Where's the "Lawrence moment" for rape investigations?

Today's IPCC decision will do nothing to tackle the endemic refusal to take rape seriously

In March 2009, Assistant Police Commissioner John Yates said that we had reached a "Lawrence moment" for rape investigations. Speaking in the wake of the convictions of two separate serial rapists -- Kirk Reid and John Worboys, who, despite being police suspects, were left free to attack more than 150 women between them -- Yates said:

We need to reinvent our response as we did in relation to homicide after the tragic murder of Stephen Lawrence.

But now, nearly a year later, what has happened to this "Lawrence moment"?

It was reported today that five police officers have been disciplined over the Worboys case. The Independent Police Complaints Commission (IPCC) admits that lives were ruined because police did not take the case seriously. But what has been done? Well, according to the BBC:

A detective sergeant and inspector had received written warnings and three other officers had been given "formal words of advice".

Let's just recap here. In 2007, Worboys was identified as a prime suspect in two attacks, but he was not investigated and was left free to carry out at least seven further assaults. He is thought to have attacked more than 100 women in total. In the face of the horrific extent of his crimes and of the police failing, written warnings are frighteningly inadequate.

However, in the light of statistics and reports on rape conviction rates, the slap on the wrist these officers received begins to look sadly typical.

Of the rapes reported between 2007 and 2008, only 6.5 per cent ended in conviction, compared to 34 per cent of criminal cases in general. Given that an estimated 95 per cent of rapes are never reported at all, the conviction rate is minuscule. Most of the convictions resulted from an admission of guilt by the defendant, and less than a quarter of those charged with rape were convicted following a successful trial. Up to two-thirds of all rape cases never made it to trial anyway.

Figures for 2006 obtained by the Fawcett Society showed that, despite government funding, the postcode lottery for rape victims had worsened. In Dorset, the area with the lowest conviction rates, fewer than one in 60 cases ended in a sentence, while in Cleveland, where convictions were most frequent, the rate was 18.1 per cent. The conviction rate across England and Wales had risen slightly above that of the previous year, but it had fallen in 16 out of of 42 police forces.

Research by London Metropolitan University shows that Britain has the lowest rape conviction rates of all 33 European states. Just 6.5 per cent of cases reported to the police end in conviction, compared to 25 per cent in France. More worryingly, the proportion of complaints leading to conviction has actually been steadily declining. In the 1970s it was one in three, in 1990 it was one in six, but today it is just one in 15.

A 2007 government report attributes this record to scepticism among police and the "view that the victim lacks credibility", as well as to delays with investigations, inappropriate behaviour from investigators, and "unpleasant environments" for victims.

The culture of distrust and the refusal to take rape cases seriously are endemic and entrenched. The IPCC commissioner, Deborah Glass, said that Worboys's victims were "let down by the Met". But if the fallout from major police failings is nothing more than a few written warnings, the attitude that rape doesn't matter will only persist.

The IPCC has attracted vehement criticism in the past for its soft-on-police verdicts, but let's hope that the tragic Worboys and Reid cases lead to an investigation on the same scale as the Macpherson report. A "Lawrence moment" is exactly what we desperately need.


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Samira Shackle is a freelance journalist, who tweets @samirashackle. She was formerly a staff writer for the New Statesman.

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Want to know how you really behave as a doctor? Watch yourself on video

There is nothing quite like watching oneself at work to spur development – and videos can help us understand patients, too.

One of the most useful tools I have as a GP trainer is my video camera. Periodically, and always with patients’ permission, I place it in the corner of my registrar’s room. We then look through their consultations together during a tutorial.

There is nothing quite like watching oneself at work to spur development. One of my trainees – a lovely guy called Nick – was appalled to find that he wheeled his chair closer and closer to the patient as he narrowed down the diagnosis with a series of questions. It was entirely unconscious, but somewhat intimidating, and he never repeated it once he’d seen the recording. Whether it’s spending half the consultation staring at the computer screen, or slipping into baffling technospeak, or parroting “OK” after every comment a patient makes, we all have unhelpful mannerisms of which we are blithely unaware.

Videos are a great way of understanding how patients communicate, too. Another registrar, Anthony, had spent several years as a rheumatologist before switching to general practice, so when consulted by Yvette he felt on familiar ground. She began by saying she thought she had carpal tunnel syndrome. Anthony confirmed the diagnosis with some clinical tests, then went on to establish the impact it was having on Yvette’s life. Her sleep was disturbed every night, and she was no longer able to pick up and carry her young children. Her desperation for a swift cure came across loud and clear.

The consultation then ran into difficulty. There are three things that can help CTS: wrist splints, steroid injections and surgery to release the nerve. Splints are usually the preferred first option because they carry no risk of complications, and are inexpensive to the NHS. We watched as Anthony tried to explain this. Yvette kept raising objections, and even though Anthony did his best to address her concerns, it was clear she remained unconvinced.

The problem for Anthony, as for many doctors, is that much medical training still reflects an era when patients relied heavily on professionals for health information. Today, most will have consulted with Dr Google before presenting to their GP. Sometimes this will have stoked unfounded fears – pretty much any symptom just might be an indication of cancer – and our task then is to put things in proper context. But frequently, as with Yvette, patients have not only worked out what is wrong, they also have firm ideas what to do about it.

We played the video through again, and I highlighted the numerous subtle cues that Yvette had offered. Like many patients, she was reticent about stating outright what she wanted, but the information was there in what she did and didn’t say, and in how she responded to Anthony’s suggestions. By the time we’d finished analysing their exchanges, Anthony could see that Yvette had already decided against splints as being too cumbersome and taking too long to work. For her, a steroid injection was the quickest and surest way to obtain relief.

Competing considerations must be weighed in any “shared” decision between a doctor and patient. Autonomy – the ability for a patient to determine their own care – is of prime importance, but it isn’t unrestricted. The balance between doing good and doing harm, of which doctors sometimes have a far clearer appreciation, has to be factored in. Then there are questions of equity and fairness: within a finite NHS budget, doctors have a duty to prioritise the most cost-effective treatments. For the NHS and for Yvette, going straight for surgery wouldn’t have been right – nor did she want it – but a steroid injection is both low-cost and low-risk, and Anthony could see he’d missed the chance to maximise her autonomy.

The lessons he learned from the video had a powerful impact on him, and from that day on he became much more adept at achieving truly shared decisions with his patients.

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide