How London let the light in for child sexual abuse victims

Walking into the North London offices of The Lighthouse, you’re first struck by how light it is. Lamps hang from the ceiling, installed to look like a tree from a children’s book. Cubby hole chairs face away from one another, allowing maximum privacy for those waiting to be seen.

Established in 2018, The Lighthouse is the UK’s first joined-up medical, investigative and emotional support service for children who have experienced sexual abuse.

It’s a partnership working effectively across four UK national and local government agencies: the Home Office, London Mayor’s Office for Policing and Crime, England’s National Health Service (NHS) and the Department for Education.

• Want to write for us? Take a look at Apolitical’s guide for contributors

But beyond its governance, cross-agency collaboration is also at the heart of The Lighthouse’s delivery. The project provides support to its young patients and their families from medical, policing, advocacy, social care and psychological experts — all in one place.

In doing so, it eliminates the need for victims to go through the trauma of repeating their story several times to different government agencies.

Developing a cross-cutting project of this nature in just three years is no mean feat. Here, Apolitical explores how The Lighthouse was born with collaboration built into its foundations.

To The Lighthouse

The journey to The Lighthouse began with a 2014 review by a commission from England’s National Health Service.

Its findings, summarised in a 2015 report, showed that the impact of investigation weighed heavily on children who had experienced abuse, and that professionals were often working in isolation from one another to deliver services to patients.

The report was delivered by Emma Harewood, previously child sexual abuse transformation lead at NHS England (London), who later became development and service manager at The Lighthouse. She worked alongside clinical lead, Dr Goddard and an expert sexual offences examiner, Dr Brennan.

“There had been a scandalous repeat failure to prosecute sexual crimes against children”

Harewood and her colleagues outlined the different options that the agency could explore to deliver effective services — with Icelandic children’s houses one of the key suggestions.

The children’s house model was agreed at the report’s launch, and Harewood started work on making The Lighthouse a reality. First, she needed ministerial and political support.

“The political wind was behind us,” said Rob Senior, clinical lead for emotional health and wellbeing, who was brought on early in the process. “There had been a scandalous repeat failure to prosecute sexual crimes against children.”

The country had experienced high profile child abuse scandals in the towns of Rochdale and Rotherham, as well as revelations about abuse perpetrated by the British TV entertainer Jimmy Saville.

So getting ministers to listen to their case for a new collaborative service wasn’t a particular challenge. “It felt like we were pushing at an open door,” Senior reflected. “It would take a brave politician to turn around and say no, we won’t look at this.”

Building stakeholder support

Getting government departments and local delivery organisations to meet proved to be the first hurdle. “It started with a lot of cold calling to key influencers,” said Harewood.

Armed with the 2015 report, Harewood had something tangible to send over as a follow-up to a conversation, which helped to keep up the momentum and prove their seriousness.

“We built on our rich relationships across North London"

Using strong existing contacts was key. Harewood and Senior were embedded in the North London health ecosystem and had a large, relevant network.

Calls were made to people working in physical and mental health services as well as potential delivery partners in local authorities. External advocacy and charity groups were also contacted. “We built on our rich relationships across North London,” said Senior.

Four North London organisations became involved: University College London Hospital NHS Foundation Trust (UCLH), the Tavistock and Portman NHS Foundation Trust, the NSPCC (a major UK children’s charity), and Solace Women’s Aid, which supports London women and children against violence.

It was important to have one lead provider to give the project clarity and direction, so UCLH was given lead hospital status.

When speaking to stakeholders, Harewood was ready with an economic imperative, alongside the moral case for action. “There were clear savings in the long term across different budgets,” said Harewood. “But it was difficult to demonstrate how quickly money could be saved.”

But the US Child Advocacy Center, an inspiration for The Lighthouse’s work alongside the Icelandic Barnahus, had reported that for every $1 spent on preventing child sexual abuse, $3 were saved.

The NSPCC had also suggested that the cost of child sexual abuse to the UK economy was £2.5 billion ($3.2 billion). These simple, short facts helped to illustrate her point that cost savings could be made from the program.

Creating a governance structure

This complex web of policymakers and influencers, drawn together at first by Harewood, then later with senior partners across government agencies, had the potential to implement something impactful.

Getting stakeholders on board was a key first step. But building a governance structure around the project meant that it could shift from an idea to a sustainable pilot.

“The workshops built up a network of champions for us. They gave us a bottom-up groundswell of support that we could use to justify the project to stakeholders higher up the chain”

The structure focused around two key boards. The first included London and national leads, chaired by NHS England and the London Mayor’s Office for Policing And Crime (MOPAC).

Departments and delivery agencies sat alongside one another to ensure that governance silos weren’t created. Other key officials around the table were drawn from the Home Office and the Department for Education, sitting alongside representatives from the Crown Prosecution Services and HM Courts and Tribunals Service. The providers of The Lighthouse also had a seat at discussions.

Underneath the first board, a delivery panel became responsible for partnership decisions: unpicking the detail of how the pilot was going to be delivered, funded and scaled. The delivery board was also influenced by five local steering groups, led by independent chairs from local safeguarding boards across different areas of North London.

Each of these five groups held workshops in their local areas, with a bespoke mix of policymakers and service delivery leaders. “The workshops built up a network of champions for us,” said Harewood. “They gave us a bottom-up groundswell of support that we could use to justify the project to stakeholders higher up the chain.”

Translating bureaucracy

Once the governance infrastructure was established, the project successfully funded and the doors to The Lighthouse about to open, cross-departmental working was also embedded into the project’s day-to-day delivery.

The architecture of the site means that medical, policing, advocacy, social care and psychological experts all sit in one building. Public servants that should be siloed by departments are instead colleagues, working towards a shared endeavour in a shared space.

Specialist employees, such as police and social worker liaison officers, are employed by The Lighthouse to help cut through silos and translate bureaucracy.

Rather than leading investigations themselves, these liaison officers help both health workers and children’s families to understand the complex layers of process and paperwork in their respective agencies.

These crucial team members previously worked as senior social workers and police officers, bringing authority and longstanding institutional knowledge to the role. “They bring with them an unmatched understanding of their own system through years of hands on experience,” said Harewood.

The “bureaucracy translators” are typical of The Lighthouse’s approach: the kind of innovation that feels like it should have always been in place, but simply hasn’t been.

Cross-agency collaboration built The Lighthouse. Now it’s established, working together is key to its ongoing success. — Emma Sisk