Oral evidence: Female genital mutilation: follow-up, HC 961Tuesday 27 January 2015
Oral evidence, 27 January 2015.
Witness
Alimatu Dimonekene, FGM Campaigner and Survivor, gave evidence.
Chair
Ms Dimonekene, thank you very much for coming in today. The reason we have you on separate panels is because of the professional relationship you have with Leyla Hussein. We have about 20 minutes on this. We have other witnesses from the police and the Royal College, but maybe I could start by asking you: have you seen much of a change between your campaigns over a number of years and last year when we had the Girl Summit, we had the Select Committee report and we had the first two prosecutions?
Alimatu Dimonekene
I have seen a massive change, I think for the last two years, seeing the overall involvement from the political side, from the statutory agencies and communities coming together. As a survivor, I made it a personal challenge that unless I put myself in the position where I am able to make a change, change will not come because it took that long. Having huge campaigners like Efua Dorkenoo on the front instigating and insisting that FGM should be at the fore, and FGM had to have a place where we are talking about FGM—because in the past no one was talking about FGM. That has now changed. We are seeing it beginning to change with professionals who had concerns initially about what their role was in interviewing and dealing with women who have undergone the practice, or how they even had a conversation with us.
Chair
We will be talking to those professionals. Let me ask you a specific question about mandatory reporting and penalties. As you know, the Government is consulting on this. What is your view on the penalties that should be imposed on doctors who fail to report?
Alimatu Dimonekene
I think it is unfair to pinpoint one group of professionals because I want it to be blanket mandatory reporting. It doesn’t follow just the role of the doctors. Yes, they are the ones who may have direct contact with women who present in their hospitals or in their surgeries, but it could also be for social workers and health visitors.
Chair
So anyone involved should be—
Alimatu Dimonekene
Anyone involved has a—
Chair
What should the penalties be?
Alimatu Dimonekene
It depends on what the disciplinary rules are for those individuals. I think it starts off with training, because we cannot start penalising until we know for sure that we have given the right information and the right tools to those professionals.
Chair
But you think there should be a penalty?
Alimatu Dimonekene
I think there should be a penalty because there are now enough tools. The multiagency guidelines spell it out and the intercollegiate report for medical professionals makes it very clear.
Chair
You say that doctors need more training in this, but I would imagine a doctor would know if it has happened. I take your point about teachers and social workers, but certainly a doctor would know if a procedure has occurred.
Alimatu Dimonekene
That is right.
Chair
They would be the most trained of those three groups, wouldn’t they?
Alimatu Dimonekene
I think there is not so much a myth, but you would be surprised how many doctors don’t know the anatomy of a person because they don’t spend much time now in their training rooms learning about anatomy. Some do general practice, and that is all it is. They give you advice. You come into their surgery, you are sitting down, and within two minutes a prescription is written, and so not much discussion. But I know the clinical approach that was sent out in October has helped because we have found a lot of GPs are now not so overawed. There is still a battle for GPs to come on board but there are certain GPs who have now taken it on, and a lot of the CCGs now are asking for GPs to have at least some form of training. But again you still find a lot more who know nothing about FGM.
Chair
How has the general community taken this laser-like interest in the practice of FGM? This is a community practice and not initiated by the state. It is mums and aunts who know about it and fathers and uncles and brothers. It is a family thing; people know. How have they taken this new light that has been shone upon community practices?
Alimatu Dimonekene
In some aspects some communities welcome what is happening now. I come from Sierra Leone and for far too long Sierra Leone has been one of those countries that has refused to accept anything when it comes to FGM. You are ostracised. I get more threats from my community from Sierra Leone, not that they don’t—
Chair
For opposing FGM?
Alimatu Dimonekene
For opposing FGM, because they see themselves as having a higher backing if anyone was to speak against FGM. But fortunately for us as campaigners, what we have seen in Sierra Leone is that because of the Ebola, FGM was halted temporarily. But we are still finding there are areas where you cannot even go and talk about—
Chair
Is that right, in Sierra Leone because of Ebola this was—
Alimatu Dimonekene
FGM was halted because of Ebola. There were certain parts of Sierra Leone where the practice still carried on even when the virus was rife, because they thought by cutting girls that would cure the girls of Ebola, but it just made it worse. So the Government had to take the step, knowing that if they didn’t the virus would rapidly spread. So certain practices have now become a discussion. I find myself going on to the BBC and saying to them, “In order for you to understand why Ebola is spreading in Sierra Leone at this rapid rate, you have to look at harmful practices and obviously FGM is one of those practices”.
Chair
What puzzles me, and what puzzled me about the last report, is that there seems to be no funding going to organisations that are community-based and, therefore, are best placed to reach parts that Government leaflets cannot reach.
Alimatu Dimonekene
That is right.
Chair
Those involved in the community will know; not everyone watches the 10 o’clock news. Do you feel that more should be done to empower local community groups to take this message forward in a much clearer way, because that has not happened, has it? The Girl Summit was a great event.
Alimatu Dimonekene
I know.
Chair
We had so many prime ministers and presidents there, and you and Leyla and others were there, but at the end of the day this was not an inner city activity somewhere. This was all behind a great security fence. Do you think there needs to be more empowerment?
Alimatu Dimonekene
Absolutely. I was the first person to speak on stage in the Girl Summit. I went back home and months after members would come up to me and say, “What are you doing about this? You had this opportunity” and I go, “Well, I don’t know”. I did literally, in May of last year, having been working in local authorities for many years, because I felt I had to do something; no one else was doing it. Everyone was saying they were doing something, helping survivors, but the only place I could go to get help was to the Dahlia Project and it was because it was another survivor who has set up something. There was nothing and there is no funding there. I recently had to set up something in Enfield where I live because again I am finding, day in and day out, just doing my normal shopping women will come up to me and say, “We saw you in the paper. We saw you in the news. Is there anywhere we could go?” Literally I say to them, “You can call me at any time” and I give them my personal telephone number because I don’t get any funding. Sometimes I am on Twitter giving out messages and information to my community so they know. I am on Facebook. Our personal pages on Facebook have become more or less a campaign page. So we use that because we think that is the only way and in doing that communities are constantly—
Chair
Sure, but not every member of the community would know to go to Facebook. It is a huge resource but there are still areas you cannot reach.
Alimatu Dimonekene
Yes. In my case what I have done, I literally was knocking on every door I could knock on, from councillors to community groups to faith groups in my borough. In March of this year I partnered with the Enfield Safeguarding Children Board because, as Leyla was saying, for me FGM is child abuse and we have to respect the rights of our children. What messages are we sending to young girls, in particular? In my borough we have a high rate of teenage pregnancy, a high rate of gang involvement, and a lot of these are from girls themselves.
Chair
This is Enfield?
Alimatu Dimonekene
This is Enfield, and so if we are not helping and supporting them—
Chair
Thank you, very helpful.
Dr Huppert
Could I ask again the question I was asking about the role of teachers and how far do you think we can go in giving teachers a strong role?
Alimatu Dimonekene
We can go as far as we can go and I think, with having teachers on board, I can honestly say we can eradicate FGM in the UK because teachers spend a lot of time—and for me I loved school and it was where I felt the most safe in terms of space. I felt I could be myself even though I underwent FGM at the age of 16. But if you do not have a strong lead in schools, teaching children, especially young boys and girls, about their rights and their bodies, you find a lot of girls who leave school—even boys—not having had sex education. In fact, the discussion around sex education is so blurred these days you have to draw the line in how you protect our children by reinforcing education.
Dr Huppert
Let us be clear, should it be compulsory for all pupils to have sex relationships education, FGM education where appropriate and so forth?
Alimatu Dimonekene
In my personal opinion, yes, because they would learn more from knowing themselves as people.
Chair
I raised with Leyla Hussein the issue of designer vaginas, and the desire for young girls and young women to alter their genital areas. Do you think that should also be the subject of a penalty?
Alimatu Dimonekene
Definitely. In my community in fact we have an FGM campaigner campaigning strongly for FGM, and what she has done is challenge the UK Government, the UK people, by using images of women who are going to Harley Street to have designer vaginas and saying to the communities in Sierra Leone, “If they are having that in London, who are they to tell us in Sierra Leone to stop having FGM?” I take it as a personal vendetta to have this stopped. We have to, otherwise we cannot have the conversation with the countries where we are from, where the practice is still ongoing, if we are going to eradicate it in the UK.
Chair
Thank you very much for coming to share your experience with us. If you have any information that you wish to give us before we compile our revisit report, please write to us as soon as possible. Thank you very much. Examination of Witness
Witness
Detective Chief Superintendent Keith Niven, Metropolitan Police, gave evidence.
Chair
Chief Superintendent Niven, thank you very much for coming here today. When we published our report last year we were pretty critical of the police service, in particular ACPO, for failing to take the initiative as far as prosecutions were concerned. We now have two prosecutions, which of course we cannot talk about because they are currently ongoing. Do you have any news for this Committee as to any more prosecutions, because at the moment we have only had two in the last decade and a half?
Detective Chief Superintendent Niven
Yes, that is very true. At the moment there are a number of investigations still ongoing, and I have the figures that might help the panel on this. We have had 17 cases that have been submitted to the CPS over a number of years; 12 of those were no further action. As you know, we have a trial and we have four cases ongoing at the moment in liaison with the CPS.
Chair
I think they may be the figures you had before. Have you started any new investigations since June of last year?
Detective Chief Superintendent Niven
Yes, we have 22 live investigations at the moment; eight are under review at this stage, which equates to 20 in total. I think one of the most important things as well is in relation to the intelligence that we have started to receive.
Chair
Just on those figures, before we go on to that, obviously those are very small numbers.
Detective Chief Superintendent Niven
Yes.
Chair
We are talking about thousands and thousands of young girls in the UK who are being subjected to FGM. The Prime Minister has hosted this massive international conference; we have published a report; there have been prosecutions; the DPP has told us that she is doing her best. That sounds like a very small number.
Detective Chief Superintendent Niven
It is a very small number that I am concerned about and when I was last here I spoke of the number of referrals that we had received over a number of years.
Chair
Does that remain the problem? The problem for you is that you cannot obviously start an investigation unless somebody comes to you with the information for you to begin that work. Are people still not giving you the information?
Detective Chief Superintendent Niven
Certainly not in the volumes. If we look at Efua’s most recent figures, tens of thousands of women have been subjected to FGM. I think our figures last year were somewhere in the region of 81 referrals. We are at about 83 referrals this year. We are not at the end of the financial year yet, so there is an increase. There has been an increase year on year, but these are still small numbers. Of those referrals, not all are FGM. A very low number turn out to be FGM. I would reiterate that we need those referrals to come in to us. We need a starting point for an investigation and, once we have that then we will—
Chair
But you see the problem for us, Chief Superintendent—and we know you are doing your best and you have this very important remit—the problem for Parliament and this Committee is everyone is talking about FGM, we have great campaigners out there, we have people writing in and saying, “My daughter has been subject to FGM, please we need help”, but at the end of the day, if the criminal justice system does not respond we are left with this very big gap, aren’t we?
Detective Chief Superintendent Niven
We are, and the Government pledged that in 10 years we would eradicate FGM. We are certainly not prosecuting our way to eradicating in 10 years, and—
Chair
No. That is an impossible target to meet at the rate of 22 live investigations a year.
Detective Chief Superintendent Niven
Absolutely, and I—
Chair
So the Government is not going to meet its target, is it?
Detective Chief Superintendent Niven
I think the situation is that if we suggest that prosecutions are the only solution, then somebody has to go through a tortuous process of FGM to do so. So we have to break the cycle.
Chair
No, go back to what I am saying. The target that was set is not going to be met at the rate of two prosecutions a year and 22 live investigations.
Detective Chief Superintendent Niven
If prosecution is the only measurement.
Chair
What other measurement is there?
Detective Chief Superintendent Niven
The other measurement is if the numbers of individuals who have been subjected to FGM continue to appear before medical settings or if they reduce. I think that would be a more accurate way of assessing whether or not—
Chair
But you are not going to eradicate it at that rate, are you? How many have appeared in the last year since you sat before this Committee? How many cases have come to the attention of the medical profession that have not ended up in an investigation?
Detective Chief Superintendent Niven
I do not know.
Chair
Is that not the problem?
Detective Chief Superintendent Niven
The problem is the reporting to police. We had this discussion last time.
Chair
We did.
Detective Chief Superintendent Niven
I was very clear that it is those referrals; it is the referrals to the NHS and the referrals from education. Once we get those lines of enquiry we robustly investigate.
Chair
But it is not even a referral, is it? What you are talking about is you, in the position that you hold, are not being given basic information of how many cases have come before doctors, teachers, social workers.
Detective Chief Superintendent Niven
Absolutely.
Chair
You do not even have that information.
Detective Chief Superintendent Niven
No, I don’t.
Chair
Have you asked for it?
Detective Chief Superintendent Niven
Yes, we have asked for it.
Chair
Who do you ask?
Detective Chief Superintendent Niven
We have a very close relationship with the NHS and my understanding is that now data is being recorded in relation to the number of individuals. That is a good starting point.
Chair
Yes, but who do you ask? You may have a close relationship with the NHS but to whom do you say, “I am going to go before the Home Affairs Select Committee. I would like to know on a monthly basis how many cases have come before the NHS”? Who do you ask for that information?
Detective Chief Superintendent Niven
We have a strategic group that one of my superintendents holds. The NHS are on that. I also go to the London Safeguarding Board, which is chaired by Cheryl Coppell, and the NHS are represented there as well, and we talk about referrals. There has just been a consultation regarding mandatory referrals. We have—
Chair
Do you support that?
Detective Chief Superintendent Niven
Yes, I do.
Chair
Do you support mandatory referrals?
Detective Chief Superintendent Niven
Yes, I support mandatory referrals and one of the—
Chair
Do you feel that if you have just one case of one doctor who fails to report, who is then the subject of criminal proceedings, that will send out a very powerful message to everyone else that they had better look carefully and report their information?
Detective Chief Superintendent Niven
I am sure that would send out a very strong message.
Chair
What do you think the penalty should be for a doctor who fails to report?
Detective Chief Superintendent Niven
I think—and this was the response that I gave when the consultation came—that these agencies and bodies have their own disciplinary proceedings because—
Chair
But that is professional.
Detective Chief Superintendent Niven
Yes, that is professional.
Chair
I am talking about the criminal law here. We know that the doctors have the BMA and the Royal College. They are coming in to see us, but what is the criminal sanction here?
Detective Chief Superintendent Niven
That would have to be assessed by others rather than—
Chair
What do you think it should be, bearing in mind you sit before us frustrated, telling us about 22 cases and saying to us nobody is telling you information? What should the penalty be? If I was the Home Secretary and I asked you what that penalty should be before I brought my legislation through, what do you think it should be? A personal opinion based on your experience.
Detective Chief Superintendent Niven
At the moment I think every case would be based upon its merits and I do not know what that penalty or what the appropriate penalty would be. I would want to seek legal advice about that and speak to people who are experts in the field, with the judiciary. I am not in a position to say what a penalty should be. The only thing I am saying is that I want to see the referrals coming in to the police so that we can investigate them.
Chair
Yes, but that is what you said last time, you see, and there has been no change. You came here and you lamented that and we lamented with you.
Detective Chief Superintendent Niven
Absolutely.
Chair
But I have not seen a mandatory answer.
Detective Chief Superintendent Niven
At that point in time though, when we last spoke, there was not mandatory recording of the information and up until this point there still is not mandatory reporting. It is at consultation stage.
Chair
No, indeed.
Detective Chief Superintendent Niven
But I do look to the future with optimism. I think we will receive more referrals. One example that I can give you—
Chair
That is based on just your normal optimistic demeanour or—
Detective Chief Superintendent Niven
Well, no, based on the fact that, following the consultation and if mandatory reporting is brought in, then I will be the recipient of some of those reports.
Chair
Right, so you cannot wait?
Detective Chief Superintendent Niven
Soon enough is—
Chair
Soon enough is better. Thank you.
Nicola Blackwood
Obviously we have heard a little bit from Leyla, the witness before, who I think you were sitting in listening to, were you?
Detective Chief Superintendent Niven
Yes.
Nicola Blackwood
She had a lot of good things to say about the multiagency guidance, saying that we have one of the best, but last year is probably the first time it has been put into practice. It is not statutory and obviously it is used by but not limited to the NHS staff, health professionals, yourselves, social workers, teachers, other educational professionals and so on. At the same time there is also a College of Policing consultation, the mandatory reporting consultation, the NHS England prevention of FGM package, which are trying to drive through change. You have just spoken to me about a roundtable of professionals getting together. I am wondering if there is a bit of FGM slipping through the gaps of who actually has responsibility for taking hold and driving through the change: which agency takes the lead on FGM and makes sure? A multiagency approach can be very strong unless nobody is taking responsibility and nobody is making sure that there are prosecutions, deterrents, preventions and so on. Do you think that there is a lot of activity but no actual outcome yet?
Detective Chief Superintendent Niven
I think there is a lot of activity. The heads of those agencies and organisations have responsibility and they should be held accountable by Parliament, and there are Ministers who have responsibility for those particular areas. In relation to those policies, the Chair mentioned ACPO and that is a national approach with the College of Policing. That will be advice and guidance to all police forces. I head that locally so it would be my responsibility, but subsequently that responsibility would be held by the Commissioner and we are accountable to MOPAC and Parliament. In relation to policies and procedures, I think you mentioned that there is nothing mandatory in relation to FGM, but FGM is child abuse, so it is mandated that people—
Nicola Blackwood
Yes. This is an exercise in accountability and so what I am asking you is: how can we approve the outcomes where we have a lot of agencies with a lot of consultations and still reporting and referrals do not seem to be going up particularly? We have had pleas for more training and more awareness; there has been a lot in the media; we have the first prosecution. There has been a lot that should be improving the situation but it does not quite seem to work. Do you think, for example, the multiagency guidelines should be statutory? You said that you think mandatory reporting should. I am just trying to understand what you think would improve the situation, because it doesn’t seem to have improved much since last—
Detective Chief Superintendent Niven
I think the guidelines should be statutory. If mandatory reporting is brought in, then it will be statutory and people will be held accountable for not reporting or referring particular cases. I think we will get the strength behind that. I am sure we will achieve that in the future. That is what this process is about at the moment; the consultation is out. For me, personally, investigating crimes and sending out a very serious and robust message, yes, mandatory reporting should come in. Those organisations that do not or fail to do so will be held accountable accordingly.
Nicola Blackwood
Once mandatory reporting comes in, are you confident that you would be able to come back to the Committee and there would be a significantly different story to tell?
Detective Chief Superintendent Niven
If the data is correct regarding the prevalence of FGM in the UK, over the next five to 10 years girls presenting at maternity clinics will be UK citizens who potentially have had FGM while living in this country, either here or being taken abroad, and to not report those individuals when they present at maternity settings is an absolute offence. I do hold optimism around that because if there is mandatory reporting and those situations arise, I will get that information and I will investigate those offences.
Dr Huppert
How many police officers in the country do you think are working on FGM at the moment?
Detective Chief Superintendent Niven
I am sorry, I don’t know. I can tell you how many are working on it in the Metropolitan Police.
Dr Huppert
Okay, how many are working on it in the Metropolitan Police?
Detective Chief Superintendent Niven
I have a unit of five individuals who are Project Azure. You may have heard of Project Azure. They are my strategic group. Then I have 16 child abuse teams who investigate all cases of FGM.
Dr Huppert
They also have to investigate all other child abuse cases?
Detective Chief Superintendent Niven
Yes, they do. They are trained in all aspects of child abuse investigation.
Dr Huppert
We can presumably assume that the Met Police would have the vast majority of people working on this in the country. Would that be fair?
Detective Chief Superintendent Niven
Yes, I think we take 20% of most of the crime in the UK. I would suggest that is correct.
Dr Huppert
This is a major Government priority to try to sort out and you are saying you have five people plus a share of 16 teams.
Detective Chief Superintendent Niven
Yes.
Dr Huppert
Does that sound proportionate to what is needed?
Detective Chief Superintendent Niven
My project team, as they are, are my partnership team. Should demand increase, then I would put other resources into that. That does not include if there are proactive operations. I have other resources that I can draw on for those operations and, of course, the 16 teams across London that deal with the investigations. Project Azure really is about partnership, awareness, training and liaising with other agencies, and that is what they have been doing and will continue to do.
Dr Huppert
If you do start to get more reports as you are hoping, are you 100% confident that you will be able to deal with all of that information appropriately?
Detective Chief Superintendent Niven
I will resource that. If I cannot resource it from within my current complement, then I will seek other resources from above me to counter that demand.
Dr Huppert
Have you had assurances that you will be able to get those?
Detective Chief Superintendent Niven
Well, they will be assessed accordingly, but we have a responsibility to investigate crimes of FGM and that is what the Metropolitan Police will do.
Chair
Mr Loughton has to go to Westminster Hall. Would you ask your question now?
Tim Loughton
My apologies, I have to lead a debate at 4.00 pm. We have talked a lot about mandatory reporting and the very small incidences of prosecutions and so on. Do you think—and it is difficult to explain a negative—the prevalence of FGM has decreased with all the publicity there has been? Do people think, “Gosh, we had better not do it now because we may get hauled up”, or do you think the prevalence has remained the same but more of it has migrated overseas rather than happening in the UK? It is a difficult question but just your judgment.
Detective Chief Superintendent Niven
I can answer it but in a very narrow way insomuch as we have had intelligence following our Operation Limelight project that we have engaged with at the airports prior and since the last Committee. Some of the information we have had is people have been deterred from taking their children abroad to have the process because they may get caught coming back into the country. That only amounts to a very small number of individuals, so it is difficult to tell. At the moment, we are very reliant upon our partners and charity workers such as Leyla to assess the temperature and give us that information. We have had community events where we have asked for that information. Unfortunately it is not an accurate picture, but again I go back to if there are women presenting at maternity clinics who have had FGM that has to be our best starting point because that will give us a gauge of what the prevalence looks like. I think conversations with those individuals will show whether or not it has happened in the UK or abroad and whether it is recent or historic.
Tim Loughton
That is a very interesting point. The logic of what you said is to suggest that if prevalence remains the same, more of it is happening in the UK rather than happening outside of the country. It is happening more on our own doorstep than it is out of sight where the children—
Detective Chief Superintendent Niven
That could be the case. Unfortunately, I do not have the data to corroborate that.
Mr Winnick
Arising from some of the questions Dr Huppert asked you, can I clarify that you said you have five altogether in the unit you lead?
Detective Chief Superintendent Niven
Yes, there are five who are dedicated to my partnership side of this work. I have 16 child abuse investigation teams to deal with the criminal investigations and I have other proactive assets that I can draw upon if they are required for proactive work. The Metropolitan Police is not just working in silos. I can draw on specialist resources but my permanent resources are 16 child abuse teams.
Mr Winnick
Within the Met?
Detective Chief Superintendent Niven
Within the Met, yes.
Mr Winnick
As regards the other police forces—mine is the West Midlands, of course; I say “of course” bearing in mind my constituency—is there co-ordination between the various police forces, including the Met?
Detective Chief Superintendent Niven
Yes, there is co-ordination. Mr Chishty, who appeared before this Committee back in April, is the ACPO lead and he co-ordinates that activity across the country.
Mr Winnick
Is there some senior police officer, more senior than yourself, who has overall responsibility at national level? That is what I am getting at.
Detective Chief Superintendent Niven
He is the ACPO lead, but each chief constable has responsibility for the activity of his or her own forces; he co-ordinates. For example, the College of Policing at the moment has just recently closed a consultation regarding guidelines to all police forces in England and Wales. That will lead the guidance for the future. Mr Chishty is involved in that because he is an ACPO lead, but ACPO officers have leads for a variety of different types of criminal activity or procedures. It just happens that he is the ACPO lead for FGM.
Chair
Do you think that mandatory reporting should be extended to those women who of their own volition go to places like Harley Street and have operations in order to create these so-called designer vaginas? Do you think that it should be extended to that?
Detective Chief Superintendent Niven
In fact, I think we raised the issue of the confusion that there is in relation to the law about this or the practice of the law. The law is very clear that that activity is FGM. I think there is a debate to be had on whether or not the designer vagina and the cosmetic surgery falls within that part of the legislation. If it does, it will then be a decision for the Crown Prosecution Service whether or not it is in the public interest to prosecute those cases if the evidence is sufficient to do so.
Chair
You think there may well be a case, but would you investigate such cases?
Detective Chief Superintendent Niven
I think there is definitely room for a debate about this because I think it needs some clarity.
Chair
Have you thought about using any of the funds that you have at the moment in order to fund projects such as those we have heard of today? They seem to be able to reach parts of the community that the Metropolitan Police may be unable to reach. Do you not think that would help you in your desire to get more information and more intelligence and more stakeholders involved?
Detective Chief Superintendent Niven
I absolutely think that outreach workers are the way forward. If we look at history, we do not get that much information being brought to our attention. Since the last Committee, our previous year was about 33 pieces of information; we have had about 130 pieces of information since. There is some progress there, which I am encouraged by. However, conversations with police officers around this are not regular and they are not consistent.
Chair
The question was: would you fund those organisations?
Detective Chief Superintendent Niven
I think there should be funding available.
Chair
Can you provide it out of your budget?
Detective Chief Superintendent Niven
That is not a matter for me because our budget is held by MOPAC. That would be a question to MOPAC.
Chair
Would you support such a move?
Detective Chief Superintendent Niven
I would definitely support that an outreach worker who is an expert in FGM should be available for each of the boroughs to talk to people. I think we would gain more intelligence and information. I have noted here that since the Girl Summit the Government has committed £270,000 for community projects to prevent female genital mutilation and £100,000 from the Home Office to run a female genital mutilation community engagement initiative. There is money there and I think that money should be spent on people who can work with communities, who are outreach workers, and that will provide opportunities for people to talk about it and provide a comfortable environment to do so. From that I think more information would flow, because the answer here is within the community, certainly from a policing point of view.
Chair
Very helpful.
Nicola Blackwood
There was a comment made in earlier evidence implying that FGM is sometimes linked to later abuse and some survivors of FGM then go on to experience child marriage, forced marriage, domestic abuse with a higher incidence. In your experience, have you found this to be true?
Detective Chief Superintendent Niven
I have not investigated cases that relate to that. Sometimes we investigate child abuse cases and then we discover that FGM has happened as well. I have one case in mind where we got to a position where we could provide the CPS with evidence of FGM because there was child abuse prior to that and historic FGM that had taken place. I did attend the Girl Summit in the summer and those correlations and links were definitely being made by people from across the world, experts in their field. I think potentially there is a link to that and again—and I apologise for repeating this—when we get those referrals in I will be in the position to absolutely say whether or not those links are true. At the moment, the suggestion is that there are links to other offences and FGM is one of those offences.
Nicola Blackwood
I wonder if the reverse process might also be possible where you have a victim or a survivor who comes in as a victim of child abuse or of domestic abuse and perhaps they fit the profile of being possibly at risk of FGM. That might be a line of investigation and a way in which to also proceed rather than having direct referrals. Have you ever considered that line of enquiry?
Detective Chief Superintendent Niven
Absolutely, and I think one of the things that we have said previously is that FGM is a unique offence, or our data suggests that it is. I accept that that might not be the case, but why it has been difficult to detect is that in a lot of cases there are no precursors to the FGM. In some families this is an honestly held belief; wrongly, but it is held by families. It is the only abuse that takes place in that child’s life, so there is nothing before and nothing afterwards. That is why I think historically it has been difficult because people do not understand the signs of FGM. It is about training and I think that is now coming more to the fore with the public. Normally child abuse indicators mainly are from schools where child abuse issues are identified—it might be bruising to a child or the behaviour of a child—and then referrals take place. This is secret. Children are taken away, as we understand, to countries. They are kept for long periods of time in those countries so the effects are not obvious when they come back to school. That is why it has been hidden, I think, or one of the reasons it has been hidden in the past. As professionals find out much more about this and there are signs that can trigger concerns in teachers and other professionals, as they learn what they are they will make those referrals to social services and risk assessments will be made.
Nicola Blackwood
I understand that. It is just I had always understood it as a single event. This is the idea that FGM could then have later links to other forms of abuse. I wonder if this is perhaps leading us to a different understanding and perhaps possibly may be of use in terms of your work.
Detective Chief Superintendent Niven
We are very open-minded in relation to this. Historically, as it has been explained to us—and we only have a basic amount of information—in a lot of cases it is a one-off event, but I certainly would not be closed to the fact that it is part of other abuse. In fact, we have one case that proves that it was part of other abuse. That report led us to discover FGM, so certainly it is a strong possibility.
Chair
Chief Superintendent, thank you very much for coming here to give evidence to us. We hope to have our report ready by the end of February.
Detective Chief Superintendent Niven
Chair, thank you very much. Examination of Witnesses
Witnesses
Professor Nigel Mathers, Royal College of General Practitioners, and Janet Fyle, Royal College of Midwives, gave evidence.
Chair
Professor Mathers, Janet Fyle, thank you very much for coming in. I am not going to start with a long introduction of why we are here; you know that. Of course, both of your organisations are critical to our understanding of FGM but also how to deal with this issue. Just to refresh our memories, Professor Mathers, is it a breach of professional guidance for a member of your organisation not to report FGM at the moment? I know you were preparing fresh guidance.
Professor Mathers
Yes. The short answer is yes. Under the clinical guidelines and under the statutory responsibilities around child abuse, it is.
Chair
How many cases of disciplinary action were taken against doctors who failed to report it last year?
Professor Mathers
To my knowledge, none.
Chair
Janet Fyle, is it in your code of ethical practice and your guidance to your members that they should report this in the same way as for GPs?
Janet Fyle
Yes, it is in the Nursing and Midwifery Council code. Midwives have a duty of care to report anything that would have an impact on the health and wellbeing of a child or a woman or anyone in their care.
Chair
How many were disciplined last year for failing to report?
Janet Fyle
I do not think anyone was disciplined but I do not know exactly.
Chair
You see, this is the problem for the Committee almost a year after we produced our report, after the Girl Summit. The medical profession in particular does not seem to have gripped the importance of what Parliament is saying and what community groups are saying. What has changed since last June when we published our report?
Professor Mathers
I think there has been a huge upsurge in interest and knowledge about FGM. The Girl Summit launched a process that has been followed through. It has been followed through by our college with the production of e-modules. E-modules are what doctors need to do as part of their continuing professional development. An e-module on FGM is being produced. There are other systems being put in place around collecting data, about its prevalence, and various other initiatives that I can list for you if that helps.
Chair
The initiatives are there but the numbers are zero still. It is still going on. The Government says it is going on; the police say it is going on. You heard the lament of Chief Superintendent Niven that he is not getting the information and he is not getting the referrals. You are not disciplining anybody for not reporting this and, Ms Fyle, your organisation is not either. Do you see the frustration of all of us?
Professor Mathers
I absolutely understand that, but we are not a disciplinary organisation. We are a membership organisation. The regulatory authority is the GMC, the General Medical Council.
Chair
How many cases have gone to the GMC?
Professor Mathers
I am sorry, I do not know that. You would have to ask them that.
Chair
All right. It just seems a little like buck passing between all these various organisations. There is clearly a desire to get something done, but there seems to be no finality to it all. Everyone is against FGM. Your members are, presumably. They regard it as being child abuse, but no one seems to be prosecuted, apart from the two individuals who are currently in court. Is that a worry to you?
Professor Mathers
Yes, I think we need to do more to address the problem of FGM. The difficulty is what you do and how you can practically apply some of the interagency guidance that exists. For a start, on the prevention side there needs to be some community initiative such as the Chief Superintendent spoke about, the outreach workers. On the education side, I think that training about FGM should be included in the statutory training for child abuse. On the raising awareness side, then there is all the material that we are producing that our members will have access to to learn about FGM.
Chair
Do you think that there should be criminal sanctions for those who fail to report FGM? A doctor arrives at the surgery in the morning; child is brought in; the doctor finds FGM has been perpetrated against this child and fails to report. Do you think that there should be a criminal sanction?
Professor Mathers
We believe that there should be mandatory reporting of those particular cases. These are cases of FGM that have been either seen or disclosed. The difficulty comes with reporting cases who are at risk or suspected because you are asking a health professional to make a decision on incomplete information. The referral or reporting should then go to the local safeguarding board where there is expertise and knowledge in order to either confirm or not confirm the diagnosis.
Chair
Let us stick to the diagnosis of the doctor seen or disclosed. Do you think that there should be a penalty if a doctor, having seen or received information of disclosure of FGM, does not report?
Professor Mathers
Yes, we do agree with that.
Chair
What do you think the sanction should be?
Professor Mathers
I think the sanction would depend on the merits of the case, as has already been stated. We think the threshold should be very high for referral to the disbarring board and that the GMC should be closely involved in the process of deciding what the appropriate punishment for deliberate non-referral of FGM is.
Chair
It does not sound very harsh. If I was a doctor and I heard that Professor Mathers told the Select Committee that the threshold should be very high and it depended on the offence and all these other caveats you put in, I would not be that keen to do it.
Professor Mathers
The threat of a criminal prosecution is a considerable one for doctors and I think a non-referral may well be down to the fact that the doctor does not know sufficient about FGM or the grades of FGM and requires more training. It may be an inadvertent failure to refer.
Chair
Indeed. That would go to mitigation, of course. Tell me something: what should you do in your royal college in order to get better training for doctors? We heard some evidence today from one of our witnesses—you were here when she said it—that doctors these days will see people for a few minutes and will not necessarily examine. Their training does not require this to happen. What are you going to do as far as training is concerned?
Professor Mathers
The training that we offer is around the e-module, which I have already mentioned. We have produced clinical guidelines that explain FGM for our members to refer to as well. We also have the recording of FGM now on the computer systems, which did not exist a year ago. The advice and encouragement from the college is to use the educational materials that are available, be aware of the law and take appropriate action when you see a proven case, either visually or disclosed, of FGM.
Chair
Janet Fyle, tell me that the Royal College of Midwives is doing more than the Royal College of General Practitioners on this.
Janet Fyle
I do not think it is about doing more or less. The Royal College of Midwives has done more than most to bring FGM to the spotlight. In 2013, we got together a group of all the medical royal colleges and wrote the nine recommendations. If we look at those, we are slightly happier that the Government is going in the right direction by trying to implement them. The issue is when you have inconsistencies in how we report FGM. For example, midwives might want to report FGM and there are others who might not want to report FGM. We had a discussion this morning about perhaps mandatory reporting, but you need to make reporting of FGM statutory because that way people will do it. We have had a very long period in this country where people have decided, “Perhaps we will report, perhaps we will not; perhaps we will take action, perhaps we will not”. Another issue for me is the fact that we are just focusing on under-18s. FGM is something that when you open this can of worms you will find that we have our own British-born children, European children, who might marry into that community and at 18-plus they might be pressured into having FGM. There are lots and lots of issues around it and I think personally we should report all cases of FGM.
Chair
Should there be a criminal sanction if that is not done?
Janet Fyle
It depends on whether the person refuses to report or deliberately does not report.
Chair
If they deliberately do not report?
Janet Fyle
I would not know what sanction to give to those people, but I think there should be sanctions if they deliberately do not.
Nicola Blackwood
I am struck by the points that you made, Professor Mathers, about professionals perhaps being uncertain in cases that are borderline, where they are not certain. We have been here before with child sexual exploitation where there was lack of knowledge, uncertainty, medical professionals, social workers and so on not sure what to do with cases because they did not know what they were identifying. We have moved a long way on that in the last few years. One of the things that I think really tipped the balance is multiagency hubs where the professionals are together. It almost acts as a referral mechanism. Those in the field can refer their worries in without being concerned that there is going to be an adverse reaction. That referral can then be assessed for whether it needs to go to the police to be investigated or early intervention or, in fact, that there is no problem at all and it does not need to be referred and no action needs to be taken. Do you think that that is the sort of model that needs to happen with FGM and perhaps would act as a reassurance to professionals in all different backgrounds, whether it is teaching or other areas, who are not going to be specialists in FGM but we are going to need to play their role in reporting in order to make sure that we make the progress on eradicating FGM that we need to do in this country?
Professor Mathers
We would strongly support such a model. We think that is exactly the right way to go. It can be difficult with the different grades of FGM, even if you are an expert paediatrician in this area, to make the diagnosis. We do need a referral agency to whom we can send women or children who we feel are at risk or suspected FGM for a definitive statement on that. It would be the local safeguarding board, because the police are represented on the local safeguarding board and so are the social services. It would be a good system if we were to refer suspected or at risk cases of children with FGM to a local safeguarding board.
Nicola Blackwood
You are comfortable with the LSB being the right body for that? You do not think that there needs to be a specialist body like the MASHs? In my area, we have the Kingfisher unit, which is set up for CSE. This is a very similar model.
Professor Mathers
In an ideal world there would be a specialist unit, but in practicality it is a question of resource, having the availability of such a resource to all the 10,000 practices in the UK.
Nicola Blackwood
Most areas in the country now have these MASHs. It is just whether they expand to include FGM or not and that is what I am wondering.
Professor Mathers
Yes.
Nicola Blackwood
What do you think?
Janet Fyle
For suspected or at risk cases where the professional is uncertain what is going on, from my perspective they need to get a doctor who is an expert to tell them what exactly they are looking at and then take it from there. The multiagency safeguarding hubs can be another place where people discuss those issues so that we can normalise it and it does not become a taboo, for health professionals not to intervene or do not want to talk about. I think we need to separate the suspected or at risk from those that we actually know about so that we know where we are going with reporting FGM.
Mr Winnick
There is no comparison, is there, Professor, between the confidences of a priest who, according to the Roman Catholic Church rules—at least as I understand it—does not disclose and a medical professional? There are no similarities, are there?
Professor Mathers
There are some similarities, not very many similarities but there are some similarities with patient confidentiality. When it comes to the law of the country and as a citizen of the country, we have to ensure that the law is followed.
Mr Winnick
As far as FGM, the position in law is quite clear. It is the duty and responsibility of a doctor to report where incidents have occurred where he believes a child has been subject or could be subject to FGM. Am I right?
Professor Mathers
You are correct, yes.
Mr Winnick
Professor, I know that you represent the Royal College of General Practitioners, but in practice it is more likely to be doctors in hospitals, isn’t it, rather than GPs? Without getting into all these details, in the main examination of a body, male or female, tends to be in a hospital. Am I not right?
Professor Mathers
No, we do plenty of examinations in practice, but it will be the midwives who will be the first to observe FGM in an adult woman. It would not be in a routine consultation.
Mr Winnick
Do you feel there is some reluctance on the part of doctors, be they, to use the term, white or of Muslim or Jewish origin or what have you, who feel there is some sensitivity? Although they do not in any way, heaven forbid, condone FGM, they do not want to feel that they are taking what could be considered to be—it would be wrong to come to that conclusion—a racist position? Therefore, they have an obligation to those who come to them to serve them in such a way that they do not betray confidences?
Professor Mathers
One has to be sensitive to the individual. You have to have some professional judgment, but I do think when it comes to obeying the law, then the law is pretty clear that if we, as professionals, suspect a case of child abuse—and FGM is the most terrible abuse—then it is incumbent on us to refer it. We need to do that with the agreement of the patient or the person in front of us.
Mr Winnick
As far as the medical profession is concerned, it is quite clear you are urging doctors, and obviously others in the medical profession, to report such incidents according to the law of the land?
Professor Mathers
Absolutely, along with child sex abuse and other forms of child abuse.
Mr Winnick
That is the position with midwives, presumably, to report all such incidents?
Janet Fyle
That is our position.
Mr Winnick
In all circumstances?
Janet Fyle
In all circumstances regardless. If we go back, we have had 30 years in this country where we have a law on the statute books that does not achieve anything for the victims of FGM. Consistently, every year, we come to this matter and talk about it. I think it is about time that we, as a society, say that FGM is against the law and we have to mean what we say.
Nicola Blackwood
I wanted to clarify a point that you made just now, Professor Mathers, where you said, rightly, that FGM is a terrible form of child abuse and that where you suspect any form of child abuse you are required to refer it to the responsible authorities. Then you said “with the consent of the patient”. That sounds a little strange to me. I am not aware that you seek the consent of a child to refer them to protective services. I have not heard of that before and I was a bit confused.
Professor Mathers
Sorry, the guidance is that one needs to engage the family and they need to know what is going on, but they do not have a veto on your referral decision. For the future, because you will be looking after that family for the next X number of years, it is very important to maintain the relationship, to be very clear about what is going on here and to explain that this referral is taking place.
Nicola Blackwood
But your primary responsibility is the protection of the child, is it not?
Professor Mathers
Yes.
Nicola Blackwood
If you have suspicions that that child is at risk, your primary responsibility is to ensure that protective services, whether it is social services or police, are notified, not to be considering your long-term relationship with other members of the family.
Professor Mathers
They are not mutually exclusive. I think you need to do both.
Nicola Blackwood
You mean try to do both?
Professor Mathers
Trying to do both, yes.
Nicola Blackwood
Try to do both, perhaps, but I think that is a mixed message that is possibly quite dangerous. I would be quite worried about the message that that would send out if it was not clarified. I think there is one that does need to be. My second question is: there must have been a time when referring for child abuse, bruises on a child or something like that, was just such a difficult decision but it has now become a much more standard procedure. I think most GPs would be well trained and well practised in that and have the training. Why is it different for FGM?
Professor Mathers
In a sense, the profile of FGM has only started to rise among the profession in the last few years. Reporting of FGM is where the reporting of child abuse a few years ago was at. I can see a future whereby FGM becomes part of the normal repertoire of care for children who are abused. I think that things are changing and have changed since the Girl Summit and the big political push that there has been to eradicate FGM from our society as far as we possibly can.
Dr Huppert
Another thing you said that took me by surprise is I think both of you talked about the difficulties in diagnosis. Are you saying that GPs and midwives cannot tell when somebody has been subjected to FGM? I can see it may be hard to predict who is at risk, but is it hard for people who have actually been subjected to FGM, Ms Fyle?
Janet Fyle
It is not that difficult to diagnose FGM, to look at it and say from my perspective as a midwife or other midwives, but sometimes the communities vary the practice. Sometimes it is just a little prick and people cannot see it. As we get more vigilant, the communities who practise FGM vary how and what they do and when. That is why I talked about the difficulties. There are standard definitions for the different types of FGM that we know, but recently somebody has come across something that we have never seen before. They do it in a different way, so that is why I said difficult. Sometimes it is just a pinprick.
Dr Huppert
The standard types look like they would be very easy to tell.
Janet Fyle
The standard types, yes. There are standard types, but the communities vary what they do. They are always one step ahead of those who are trying to stop them.
Dr Huppert
You would be able to diagnose the standard types but it is harder if it is done with an intention to conceal?
Janet Fyle
That is the issue.
Dr Huppert
Okay, that is helpful. Professor Mathers?
Professor Mathers
I would say that some of grade 1 FGM, unless you have seen a lot of FGM, is quite difficult to diagnose. This is why we need the expertise in the community for a definitive diagnosis to be made.
Chair
Are you confident that you are doing enough to inform your members of the seriousness of the situation, bearing in mind they have not been able to have a huge increase in training since the publication of this report and the Girl Summit? You talked about a number of initiatives, but at the end of the day this is happening in a surgery somewhere in Britain where somebody may not be able to go to the Girl Summit or any of these other conferences or events. It is happening at the frontline, isn’t it?
Professor Mathers
We are always open to new initiatives. We are doing everything we can think of to raise the profile and to raise the awareness and training of our members.
Chair
Did I put the issue of the private clinics to you before?
Professor Mathers
No.
Chair
I have put it to all the other witnesses so I should put it to you. Do you think those who are operating private clinics in places like Harley Street and elsewhere and are performing these designer vagina operations should also be covered by this law?
Professor Mathers
Yes.
Janet Fyle
I think so. I will expand a little bit on that. We could be accused of double standards if we are saying to the communities, “You cannot do that” but we are saying to doctors and surgeons, “Yes, of course, you can do that if you give anaesthetic and have a very nice room where you can put the girl”. Sometimes girls of 16 and 17 are at greater risk of being taken to one of these places to have it done, so I think we should look at that because there is not much difference.
Chair
Ms Fyle and Professor Mathers, thank you very much for coming in today. If you have any statistics for us, especially from the GMC—obviously we will write to the GMC about this but if you know of any statistics—please would you write and tell us about them?
Professor Mathers
We will. Last time you asked us to look at best practice overseas and we have looked at that and have some interesting data that the Committee might be interested in.
Chair
Have you? Tell us about that before you go. Which countries?
Professor Mathers
Well, particularly the Netherlands. We looked at the situation in the Netherlands, Australia and France, following your recommendation. In the Netherlands a report has just been produced that of 70,000 women living in the communities that are likely to be affected by FGM, the estimate is about 40%. But from that community they estimate that there are about 40 to 50 girls out of the 70,000 community who are at risk of FGM. That is a surprisingly small number but they have a very robust methodology. I will obviously forward that report to you.
Chair
Thank you for taking our recommendation. Janet Fyle?
Janet Fyle
I was just going to say about the statistics that you probably are aware that there is another part of the prevalence study about to be reported on 6 February that would give us a rough estimate or prediction of how many girls are at risk. It is going to be quite surprising.
Chair
Thank you very much for coming in. We are most grateful. That concludes the session today. Q116 Q117 Q118 Q119 Q120 Q121 Q122 Q123 Q124 Q125 Q126 Q127 Q128 Q129 Q130 Q131 Q132 Q133 Q134 Q135 Q136 Q137 Q138 Q139 Q140 Q141 Q142 Q143 Q144 Q145 Q146 Q147 Q148 Q149 Q150 Q151 Q152 Q153 Q154 Q155 Q156 Q157 Q158 Q159 Q160 Q161 Q162 Q163 Q164 Q165 Q166 Q167 Q168 Q169 Q170 Q171 Q172 Q173 Q174 Q175 Q176 Q177 Q178 Q179 Q180 Q181 Q182 Q183 Q184 Q185 Q186 Q187 Oral evidence: Female genital mutilation, HC 961 32