**7. Perpetrators: a missing element of the Inquiry**

The Inquiry had only a limited remit in respect of addressing the dynamics of child sexual abuse; the nature of abusers and the reasons for sexual abuse of children; the effectiveness and appropriateness of the strategies used once the problem has been identified; and the response of societies and the agencies to those who abuse.

At the time of Cleveland we did not fully appreciate the power of perpetrators, in particular the nature of the threats and other techniques they commonly use to ensure secrecy. For example, an adult survivor, who had been referred to one of the editors via a Child and Adolescent Mental Health Service as a teenager revealed that as a child of 6, she was abused by her father in his car on her way to hospital following a broken arm to make sure that she kept quiet about his ongoing sexual abuse. Children who are dependent on their abusers are often trapped in secrecy, so that abuse by family members and caregivers is unlikely to be revealed spontaneously.

In a climate where very little attention is paid to detecting and intervening effectively with perpetrators, opportunities for protecting children are correspondingly lost. We believe that this was the case in Cleveland. The media storm that gathered and vilified the professionals was exploited by perpetrators and allowed them to hide under the umbrella of being part of 'innocent families.' A specialist colleague working with sex offenders found indications that, post-Cleveland, some perpetrators had changed their behaviour, anal abuse now being seen as reducing the risk of conviction [8].

Unlike the doctors, social workers and psychologist whose actions were scrutinised in detail by the Butler-Sloss Inquiry, the omissions and failure of the police and legal system were subject to less stringent criticism. The successful scapegoating of the health and social services left an unbalanced system where intervention with perpetrators did not go hand in hand with intervention for the child and family.
