Smith was appointed as chairwoman of the Scottish Child Abuse Inquiry in July 2016; since February 2017 she has been the sole member of the panel.

The allegation was that Smith discriminated, harassed and victimised a junior advocate of the inquiry when he was diagnosed with cancer, undergoing surgery, during chemotherapy and thereafter to date.

[6] John Halley, a former Counsel to the Scottish Child Abuse Inquiry, has written a book documenting his experience of disability discrimination by Smith.

A group of 75 survivors from various backgrounds wrote to the First Minister of Scotland John Swinney in December 2024 demanding that he commence proceedings to remove Lady Smith from her post, on grounds of bias, and recommending replacing her with an impartial Chair.

[10] The next report from the survivor group will be published in Q1 of 2025, and will cover: - work being done to influence safeguarding in schools today - progress with criminal convictions - the role and culpability of former governors and school management - collusion and cover up - interference and abuse of position by senior members of the legal profession in Scotland - systematic mistreatment of whistle-blowers by Lady Smith.

[13][14][15] Smith has been criticised for receiving in two weeks of work at the Inquiry the same amount of money as survivors are given in compensation for a lifetime of suffering.

[17] Another similar but much larger inquiry, the Royal Commission into Institutional Responses to Child Sexual Abuse completed the hearings and final report in just 5 years.

[18] Survivors of child abuse have criticised the Inquiry for not investigating sports and leisure clubs or faith based organisations attended on a day-to-day basis.

[19] In 2016, Kezia Dugdale the Scottish Labour Leader at the time, called on the Inquiry to be expanded to include football in light of the evidence of attacks on young players, stating unless the remit of the Scottish Child Abuse Inquiry was widened, the majority of abuse survivors would be “denied justice”.

Graeme Pearson Labour's justice spokesman said there should have been an investigation as to why the child abuse allegations against Conservative MP Nicholas Fairbairn and barrister Robert Henderson were dropped by police, stating "Given the new knowledge we have of the powerful people involved in some of these cases, I think the time is right to revisit this and get a clear understanding of what went on and to ask if [the case] was abandoned, was it abandoned for the right reasons?

[24] On 23 February 2022, an appeal court ruled Smith was found to be acting beyond her powers to prevent the BBC from fully reporting a £2.6m legal claim against Scotland's child abuse inquiry.