This report is the final statutory report published by the Independent Inquiry into Child Sexual Abuse (the Inquiry). In accordance with the Terms of Reference, it sets out the main findings about the extent to which State and non-State institutions failed in their duty of care to protect children from sexual abuse and exploitation and makes recommendations for reform. It draws on the Inquiry’s 15 investigations and 19 related investigation reports, the Interim Report of the Independent Inquiry into Child Sexual Abuse and 41 other Inquiry reports and publications. The Inquiry has made 20 recommendations in this report. These final recommendations complement the 87 recommendations contained in the previously published investigation reports (including six which have been restated).
There are nearly 13 million children in England and Wales, each of whom needs and deserves to be protected from harm. Babies, toddlers and children are potentially at risk, with current estimates indicating that 1 in 6 girls and 1 in 20 boys experience child sexual abuse before the age of 16. In March 2020, the Office for National Statistics estimated that 3.1 million adults in England and Wales had experienced sexual abuse before the age of 16. Reflecting the guiding principle that the child’s welfare is paramount, the Inquiry’s recommendations are focussed on making England and Wales places for children to grow up safely and thrive.
The work of the Inquiry over the past seven years demonstrates that:
At the heart of this report are the Inquiry’s recommendations to help protect children. There needs to be a greater priority and focus, politically and across society as a whole, on protecting children from sexual abuse. The establishment of the Child Protection Authorities in England and in Wales, coupled with national public awareness campaigns, are designed to ensure that the spotlight remains directed at preventing child sexual abuse.
These recommendations will be reinforced by cabinet-level ministerial positions for children to provide senior leadership and increased priority within government. One of the aims of the public awareness campaign is to inform the public about the action they should take if they know or suspect a child is being sexually abused. This will complement the recommendation for a new law of mandatory reporting making it a legal requirement for those who work in regulated activity or work in a position of trust to report child sexual abuse.
The impact of past failures to protect children from sexual abuse and to support those who have been harmed is incalculable. To address this, the Inquiry considers that a redress scheme must be established to make some reparation for the harm suffered.
The sexual abuse and exploitation of children is criminal and morally wrong. There is no excuse for those who perpetrate this crime. It has never been right or excusable whenever it occurred. To a significant extent, this also applies to those who knew about the abuse but did nothing, as well as to those who actively covered it up or contrived to assist a perpetrator in escaping justice or avoiding the scrutiny of the statutory authorities.
As the Inquiry progressed, the extent of the global crisis in child sexual abuse and exploitation became increasingly clear. This is manifested in one way by the number of national and institutional inquiries being conducted across the world – including in the US, Australia, Ireland, Germany, France, Spain and Japan. The extraordinary, soaring numbers of child victims of internet-based sexual abuse also confirm the scale of the problem, providing evidence that the sexual abuse of children cannot be conveniently committed to the annals of history. Millions of child sexual abuse images can be accessed within just three ‘clicks’, many of which depict young children and babies.
Nearly every one of the Inquiry’s investigation reports concluded that the true scale of sexual abuse of children is likely to have been much higher than the actual numbers recorded, and this continues to be the case with current methods of data-gathering. Information collected by children’s services shows high numbers of assessments where child sexual abuse and exploitation is identified as a risk factor, but the number of children placed on child protection plans under the primary category of child sexual abuse is comparatively low.
In surveys, girls were at least three times as likely as boys to describe experiences of child sexual abuse. Disabled participants were twice as likely to describe such experiences as non-disabled participants, and those who lived in a care home were nearly four times as likely to have experienced child sexual abuse. Those who had experienced childhood neglect were nearly five times as likely to have experienced child sexual abuse as those who had not.
While many may think that child sexual abuse is not a matter that affects them, the economic and social costs of child sexual abuse affect everyone. In December 2021, the Home Office published a study into the costs relating to children whose contact sexual abuse began or continued in the year ending March 2019. The estimated cost to society exceeded £10 billion.
Over decades, society’s responses to child sexual abuse have reflected its attitude towards children. At worst, within some institutions, children have been treated as commodities at adults’ disposal to do with as they wished. In the mid-20th century, child sexual abuse was not believed to be widespread. There was even a belief that there was such a thing as a ‘seductive child’. The notion that child sexual abuse was ‘not harmful’ persisted into the 1990s and, in some professional spheres, responses to it were seen as ‘over zealous’ and characterised as a ‘moral panic’. In the 2000s, some responses became more child-focussed, but others continued to deflect blame away from perpetrators and institutions, especially in the area of child sexual exploitation. While some of these attitudes have been challenged, there remains an incomplete public understanding of child sexual abuse, exploitation and power dynamics. Children cannot consent to their own abuse, and questions of empowerment, inclusion and hearing children’s voices are still not being fully addressed.
This report is the culmination of a public inquiry, the focus of which was the institutional responses to child sexual abuse in England and Wales ‘in living memory’. Examining past failures across such a broad spectrum of institutions and organisations, coupled with the contributions of many thousands of Truth Project participants, has provided the Inquiry with a unique body of knowledge, enabling it to make recommendations to protect future generations of children.
The breadth of the Inquiry’s investigations across diverse settings has identified many common themes directly relevant to child sexual abuse. These themes have occurred across many different institutions.
The pain and suffering caused to victims and survivors often affected many aspects of their lives. Relationships – whether personal, familial or sexual – suffered. Physical, emotional and mental health was damaged, in some cases beyond repair. The institutional responses often involved insincere apologies and the inadequate provision of support and counselling, thereby compounding the harm.
The deviousness and cruelty of perpetrators was limitless. Children were threatened, beaten and humiliated. Those with disabilities or other vulnerabilities were often deliberately selected for that very reason. Offenders groomed victims and befriended parents in order to create a veneer of genuine affection which not only enabled the abuse to be committed but often inhibited the subsequent reporting of any disclosure.
The protection of personal and institutional reputations above the protection of children was a frequent institutional reaction. Statutory agencies were not informed, perpetrators were ‘moved on’ and there were failures by those in authority to thoroughly investigate allegations. Records about child sexual abuse allegations were not kept.
Some institutions had no child protection policies and procedures. Where policies and procedures were in existence, they were often inadequate or not complied with. Inspections of institutions were, at times, lacking. Recommendations made following internal or external reviews were infrequently implemented and sometimes ignored.
Online-facilitated child sexual abuse magnifies the risk to children both nationally and internationally. Escalating production and sharing of child sexual abuse material and the live streaming of sexual abuse affects children of all ages but particularly those aged under 13 years.
The scale and extent of child sexual abuse and child sexual exploitation are difficult to ascertain as data collection is poor. The available data present a confused and confusing picture, and there is no consistent approach to the recording of data, including by key statutory agencies such as the police and local authorities. The prevalence figures cited in this report cover all forms of child sexual abuse and there are no data which separate abuse which takes place within a family environment from that which takes place in institutions.
Problems in the criminal justice system included investigative and prosecutorial failures. Disruption tactics, which operate to prevent offenders from committing sexual offences against children, were underused. Delays in the system mean victims and survivors often have to wait years for the case to conclude.
The Inquiry also identified wider societal issues where responses to children’s disclosures were characterised by embarrassment, fear and disbelief. There needs to be greater public awareness of the scale and scope of child sexual abuse and exploitation in order to improve our response to children who are abused.
The following summaries set out the key issues to emerge from each of the Inquiry’s 15 investigations. The summaries do not include reference to any subsequent developments, whether positive or negative.
The investigation into the Roman Catholic Church in England and Wales revealed a sorry history of child sexual abuse where abusive priests and members of religious orders and institutions preyed on children for prolonged periods of time. Between 1970 and 2015, the Church received more than 3,000 complaints against more than 900 individuals connected to the Church. In the same period, there were 177 prosecutions, resulting in 133 convictions. Millions of pounds have been paid to victims and survivors in civil proceedings. Since 2016, there have been more than 100 reported allegations of recent and non-recent child sexual abuse every year. The true scale of abuse over a 50-year period is likely to be much greater.
Responses to disclosures about child sexual abuse have been characterised by a failure to support victims and survivors – in stark contrast to the positive action often taken to protect perpetrators and the reputation of the Church.
The reactions of Church leaders over time were marked by delay in implementing change, as well as reluctance to hold individuals to account or to make sincere apologies. On occasions, they conveyed a grudging and unsympathetic attitude to victims and survivors. In order to shake off the failures of the past, real and lasting changes to attitudes are needed.
Although there have been some improvements to current safeguarding arrangements, more recent audits have identified weaknesses. The culture and attitudes in the Roman Catholic Church have been resistant to change.
During the Roman Catholic Church case study on the Archdiocese of Birmingham, the Archdiocese accepted that it was responsible “for institutional failings which on occasion permitted the sexual abuse of children to continue when it might otherwise have been stopped”.
The publication of the Nolan report in 2002 was a significant milestone for the Roman Catholic Church because it examined the Church’s child protection arrangements and made recommendations for structural and procedural reforms. The Cumberlege report was published in 2007 and was intended to identify further reforms. The recommendations of these reports set a clear and unequivocal direction for the Church and were intended as a springboard for major change. While some improvement has been noted in the Archdiocese of Birmingham since the publication of these reports, there were still significant gaps in their child safeguarding arrangements.
The Inquiry widened its understanding of the role of the Roman Catholic Church in education through the English Benedictine Congregation (EBC) case studies incorporating Ampleforth and Downside Abbeys and schools and Ealing Abbey and St Benedict’s School.
The Ampleforth and Downside case study heard evidence of appalling sexual abuse inflicted over decades on children aged as young as seven at Ampleforth and 11 at Downside.
Ten individuals – mostly monks connected to these institutions – have been convicted or cautioned in relation to offences involving sexual activity with a large number of children, or offences concerning pornography. Many perpetrators did not hide their sexual interests from the children.
Rather than refer a suspected perpetrator to the police, in several instances the Abbot of the particular school confined the individual to the Abbey or transferred him and the known risk to a different parish or other location. For much of the period under consideration by the Inquiry, the overriding concern was to avoid contact with the local authority or the police at all costs, regardless of the seriousness of the alleged abuse or actual knowledge of its occurrence.
Time and time again, the most senior clergymen in the EBC and in the two Abbeys, including past presidents of the EBC, admitted wrong-headed judgements and expressed regret at past failures to protect children.
Child sexual abuse was extensive at Ealing Abbey. Since 2003, two monks and two lay teachers have been convicted of multiple offences involving the sexual abuse of over 20 children between the 1970s and 2008. In 2016, the deputy head was convicted of offences relating to the possession of indecent images of children.
There was a culture of excessive corporal punishment. Physical abuse in many cases was used as a platform for sexual gratification and a means by which to instigate sexual abuse. Corporal punishment was used to punish boys who sought to protect themselves or others from sexual abuse.
It appeared that many in St Benedict’s School and Ealing Abbey – teachers and monks alike – were aware of sexually abusive behaviour but were seemingly powerless to do anything about it. Gossip amongst boys and staff was rife and complaints, including from parents, failed to trigger any action from the school. On the rare occasion information was passed on to the authorities, little if any action was taken.
Headteachers and Abbots did little to improve child protection activity at St Benedict’s School. Child sexual abuse was played down. When cases were reported to the police, investigative mistakes were made and, on the rare occasions allegations were referred to the Crown Prosecution Service, the analysis of the evidence was sometimes deficient. Not until much later in time were the named perpetrators finally brought to justice.
The Anglican Church investigation examined whether the Church of England and the Church in Wales protected children from sexual abuse. Current safeguarding arrangements were also considered. A total of 390 people associated with the Church of England from the 1940s to 2018 were convicted of sexual offences against children. In 2018, 449 concerns were reported to the Church about recent child sexual abuse, of which more than half related to Church officers. Latterly, a significant amount of offending involved downloading and possession of indecent images of children.
As with other religious organisations, the Anglican Church is marked by its explicit moral purpose in teaching right from wrong. In the context of child sexual abuse, the Church’s neglect of the physical, emotional and spiritual well-being of children and young people in favour of protecting its reputation was in conflict with its mission of love and care for the innocent and vulnerable.
Safeguarding arrangements in the Church of England were under-resourced until 2015, when resources increased considerably. Changes were also made which aimed to ensure that the advice of safeguarding staff should not be ignored. Nevertheless, there were still some occasions when the advice was disregarded.
The Church of England failed to respond consistently to victims and survivors with sympathy and compassion, accompanied by practical and appropriate support. This often added to the trauma of those who had experienced child sexual abuse by individuals connected to the Church. While there have been important improvements in child protection practice, the Church of England still has more to do to rebuild the trust of victims and survivors. Some internal past case reviews were flawed and inaccurate, and there was a tendency to minimise offending.
In recent years, a number of clergy in the Church in Wales have been deposed from holy orders following sexual assaults on children, or for offences concerning indecent images of children. No precise data on actual numbers are available.
A Historic Cases Review, published in 2012, concluded that there was a need to improve compliance with existing safeguarding policies and adopt additional policies to improve child protection. Further improvements are still required, particularly in the area of record-keeping and the capacity of provincial safeguarding officers.
The Anglican Church investigation considered two case studies. The first was the Diocese of Chichester, where there had been multiple allegations of sexual abuse against children. Over 50 years, 20 individuals with a connection to Chichester Diocese, including four clergymen, were convicted of sexual offending against children. The responses of the Diocese were marked by secrecy, prevarication, avoidance of reporting alleged crimes to the authorities and a failure to take professional advice. Internal reviews failed to expose the nature and scale of the problem within the Diocese. Instead, they were used by Church leaders to act out their personal conflicts and antagonisms. The reviews ultimately came to nothing until 2011, when the Archbishop of Canterbury intervened by ordering a Visitation.
The second case study concerned Peter Ball, who was a bishop in the Chichester Diocese before becoming Bishop of Gloucester. In 1993, he was cautioned for gross indecency. In 2015, Ball pleaded guilty to further offences, including misconduct in public office and indecent assault in which he admitted that he had abused his position as Bishop of Lewes and Bishop of Gloucester to offend against 17 teenagers and young men. One victim, Neil Todd, was seriously failed by the Church and ultimately took his own life. At the time, the Church discounted Ball’s behaviour as trivial and insignificant, displaying callous indifference to Mr Todd’s complaints. The Archbishops’ Council accepted that the Church had displayed “moral cowardice” in response to the allegations.
The Inquiry found failings in the response of Lord Carey, the then Archbishop of Canterbury, including showing Ball a degree of compassion which he did not extend to his victims and not disciplining Ball after he was cautioned. Other people of prominence also supported Ball but without any consideration of the experiences of Ball’s victims.
The Inquiry also conducted a thematic investigation into Child protection in religious organisations and settings. In total, 38 religious organisations, including Buddhism, Hinduism, Islam, Judaism, new religious movements, non-conformist Christian denominations, non-trinitarian Christian denominations, Paganism and Sikhism, provided evidence to the Inquiry.
Respect for a diversity of beliefs is the hallmark of a liberal democracy but can never be used to justify harm to a child. There were significant barriers to effective reporting of child sexual abuse, including victim-blaming and notions of shame and honour. In some religious traditions and communities, children are not taught about sex or sexual relationships. The Inquiry was told by representatives of some faiths that in some languages there were no words for rape, sexual abuse or genitalia.
Not all religious organisations had adequate child protection policies, despite the advice readily accessible in the public domain. In some, safe recruitment practices were not always followed and there was limited uptake of child protection training offered by local authorities. While some religious organisations had effective systems in place for responding to child sexual abuse, this was not the case across the board. Very few had arrangements in place for the provision of counselling or therapy sessions for victims and survivors.
Some religious organisations provide education and services to children through supplementary schooling or out-of-school provision. There are also a number of unregistered schools providing full-time education. Serious concerns were expressed by Ofsted that a minority of out-of-school settings were putting children at risk by failing to adhere to basic child protection standards.
The Cambridge House, Knowl View and Rochdale investigation focussed on child sexual abuse in Rochdale and institutional failures to protect vulnerable boys in care. This included Cambridge House hostel for boys and young men where the Inquiry heard about the predatory activities of Cyril Smith. Between 1962 and 1965, Smith, who was not medically qualified, conducted ‘medical examinations’ on a number of boys, including of their genitalia. Smith’s prominence and standing in Rochdale in the mid-1960s allowed him to exert pressure on others locally, in particular to keep quiet about any allegations of abuse. Years later, in 1998 and 1999, for reasons unconnected to Smith’s position, the Crown Prosecution Service wrongly advised that Smith should not be charged.
Knowl View School was basic and bleak, providing neither care nor education. Staff were at best complacent, and at worst complicit, in the abuse they knew to be taking place.
Senior council officials in social services and education departments were at fault for failing to treat the problem of sexual abuse at Knowl View School with any urgency. In evidence, the council leader lied to the Inquiry when he denied all knowledge of the issues about child sexual abuse at Knowl View.
Police investigations into other individuals involved in the sexual exploitation of boys from Knowl View School in the town centre toilets also resulted in no charges being brought, despite the police knowing their identities and having obtained disclosures from the young victims. These failures, along with those relating to the allegations against Smith, deprived victims and complainants of the opportunity of seeing perpetrators being brought to justice.
For more than five decades, Nottingham City Council and Nottinghamshire County Council failed in their statutory duty to protect children in their care from sexual abuse, perpetrated primarily by predatory residential staff and foster carers. The Inquiry received evidence of approximately 350 complainants who made allegations of child sexual abuse from the 1960s onwards. In residential care, there were poor recruitment practices, low staffing ratios, few qualified staff and little training. In some instances, a sexualised culture prevailed, with staff behaving wholly inappropriately towards children, paving the way for sexual abuse. It was as if anyone could carry out the important work of being a substitute parent to damaged children. Residential care carried little priority with senior managers, even when they were aware of escalating numbers of allegations of sexual abuse.
From the mid-1970s to the 1990s, the picture was equally poor in foster care. Recruitment, assessment and support of foster carers, and supervision of children’s placements, were inconsistent and almost casual. When allegations of abuse were made, Council staff were too willing to take the side of the foster carers and to disbelieve the child.
Neither Council learned from its mistakes, despite commissioning many reviews which made clear what changes were needed in their care systems to stop the sexual abuse of children. Nor did they have a satisfactory approach to addressing the issue of harmful sexual behaviour amongst children in their care.
It is hard to comprehend the cruelty and sexual abuse inflicted on children in the care of Lambeth Council over many years, by staff, by foster carers and their families, and by ‘volunteers’ in residential settings. By 2020, the Council was aware of 705 former residents of three children’s homes examined in this investigation who had made complaints of sexual abuse. Foster care was equally bad, with foster carers not adequately vetted or made the subject of criminal records checks. A review of criminal records checks in the late 1990s led to Lambeth Council’s foster care placements being reduced by one-third.
In the 1980s, the culture of Lambeth Council was dominated by politicised behaviour and turmoil, as it took on the government of the day. In 1986, its stance in failing to set a council tax rate resulted in 33 councillors being removed from their positions. This preoccupation meant the majority of members were distracted from their primary task of providing good-quality public services, including children’s social care. Despite what was claimed to be a ‘progressive’ political agenda, bullying, intimidation, racism, nepotism and sexism thrived, and were set within a context of corruption and financial mismanagement, which permeated much of Lambeth Council’s operations. All of this directly impacted on the safety and protection of children in care.
With one or two exceptions, a succession of elected members and senior officials ought to have been held accountable for allowing the sexual abuse of children in their care to continue over decades. Lambeth Council was only able to identify one senior Council employee, over the course of 40 years, who was disciplined for their part in this catalogue of failures to address child sexual abuse. Many reports commissioned by Lambeth Council also described serious failures in services and staff practices which rendered children unsafe, often from the people paid to look after them. Nobody in relevant positions of authority during that time could truthfully have said they did not know about the abuse of children. The conclusion was therefore unavoidable that those who ran Lambeth Council for the most part simply did not care enough to prioritise the protection of children.
The investigation into Child sexual exploitation by organised networks examined six case study areas across England and Wales to obtain an accurate picture of current practice of police and local authorities, at a strategic level and by examination of individual cases.
The accounts of the victims and survivors in the case studies demonstrate the cruelty of perpetrators towards the children they exploit. It confirmed that the sexual exploitation of children by networks was not a rare problem confined to a small number of areas with high-profile criminal cases but was widespread.
There appeared to be a flawed assumption that this problem was on the wane. Data presented to the Inquiry at a national level and in the six case study areas were confused and confusing, marked by inconsistencies, unexplained trends and variations. In addition, the ethnicity of victims and alleged perpetrators was rarely recorded.
Children in residential care and those with a disability are at a heightened risk of being sexually exploited. There is a national shortage of suitable residential care placements for children who are at risk of or have experienced child sexual exploitation. This has resulted in some older victims being placed in unsuitable accommodation, without proper support or supervision, making them at increased risk of further exploitation.
The investigation on the Internet focussed on the rapidly growing problem of online-facilitated child sexual abuse. Increased access to and use of the internet have enabled a section of society to misuse it to distribute indecent images of children; to groom and manipulate children to commit sexual acts on-screen, often for the purpose of sexual exploitation; and to live stream the sexual abuse of children from around the world, including from the UK. Those affected live in fear that images of them being sexually abused remain available on the internet indefinitely. The harm done to children and their families is incalculable.
In particular, there has been a recent, significant increase in child sexual exploitation online, including live streaming appalling abuse. For example, the sexual abuse of children was live streamed for money, at times at the direction of the person paying to view the abuse.
While most internet companies either prohibit or discourage children under 13 years from accessing their platforms, the Inquiry repeatedly heard evidence that under 13-year-olds easily accessed their services and that they were at significant risk of being groomed. Industry witnesses spoke of their companies’ commitment to preventing online child sexual abuse, but action taken by industry was too often reactive and sometimes seemingly motivated by the desire to avoid reputational damage caused by adverse media reporting. Technology has been developed to detect online-facilitated child sexual abuse. However, there needs to be greater collaboration across the industry to demonstrate that the internet companies are doing more than paying lip service to their stated commitment to protecting children.
There remains the question of end-to-end encryption, and the stark debate between protection of privacy and protection of children. A technical solution is now overdue to assist the detection of online-facilitated child sexual abuse, and to make the internet safe for all children.
The investigation of the experiences of sexual abuse by Children outside the United Kingdom started with an examination of Child Migration Programmes. Over a period of many years before and after the Second World War, successive UK governments allowed children to be removed from their families, care homes and foster care in England and in Wales to be sent to institutions and families abroad without their parents. After the war, around 4,000 children were migrated, mainly to Australia.
The children lived in many settings characterised by physical and emotional abuse and neglect, as well as sexual abuse. The treatment of many of these children was akin to torture and had lifelong consequences. When they tried to report their experiences, the children were disbelieved and intimidated, often with violence. Some were lied to about their family background, and even about whether their parents were alive or dead.
While a number of organisations participated in child migration programmes, it was the overwhelming conclusion of the Inquiry that, after the Second World War, the UK government was primarily to blame for the continued existence of the programme. It was a deeply flawed policy that caused lifelong damage to many children, and immediate financial redress was required for surviving child migrants.
In phase 2 of the investigation, the Inquiry also examined the sexual abuse of children by UK nationals and residents outside the UK. The full scale of this offending was unknown but was undoubtedly extensive. Moreover, the sexual abuse of children abroad does not have to take place abroad. In 2018, the National Crime Agency estimated that some 80,000 people in the UK could pose a threat to children online, increasingly through live streaming.
The Inquiry was concerned by the under-use of civil orders, which can be used to restrict foreign travel. In addition, when these orders are made they can be circumvented by travelling to the restricted country via another route. The powers to prosecute offenders in England and Wales for child sexual abuse offences committed abroad are now set out in section 72 of the Sexual Offences Act 2003. There have been a small number of prosecutions under this section – more needs to be done to raise awareness of these powers in police forces. Increased cooperation between law enforcement agencies internationally depends on raising the number of international liaison officers to work with partners in high-risk countries.
The operation of the Disclosure and Barring Service (DBS) caused some concern for employers in England and in Wales who were required to obtain a DBS certificate when seeking to engage staff to work with children overseas. Institutions based overseas cannot request a DBS check and must rely on an International Child Protection Certificate. There were some discrepancies between the two certificates and the system as a whole was confusing and capable of exploitation by offenders.
The Westminster investigation concerned institutional responses to allegations of child sexual abuse and exploitation involving people of public prominence who were associated with Westminster. It was unacceptable that at the time of the public hearing in this investigation (March 2019) some political parties had chosen not to put appropriate safeguarding and child protection policies in place.
Several cross-cutting themes recurred throughout the investigation, including undue deference by police, prosecutors and political parties towards politicians and others in public life; differences in the treatment of wealthy and well-connected individuals, as opposed to those who were poorer, more deprived and without access to networks of influence; failures to put children and their welfare first; and the prioritisation of reputation over the needs and safety of children.
Political parties showed themselves to be more concerned about political fallout than safeguarding and, in some cases in the past, the honours system prioritised reputation and discretion in making awards with little or no regard for victims of nominated persons.
There was ample evidence that individual perpetrators of child sexual abuse were linked to Westminster but, despite some assertions to the contrary, there was no evidence of an organised ‘Westminster paedophile network’.
The investigation concerning Institutional responses to allegations involving the late Lord Janner of Braunstone QC focussed on the institutional responses to allegations of child sexual abuse in circumstances where there had been no conviction or judicial finding of fact that the alleged abuse occurred. It was necessary to conduct much of the public hearing in closed session to protect the identity of complainants who are entitled to lifelong anonymity under the Sexual Offences (Amendment) Act 1992.
In two of the three police investigations into the allegations made by complainants, there were failures in the way Leicestershire Police investigated the allegations and, despite some isolated efforts by police officers to remedy the position, the complainants were not given sympathetic treatment. However, the Inquiry found no evidence that the police were unduly influenced or placed under improper pressure not to pursue the allegations.
In Operation Magnolia (2000 to 2001), statements containing two complainants’ allegations relating to Lord Janner were not provided by Leicestershire Police to the Crown Prosecution Service when they should have been. This was a significant and unjustifiable failing. There was also strong suspicion that children in local authority care were not to be trusted and so complainants were ignored.
In Operation Dauntless (2006 to 2007), there appeared to be a reluctance to progress the police investigation and the Crown Prosecution Service advice about this Operation lacked detail and was strategically flawed.
More generally, Leicestershire County Council accepted that during the 1970s and 1980s it failed to take children’s concerns about physical and sexual abuse seriously and admitted that its responses were inadequate.
Children in custodial institutions are some of the most vulnerable in society. At the time of the public hearing in July 2018, there were around 900 children detained by the criminal justice system in either a young offender institution (YOI), a secure training centre (STC) or a secure children’s home (SCH).
This investigation concentrated on the period from 2009 to 2017, at the start of which over 3,000 children were in custody. Many of these children were engaged in regular offending, including violence and sexual abuse, following unhappy and disrupted childhoods. The accounts of adult survivors of child sexual abuse who were detained in custodial institutions in the earlier years were among the worst the Inquiry has heard. Recent inspection reports from Ofsted and HM Inspectorate of Prisons raised serious concerns about the safety of children in several units in the custodial estate.
Complaints of sexual abuse in YOIs and STCs were rarely investigated properly, with little evidence of involvement of the statutory authorities, signifying a failure to adhere to normal child protection procedures. Forms of control such as pain compliance techniques, approved by the Ministry of Justice, were particularly intimidating for children who had been sexually abused.
Throughout this investigation, the differences between the regimes in YOIs and STCs and those in SCHs became increasingly clear. The latter are more child centred, with better staff ratios and training requirements. These institutions are subject to similar standards of care to those applied by Ofsted to children’s homes. A serious concern is the uneven availability of SCHs which accept children detained for criminal justice reasons, with none in London and the south-east of England.
Custodial institutions for children were under-resourced. Staff turnover was unacceptably high, not helped by structural change and instability, following attempts by various governments to provide an effective model of care and control.
The Accountability and Reparations investigation heard that many victims who sought reparations for child sexual abuse found the experience of the legal processes involved were sometimes hostile, baffling, frustrating and futile.
The redress available for victims and survivors included punishment of the perpetrator, compensation from an individual or institution, acknowledgement that the abuse occurred, an apology, an explanation of how the abuse was allowed to happen, an assurance of non-recurrence, and counselling or other support.
In the criminal justice system, a report to the police may lead to prosecution, conviction and imprisonment of the perpetrator and a compensation order being made. A criminal allegation must be proved to a high standard – so that the jury are sure (formerly beyond reasonable doubt) – but there is no time limit for the complaint to be made. A Criminal Injuries Compensation Authority award may be sought.
A complaint in civil law is, by contrast, usually for compensation from an institution which has legal responsibility for the perpetrator. A civil law complaint must be proved on the balance of probabilities but must usually be brought within three years of the abuse or by the 18th birthday of the complainant. However, very few victims and survivors of child sexual abuse bring their claims before the age of 21.
None of the processes associated with the remedies available adequately compensated victims and survivors for the distress and suffering brought about by their experiences of child sexual abuse. Many felt forced to give up rather than pursue a process that caused such distress and was often characterised by delay over many years.
The Residential schools investigation examined a broad range of educational settings and contexts in which staff had been convicted of the sexual abuse of pupils, or in which serious safeguarding concerns had arisen. This included residential specialist music schools, residential special schools and boarding schools, and other mainstream schools and was complemented by Non-Recent Sexual Abuse in Residential Schools: An account submitted by Counsel to the Inquiry concerning eight closed residential schools. The Inquiry found evidence of teachers and others exploiting their positions of trust to abuse children in all the various educational settings it considered.
The investigation report includes many deeply distressing cases of sexual abuse, the signs of which went unnoticed or were not responded to appropriately. Some staff were reluctant to report concerns, while some headteachers found it inconceivable that staff might abuse children. Many were also unaware of their roles in relation to safeguarding. Although some perpetrators have been brought to justice, many have not. Likewise, many in positions of authority and responsibility have not been held to account for serious failures of leadership and governance.
In the specialist music schools examined, the reputations of both the musicians and the schools were often seen as more important than their victims and potential victims when allegations were made or concerns were raised. The response was similar when concerns were raised about well-liked and generally respected members of staff in other school contexts, in both the independent and state sectors.
Despite 20 years of enhanced focus on safeguarding, schools are not as safe for children as they should be, and children’s interests do not always come first when allegations or concerns of sexual abuse arise. The Inquiry identified many shortcomings in current systems of protection, regulation, oversight and enforcement, including the scope and practical operation of the DBS scheme, workforce regulation, inspection systems and standards. Statutory guidance is not always sufficiently precise and clear. Some staff were reluctant to report concerns, in part fearful of the consequences of doing so. When concerns were raised, they were not always referred to statutory authorities when they should have been. Where the threshold for formal referral was not met, there was confusion regarding what, if any, further steps should be taken, and by whom.
The thematic investigation about effective leadership of child protection built on the Inquiry’s findings on leadership across its investigations. There was a mixed picture in many institutions. The worst examples involved people in charge of institutions who demonstrated indifference, even hostility, to victims, despite evidence or suspicion of wrongdoing by perpetrators. These attitudes were communicated as acceptable from the top of the institution through its various levels, leaving victims with few, if any, adults to trust.
There is no doubt that good leadership is essential to better outcomes for vulnerable children. Staff who are unclear about their role, lack confidence in their managers or leaders, and do not base their practice on the unequivocal primacy of the best interests of the child will not deliver good child protection, whatever the setting.
The public hearing identified several important dimensions to good leadership practice. These included embedding child-centred values, making child protection everyone’s responsibility, creating strong governance and clear individual accountability, providing a visible role model of listening to children and involving them, ensuring diverse and inclusive practice, creating a ‘speak up’ culture, gathering good data and making best use of it, and learning from institutional failure.
This final Report by the Inquiry comprises two parts.
‘Victims and Survivors’ Voices’ uses the words of those who have been sexually abused to describe what happened to them. Some of the content is therefore explicit, but these experiences and perspectives are at the heart of this Inquiry.
Each account represents a life fundamentally altered and affected by the abuse. The harm brought about by sexual abuse cannot be overestimated or ignored – education, familial relationships, sexual relationships, mental, emotional and physical well-being, job prospects can all be affected. In some cases it has driven victims to self-harm and even take their own life.
It is difficult to imagine what it feels like to be silenced or dismissed when trying to tell someone that you have been sexually abused. This happened so often to victims and survivors that many gave up trying to report what had happened to them. That is why the Truth Project – designed to enable victims and survivors to share their accounts in a confidential setting – was such a vital part of the Inquiry’s work, and why ‘Victims and Survivors’ Voices’ represents a cornerstone of the Inquiry’s analysis and recommendations.
More than 6,200 victims and survivors contributed to the Truth Project – for some, it was the first time they had spoken about the child sexual abuse they had suffered. Across the Inquiry’s work, victims and survivors recounted the barriers they faced when reporting abuse. Many felt a deep sense of shame about what had been done to them; they worried about the consequences of reporting the abuse. Some victims and survivors were too young at the time of the abuse to recognise that what had happened to them was abusive; some did not have the vocabulary to describe that abuse.
Accounts revealed how sexual abuse was often accompanied by physical abuse or neglect at home. Many of the acts perpetrated caused agonising physical pain, most often inflicted by an abuser who was known to the victim and whom they trusted. The Inquiry heard how difficult it was for many victims and survivors to report what was happening to them and how many were ignored or not taken seriously.
Many victims and survivors who contributed to the Inquiry’s work were motivated to share their accounts in order to try to help prevent other children being abused. As a result, this report starts with the victims and survivors.
As well as the contributions made to the public hearings, victims and survivors assisted the Inquiry through the Victims and Survivors Consultative Panel and the Victims and Survivors Forum. Engagement was enhanced by discussions with young people, the LGBTQ+ community and specialist organisations assisting victims of child sexual abuse from ethnic minority communities. Each group described particular concerns, but common themes emerged that were reflected throughout the Inquiry’s work: lack of trust in institutions that were supposed to help and a failure to understand and respond appropriately to the impact of the sexual abuse as well as cultural and other related issues.
‘The Inquiry’s Conclusions and Recommendations for Change’ is derived from the evidence that was heard at the public hearings, the accounts given to the Truth Project and the work conducted by the Inquiry’s research programme. It considers the institutional response to child sexual abuse allegations by examining the various ways in which institutions and organisations protect children, and investigate and respond to child sexual abuse. The accounts of victims and survivors of child sexual abuse and the institutions that were responsible for protecting children have led to the important recommendations and changes for improvement described in detail in this report.
Institutions, whether state or non-state, should not rely on children coming forward as the sole means of identifying and detecting child sexual abuse. Most statutory agencies provide simple information on their websites about how to recognise indicators of potential sexual abuse, and what to do if an individual suspects abuse has occurred. It is evident from these summaries that child sexual abuse came to the attention of people in authority in institutions in many different ways, at different times, and with widely varying responses, or none at all.
All institutions involved on a regular basis with children must be proactive and vigilant. If information about known or suspected sexual abuse is held by anyone in the institution, the information must be acted upon and proper investigation must take place, regardless of cultural, religious, educational or societal norms and beliefs. There should be no exceptions to this requirement.
While many of the investigations considered the response to non-recent allegations of child sexual abuse, Part J considers current and emerging challenges facing the institutional response. In particular, the much-anticipated regulation of the internet as set out in the Online Safety Bill is likely to be implemented after the publication of this report and so the efficacy of the new regime will not be properly understood for some time to come. Nonetheless, the Inquiry welcomes the introduction of both Ofcom as the online safety regulator and the Interim Code of Practice on Online Child Sexual Exploitation and Abuse.
Child protection must be given the priority it deserves and needs. To achieve this, and to counter the lack of responsiveness across many of the institutions and the individuals associated with them, the Inquiry has made 20 recommendations in this report. These recommendations are all designed to tackle systemic weaknesses in organisations and practices which have left children vulnerable to abuse, exposed them to harm or denied them access to justice.
Three recommendations form the centrepiece of the Inquiry’s work.
The first relates to the introduction of a statutory requirement of mandatory reporting. In effect, it requires individuals in certain employments (paid or voluntary) and professions to report allegations of child sexual abuse to the relevant authorities. Failure to do so in some circumstances could lead to the commission of a new criminal offence of failure to report an allegation of child sexual abuse when required to do so.
The second concerns the establishment of a national redress scheme for England and for Wales, to provide some monetary redress for child sexual abuse for those who have been let down by institutions in the past. This is a fixed-term scheme with straightforward processes to ensure that, as far as possible, victims and survivors secure efficient access to the help they need. The redress scheme is not a substitute for criminal or civil justice systems and it does not replace the Criminal Injuries Compensation Authority. The government should seek contributions to the scheme from the institutions affected.
The third recommendation is intended to secure the long-term spotlight on child sexual abuse through the creation of a Child Protection Authority (CPA) in England and in Wales. The CPAs will have powers to inspect any institution associated with children. They will not replace current inspectorates in relation to the statutory authorities, but may require inspection of those authorities by existing inspectorates. The CPAs over time will become centres of expertise, and may extend their child protection functions to other forms of harm experienced by children. They will also, in due course, monitor implementation of the Inquiry’s recommendations and report regularly on progress.
Other recommendations in this report include:
As this report demonstrates, child sexual abuse has devastated the lives of children in England and Wales and continues to do so. The protection of children from these crimes requires an uncompromising commitment to the swift implementation of all the Inquiry’s recommendations. The Inquiry expects the UK government, the Welsh Government and specified institutions to act upon its recommendations promptly and publish details of the steps they have taken within six months of the publication of this report.