Luke Clements

Fabricated or Induced Illness (FII): a new critical report

St George’s House, based in the grounds of Windsor Castle was founded in 1966 by the (then) Duke of Edinburgh and the (then) Dean of Windsor.  It seeks to effect change for the better in our society by nurturing wisdom through dialogue.

In March this year it invited a range of experts: practitioners, academics, politicians and experts by experience to a consultation on “FII: Finding a Fair Way Forward” to discuss the current impact of false FII allegations and the steps that can be taken to reduce its level of harm.

The report of the consultation has now been published and can be accessed by clicking here.

The report echoes the concern of many commentators that guidance published by the Royal College of Paediatrics and Child Health (RCPCH)[1] is having a disproportionate and adverse impact on the well-being of parents and children.  The guidance is cited by the NHS in England[2] and Wales,[3] as well as in safeguarding training programmes attended by health, social care and education professionals.

In Wales the report has already prompted a question to the Cabinet Secretary for Social Justice, by Mark Mr Isherwood SM, who referred to the disproportionate number of disabled parents facing accusations of FII, and asked “when, if ever, will the Welsh Government … take action to stop this cruel abuse”.[4]

It is to be hoped that the English Government will also reconsider its endorsement of RCPCH guidance in the light of the report.

The report (at page 3) lists a number of concerns raised by those attending the St George’s discussion, including:

• RCPCH guidance lacks an evidence base and leads to overreaction and moral panic amongst professionals in health, social services and education. FII is a term that can be applied to a parent who is simply ‘anxious’ and to one whose actions are likely to kill their child.
• The conflicting guidance that has been issued concerning FII is creating significant problems in practice – in particular the guidance issued the RCPCH, the Royal College of Psychiatrists and the British Association of Social Workers (BASW). It is vital that professional guidance approaches the question of FII: (1) using a common set of principles – for example the need for a proportionality and equality impact assessment before interventions occur; and (2) grounded in research based evidence and containing warnings about the harm resulting from incorrect allegations being made against families.
• The prevalence of FII allegations targeted usually at mothers, many of whom are professionals themselves, and the number of allegations aimed at mothers who either have disabilities or neurodivergence themselves or have children who do.
• The cost borne by the state when false allegations are shown to have been made.
• The lack of funding across the NHS which increases workload pressure on practitioners and could result in families falling into crises: ‘preventable crises’.
• A system which in practice all too often vilifies parents and defers to the opinion of a single professional rather than encouraging collegiate decision making, professional curiosity and humility.
• A lack of accountability across all sectors following a false accusation of FII which adds to the trauma felt by families who have experienced such cases.
• A ‘safeguarding first’ culture which targets parents and all too often fails to consider in sufficient detail (1) the disproportionate harm that may result from state interventions; and (2) the vital importance of providing support.
• Professionals overstepping their roles in making FII referrals despite lacking the relevant safeguarding expertise.
• The trauma faced by professionals giving evidence during trials either in the capacity of a court appointed expert or in relation to their role with the family. This can be a difficult experience and can involve challenging cross examination including as to credibility.
• Normal reactions to a false FII allegation such as anxiety, confusion or assertiveness are treated with suspicion and used to build a case against parents.

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[1] Royal College of Paediatrics and Child Health ‘Perplexing Presentations (PP) / Fabricated or induced illness by carers: A practical guide for paediatricians’ (2021).

[2] See for example, NHS Fabricated or induced illness (FII) (2025) at https://safeguarding-guide.nhs.uk/types-of-abuse-exploitation-and-neglect/s3-14/ and NHS What happens – Fabricated or induced illness (2023) at https://www.nhs.uk/mental-health/conditions/fabricated-or-induced-illness/what-happens/.

[3] See for example, NHS 111 Wales Fabricated or induced illness (2025) at https://111.wales.nhs.uk/encyclopaedia/f/article/fabricatedorinducedillness/#Signs.

[4] See FII ~ Welsh Government Failing to End the ‘Cruel Abuse’ of Autistic Parents and Autistic Children.

Posted 26 May 2025.