of it, as the campaigning midwife Comfort Momoh commented, what Dharmasena did was against the law on FGM.  This was surely though a case with extenuating circumstances, which in itself shows how further training is needed for doctors, let alone other health workers and civil servants.  In the end the jury reached the correct decision and Dharmasena seems likely to be able to carry on as a doctor.  It should also though concentrate the minds of journalists over the power they have to affect policy, and just how easily it can lead to good people being made scapegoats.

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