Cumbrian police. Wikicommons.KRoock74. Some rights reserved,Poppi Worthington’s happy photo - her smile, her baby teeth and fluffy red jacket - joins the gallery of children whose deaths have haunted the political history of childhood for half a century. These iconic infants’ lives and deaths challenge the approach to violence, cruelty and neglect by children’s services and police.

Poppi Worthington brings something else to this mournful gallery. Her case is dynamite, since it is about sex and death.

Three decades ago these deaths provoked radical reform of Britain’s child protection systems. Sexual abuse was added for the first time to the inventory of concerns that should trigger intervention and investigation.

Instantly, there was crisis and political retreat. The case of Poppi Worthington exposes decades of political bad faith about child sexual abuse, the decline of child protection systems and the disastrous dominance of the police.

What happened?

One-year-old Poppi Worthington lived in the county of Cumbria in the north-west of England with her parents and brothers and sisters.

She was healthy when she was put to bed by her mother on 11 December 2012. But she was dying, if not already dead when her father rushed downstairs with her early the next morning. Her mother called the ambulance and she arrived at hospital exactly 15 minutes later. Her heart was not beating. 

Her sudden death seemed inexplicable. Yet the police, though they visited the home and hospital that day, decided not to investigate.

The pathologist conducting the autopsy, Dr Alison Armour, called Cumbria police not once but three times - including on Christmas Eve - to alert them to her injuries and the implications: they indicated sexual trauma that preceded or precipitated her death early that morning. 

The police dismissed her alerts. She had ‘jumped to conclusions’, she was ‘rash,’ they said.  

When Dr Armour’s final report appeared nine months later, it described two recent leg fractures, revealed by a skeletal survey, that could only have been caused by ‘considerable force’. Poppi Worthington would have been in great pain, but she had never been taken to a doctor.

Dr Armour reported a cluster of signs of penetrative sexual abuse - a dilated and bleeding anus, marked by bruising and tears.

Although swabs had been taken from her father when the child died, they’d not been sent for analysis. Now they were belatedly examined: Poppi’s DNA was found on her father’s penis.

Still, although the parents were arrested there was no charge and none of this triggered a police investigation.

Ultimately, it was social services’ concerns about her siblings’ safety that got the Worthington case into the family court in 2014 in front of the senior High Court judge, Mr Justice Peter Jackson. He brought his fastidious eye to the evidence and in 2014 delivered a damning inventory of police failures.

Though there had been a duty to investigate, and a trail of clues, including blood at the home and the hospital, the police had not preserved evidence or checked the parents’ phones and computer; interviews with the parents and other witnesses had not been properly conducted or cross-checked.

The judge accepted the findings of the pathologist, Dr Alison Armour. The father, Paul Worthington, had brought the child downstairs that morning, ‘in a lifeless state and with troubling injuries, most obviously significant bleeding from her anus.’

He did not accept the father’s explanation - constipation: her gut and anal canal were empty.

‘Careful assessment of the meticulous pathological and paediatric evidence has clearly established that the injuries were the result of trauma from outside the body,’ concluded the judge, Paul Worthington had perpetrated a penetrative sexual assault.

Stung by Jackson’s criticism, the police still didn’t investigate and instead they sought alternative expert evidence.

It seemed that the police not only did nothing, they did it with determination. They have since been criticised by the Independent Police Complaints Commission.

A coroner’s inquest threw no light on the cause of death: it lasted a meagre seven minutes. There is to be a fresh inquest next month.

There are calls for a public inquiry - this case just isn’t going away.

We only know the narrative of institutional inertia because Mr Justice Jackson’s judgments have been made public.

Where’s the evidence?

Evidence in Britain’s family courts is drawn wide and deep, it is not just concerned with criminal acts but more generally contexts, pressures and patterns that bear upon a child’s life;

The evidence is governed by ‘balance of probability’ rather than the criminal standard ‘beyond reasonable doubt’; and proceedings are not secret but strictly confidential to protect the privacy of the children.

Public interest in child abuse, conflicting forensic evidence, mass media pressure and child protection professionals’ own stake in raising awareness, have all encouraged judges to publish their findings. Journalists’ pressure in the Worthington case secured publication of Mr Justice Peter Jackson’s 2014 judgment.

It was delayed, however, to allow the possibility of a criminal case, the alternative experts sought by the police and a re-hearing, at the father’s request.

In December 2015 I joined a small coterie of BBC northern regional reporters and the Press Association in Liverpool family court in December to hear a revelatory interrogation of the medical evidence and hypotheses about what happened to Poppi Worthington. 

The findings were announced in Jackson’s final judgment published last month.

Unnoticed, however, in the national reporting, was its significance beyond the life and death of Poppi Worthington: the evidence takes us to the beginning of the contemporary era of child protection politics.

From Cleveland to Cumbria

It was in 1986 that sexual abuse was first added to government guidelines on child protection. It was also the year that British paediatricians Jane Wynne and Christopher Hobbs published pioneering research on signs of buggery in children: injuries and anal dilatation - the anal canal opening when it should be shut.

This research challenged everything people believed about heterosexuality, families and fathers. 

The first test of the new knowledge was in the county of Cleveland in the north east of England in 1987. As in Cumbria, the police mutinied when doctors identified signs of anal abuse, and refused to investigate.

But the medical evidence was dramatic and suggestive of serious and chronic penetration.

Cleveland was the defining test of the new system and whether it could withstand overwhelming pressure not to intervene, and take the side of children.

The Establishment intervened to quell the tempest: the government called in a judge, Elizabeth Butler-Sloss, daughter of a judge and sister of the Attorney General - and later Britain’s first woman Lord Justice of Appeal - to sort it out. 

Though she fired her toughest criticism at the doctors and social workers, contrary to Cleveland mythology she never disputed the clinical findings.

She blamed the doctors not for the quality of the diagnosis but for the consequences: the impact on Cleveland’s ragged health service and children’s services generally.

So, the crisis was political and managerial, not medical.

Butler-Sloss never relieved the public of its misapprehension that children had been stolen from ‘innocent families’ on the basis of a dodgy diagnosis.

American researchers joined the fray in the early ‘90s with the claim that anal dilatation was so common as to be normal and, therefore, of no significance.

Despite the volcanic impact of the new knowledge, no research was carried out in Britain for another quarter century. 

New consensus

However, recent studies in the UK, Norway and the US have created a new professional consensus.

The settled view of around 30 professional organisations, from the Royal College of Paediatrics and Child Health to the American Academy of Pediatrics, was published last May in what is known as the Purple Book. It discards the American claim that ‘it’s normal’ and affirms the previously contested physical signs as serious and suggestive of anal abuse. Nevertheless, the Cumbria case rehearsed the old debate. Though all the experts agreed that there was anal injury and bleeding, they disagreed about the cause and the significance of anal dilation.

The discredited American research was invoked by some of the police experts. Among them was the eminent Dr Nathaniel Cary, one of Britain’s top pathologists - he led the hazardous investigation into the radioactive corpse of Alexander Litvinenko.

Dr Cary introduced a novel hypothesis: the anal bleeding could have been caused by viral infection. He was forced to abandon that when no infection was found.

He was unyielding, ’I strongly disagree with any suggestion that there has been penile penetration,’ he told the court.

Dr Cary and his colleague Dr Victoria Aziz, who is frequently used by the Metropolitan police, insisted - citing the old American research - that anal dilatation was ‘of no significance.’

Mr Justice Peter Jackson’s judgment published on January 19 didn’t agree, and accepted the findings of the first pathologist, Dr Armour. The father had ‘perpetrated penetrative assault.’ 

The judge was careful, however, not to infer cause of death from the sexual assault.

The father had described Poppi as going rigid and clenching her teeth the morning she died. If so, said the judge, ‘sadly this would have been in the context of an assault’ and she died ‘during or shortly after.’ 

Jackson’s judgment will be influential. The judgment addressed controversies about standards of proof, whether more serious sexual abuse should attract higher standards of proof, and how conflicting opinions should be assessed - by the quantity of experts or the quality of their evidence.

The case ventilates both the latest state of knowledge and investigation of child sexual abuse.

Already it has triggered what might be called the ‘backlash narrative’, usefully enunciated by law lecturer Hannah Quirk’s blog, and this response to it.

Quirk claims that Jackson’s decision to publish his judgment ‘forms part of a recent trend in which – rightly or wrongly – criminal proceedings have not been possible and other agencies have taken it upon themselves to pronounce on a person’s culpability.’

But family courts have always pronounced on responsibility for harm if there is sufficient evidence. And a criminal trial was not possible because there wasn’t a criminal investigation.

In the Poppi Worthington case medical evidence was primary. But between Cleveland and Cumbria medical signs of sexual abuse have been marginalised, doctors discouraged, social workers disempowered and processes dominated by the police.   

This has been bad for children and bad for justice. Her Majesty’s Inspectorate of Constabulary warned last year: ’overall’ police investigations are ‘poor’ and risk ‘failing another generation.’ 

The Poppi Worthington case delivers that same verdict on the bleak bequest of the Cleveland inquiry to Cumbria.